Hi All,

I recently filed a grievance case for denying coverage to go out-of-plan to have NA. I made the case as so many others have (costs, scarring, pain, therapy, etc.). The denial was simply based on my plan coverage - no out of plan care unless it is emergency care.

There is no argument for this denial, I simply have no coverage for it. The review was carried out by a board certified INTERNIST - not hand surgeon, not orthopedic surgeon, an internist! It is an insult to my intelligence. To further insult me, they claim that acceptable surgical techniques are available within the plan coverage area.

I live in New England, where theoretically the best medical care is available in the world. I saw three hand surgeons. None wanted to discuss NA, None would discuss segmental (Moermans). All each of them would offer is to remove as much of the diseased tissue as possible, close up my hand and send me to "the finest hand physical therapy team" in New England.

Why do these otherwise competent surgeons feel that cutting a hand open (on people who all scar easily and prolifically) is the best course of action?

When will they get it? I think it will be a long time. It feels like we deal with old woodworkers - tried and true techniques are the only way to go, even if the joint is a little crooked - instead of using the latest tool for the job.

While I plan to go ahead with out-of-pocket expenses, I can't imagine what choices may be made for me when other parts of my body fail. If it weren't for this forum, I probably would have simply agreed to get cut up.

Thank you all for sharing your knowledge and experiences that has convinced me that NA is always the first choice - whatever the cost. I'll just have to save up. ;-)

Bob

Another story to keep the spirit up:

We recently found another doctor in Germany who does NA (wow, that doubled the number!). He told us that he got into NA because his father, having Dupuytren, wanted to avoid surgery. So his son found out about NA and his father was his first patient. That was 4 years ago and since then he is practicing it on a more or less regular basis and patients love it.

Progress is slow but it's on its way.

Wolfgang

It is forums like this and Wolfgang's site that keep us informed and able to make the best decisions for us. I recall my mother saying that whatever the doctor said to do, she would do. It's an old belief system that they are all experts. We find different. Now that the internet allows us to share information, we become much more in control of our destiny.

(But the thing that really ticked me off was the internist evaluating my hand procedure request. If most hand surgeons won't discuss it, what in the world would an internist be thinking?)

Thanks for the spirit raising efforts - it works!

Bob

If its any help, my NA performed by Dr. Denkler in May was covered by Blue Cross Blue Shield of California. I called them and told them the procedure codes listed on Denkler's website. They didn't pay a whole lot because I have a $500 decuctable for out of network services and they pay only 70% after that. When I talked with them they told me I should have used someone in their network. I told them there were only a very few doctors in the nation who do this and none are in their network and that having this procedure saved them many thousands of dollars. Two years ago they covered my traditional surgery and all that cost them at least 10 times more. Of course they had no response but it felt good to tell them that.

Diane,
Its good to know that Blue Cross covered the procedure with Dr. Denkler. Mine was done with him 7/24 and I am wondering how long it took for them to reimburse you. Do they cover the whole cost? My plan only has $100 deductible (which I have met for the year) and then they pay 80%. If I have problems with their reimbursement, I might ask you more details about how you got it done, if its ok with you.