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.

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

One suggestion would be to tie in how this would benefit them financially (how much your treatment is costing them right now and in the future, also tying in cost for mental health services as related to this condition if it applies for you), and how HBOT can actually save them money.

I am sorry you have had to go through so much, and that it has spread for you. I am currently going through HBOT--I have had about 23 treatments now and plan to do 40. I feel like it is making a difference (although it took awhile to get results--you need to be patient). The other woman I am getting treatments with was pain free after about 15 sessions. I am excited to get back in the chamber on Tuesday. If this turns out to be the key treatment for me, I'll also be consulting with insurance to cover maintenance sessions. I had med pay from my accident that covered most of the 40 sessions I'm doing now. Best of luck to you!!

Thanks for the ideas- I will try and incorporate that into the letter. I think you said you experienced increased pain during your sessions? Thats what happened to me the first time so I stopped (not realizing that it is normal for that to happen) Please keep us up on how it is going!

Thanks

Deb

Yes--I had increased pain for awhile. Now I am finally experiencing the benefits (after 23 dives). After a year of having RSD my foot and leg finally feel close to "normal." Today I went to a store with my husband and I had to ask him if the air conditioning was on. Usually my RSD leg would chill to the bone and I didn't even notice it. I am amazed and I hope the benefits continue.

Another thing you could consider incorporating into the letter would be how this disorder affects you on a daily basis. What does it really "feel" like to have this dreadful condition. You could also ask a family member to write a letter for you from their perspective on how this has impacted you and perhaps your family.