Denials for RT for osteoarthritis or plantar fasciitis

[TheWallnerus]

I have come up with a "PDF packet" I have been sharing with insurance companies when a denial for RT for OA or PF occurs. Hopefully can attach here. If not, will attempt to share through a file sharing service.

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[OTN]

This is awesome, thanks a ton

 

[NotMattSpraker]

I have come up with a "PDF packet" I have been sharing with insurance companies when a denial for RT for OA or PF occurs. Hopefully can attach here. If not, will attempt to share through a file sharing service.

Fantastic, thank you for sharing!

 

[A_DeMichele]

the only contentious part is using IMRT or daily image guidance with 3D-IGRT. don’t bill for these in benign disease and you’ll never have to deal with insurance company

 

[NotMattSpraker]

the only contentious part is using IMRT or daily image guidance with 3D-IGRT. don’t bill for these in benign disease and you’ll never have to deal with insurance company

Or protons. I seen it!

 

[TheWallnerus]

the only contentious part is using IMRT or daily image guidance with 3D-IGRT. don’t bill for these in benign disease and you’ll never have to deal with insurance company

Wish were true

 

[evilbooyaa]

Or protons. I seen it!

I can't find it now but there was a whole editorial written about the wonders of protons for OA. I legitimately thought it had to have been published on April 1st...

 

[A_DeMichele]

Evicore still insists on 2D in these conditions?

 

[OTN]

Evicore still insists on 2D in these conditions?

Why would you need anything else?

 

[NotMattSpraker]

Why would you need anything else?

I agree. I do a CT (3D) sim but it collapses to 2D in the insurance universe.

 

[grenz]

Are you guys getting plantar fasciitis referrals from podiatrists; or PCPs?

 

[evilbooyaa]

Evicore still insists on 2D in these conditions?

It's not 2D (like you can't do a CT sim)...

It's complex isodose.

You do a CT sim, then you do 3D but there's no DVH and it's not a 77295.

 

[NotMattSpraker]

It's not 2D (like you can't do a CT sim)...

It's complex isodose.

You do a CT sim, then you do 3D but there's no DVH and it's not a 77295.

True, this just doesnt facilitate jokes about arbitrary insurance coverage 😊

In the last region I worked, they would only approve complex isodose for some cases of spine palliative (3D) RT even though our standard process was 3D planning with a DVH. I moved and have not seen that since.

My concern for arthritis is the usual. People will abuse billing and then it will be targeted 😥