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Does anyone know if BCBS will cover RT (I'm in Massachusetts).
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11/01/12 15:15
mrl 
11/01/12 15:15
mrl 
Does anyone know if BCBS will cover RT (I'm in Massachusetts).

Hi - I've read that people have had success in getting BCBS to pay for Radiation Treatment. Is this still true? I called BCBS, but they couldn't specifically tell me if it would get covered. They phrased it that "if a doctor deems it necessary", then radiation treatment is definitely a "billable" treatment (not surprising), but that's all they could tell me. Thanks. - Mark

11/01/12 15:33
RetiredTeacher 
11/01/12 15:33
RetiredTeacher 
Re: Does anyone know if BCBS will cover RT (I'm in Massachusetts).

My BCBS of New Mexico paid all of my RT. I think Aetna helped by declaring RT as a treatment for DD or DC. Check out the Aetna article at: http://www.aetna.com/cpb/medical/data/800 899?0800.html
I would send that article to BCBS of Massachusetts. Hope you can get it approved.

11/01/12 15:53
callie 
11/01/12 15:53
callie 
Re: Does anyone know if BCBS will cover RT (I'm in Massachusetts).

I think the Aetna acceptance is the "smoking gun" for getting insurance companies in the U.S. to approve RT. The problem, from the insurance standpoint, is that RT is so very expensive in the U.S. for a procedure that has marginal results. The marginal results are a direct reflection of a very inconsistent disease that very often goes into remission for years/decades after the appearance of nodules. It is very hard to separate the natural remission from RT results. My hand went into remission for 15 years after the appearance of nodules. If I would have had RT, I would have easily given the credit to RT, but I didn't have RT.

11/01/12 17:42
mrl 
11/01/12 17:42
mrl 
Re: Does anyone know if BCBS will cover RT (I'm in Massachusetts).

My next follow up question that I should have also asked, is how many people who had RT, actually have nodules that soften or reduce. I've read of several such cases on this forum. That's my main problem right now. I have a nodule near the center of the palm of my hand, but I also have a tender point near that nodule, that I've had most of my life. I have it in both hands. It's probably related to my fibromyalgia. In any event, the nodule seems to irritate that tender point. From my readings, I don't believe I qualify for a Xiaflex injection to break up that nodule, because I don't have a "palpable" cord. NA treament would only split the nodule, which I don't think would help me. So my only option to reduce it's size at my stage, seems to be RT. Any other recommendations would be appreciated. Thanks. - Mark

11/01/12 23:07
lori 
11/01/12 23:07
lori 
Re: Does anyone know if BCBS will cover RT (I'm in Massachusetts).

Mark,

BCBS paid for my RT. That was 3 years ago, but I had the RT oncologist call and basically get pre-authorization. I had a hand surgeon diagnosis DD, then I took the diagnosis to the oncologist who treated it. I believe by having the RT oncologist call and authorize it, it became "medically necessary", kind of. BCBS has "medically necessary" as a disclaimer to everything. Not very reassuring, but I believe that by getting the RT doctor to authorize the treatment you stand a better chance of payment.

Rt did soften my nodule, in fact the nodule disappeared. I have pictures of my hand from about 3 years ago that if you research under "pictures of my hand from MRI to now" and my name, you should be able to see before and after pictures. I had a cord that also recessed into my palm.

Lori

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