key words for Insurance co & HBOT
 

I have to write a Letter of Medical Nec. for my insurance co regarding HBOT- Actually my doc has to write it but I am doing it for her. I have a feeling they are not going to cover it because the last time I tried they did not ask for a letter. Here is a copy- does anyone think I could make improvements to get this to happen

Debra Huberman, a patient of mine for many years, has been suffering from RSD since 1998. She has tried many treatments including nerve blocks, 5 day continuous ketamine infusion, Aredia infusion, lidocaine infusion and most recently direct Transcortical stimulation. Unfortunately, non of these treatments have provided any pain relief. Her RSD continues to spread and is now in all four extremities. Her symptoms include burning pain, skin sensitivity, swelling and severe muscle tightening. Of course, this is causing her to feel great despair.

I have read some promising articles on Hyperbaric Oxygen Treatment for people with RSD. I see no other options for Mrs. Huberman at this time and highly recommend a trial of 40 sessions of treatment.


Thanks for any suggestions!

Debbie

The first time you use RSD type the whole name out with a slash or in parenthesis oh heck try it this way

Reflex Sympathetic Dystroph (RSD), also known as Complex Regional Pain Syndrome (CRPS),

Then maybe as far as using the letters only

RSD/CRPS

I know if you use one name only the insurance people can be so damn dense.

Also Maybe for their convenience ask your doctor if she ever uses the Diagnosis Codes &/or Procedure Codes within her letters to insurance companies. The less work they have to do as far as researching, maybe the more likely they would be to give the go ahead???

I am just throwing out suggestions here & I could be way off line.

DebbyV

Hi Debbie,
Good luck in your pursuit. Twice I unsuccessfully appealed the decision of our insurance company to deny payment for hbot for my daughter. I was, however, recently encouraged when I read that the New Mexico Public Regulation Commission ordered a health plan to pay for hbot for an 11 year old girl who has RSD. So, hold onto that as you move forward. If you would like to access that article, send me a private message. Once again, best wishes ... I so hope that you are successful!!
Jeanne

I haven't ever written anything like this but maybe adding in more descriptive words might help to convey how painful and chronic RSD/CRPS is.
Like extreme, chronic, continuous, spasms, sharp, what ever applies for you.
Hopefully those same descriptions are documented in your drs files , in case they request more info or records.

Is your dr going to go over the final version with you?

If you can add some case studies, articles , links that they can look up for reference... might help.

just my thoughts , I hope someone that has gone thru it successfully will reply. :grouphug:

TY
 

Thanks for all of your suggestions- I would like to give the Dr, some research data but I can only find anecdotal stories so if anyone can give me a link to a real study that would be great!!

Thanks

Debbie

Hi Deb,
Along with the letter the Doctor should enclose a written prescription for HBOT treatment. Here is a link on the RSD Hope site that has links to RSD and HBOT studies. I hope this works for you. Call if you need anything.....diana

http://www.rsdhope.org/Showpage.asp?...5&PGCT_ID=4564

Hey- Just a quick note. Instead of "I have read . . ." I would put "Current research suggests that Hyperbaric Oxygen Treatment is promising for patients suffering from RSD." It's a little bit more authoritative and direct. This way it's not her opinion but the opinion of current research, which is a lot more powerful.

Hope this helps.
Lynn

TY
 

Thanks again for your advice and help. I have changed the letter and it does sound better. I will keep you informed on how it goes....

Debbie

Debbie,
Since we talked, I spoke with my husband and he suggested this site to use for info and articles. I think it would be good reading for all of us. Let me know if you think this could be of benefit. Remember, we talked about addressing the symptoms and the effects HBOT had on the symptoms verses RSD/CRPS..because that is where the doc's and insurance get hung up. We need to address, hypoxia, edema, cyanosis etc.
Let me know. I may be going out of town for the holiday weekend to Sante Fe, but I will try to speak with you again before we leave. Hope this helps.
Diana
http://www.hbotreatment.com/ Click on studies.

I think this is a really useful website for all of us, who are fighting this battle with the sytem of things the ways it is.

Unable to PM Dr Fife Study
 

Deb, Here is another study on HBOT for a lot of conditions but read the part on RSDS and the Turkey studies hope this helps.
diana




http://healthy-aging.advanceweb.com/...&AD=03-01-2007