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Getting Insurance to pay for Nano knife/ IRE treatment
BCBS denied payment for the Nano knife/IRE treatment stating it is "experimental". However, the procedure is FDA approved and in Jan. 2026 the classification for the CPT code is changing away from "Experimental". Does anyone have any tips on how to appeal the denial with BCBS as Dr. Lomas @ Mayo in MN recommended this treatment. Has anyone traveled to Europe, as it is regularly offered there?
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I have always found the prescribing physician to be the best advocate and most qualified to act on your behalf when filing an appeal. Most do not like an insurance company second guessing their recommended treatment and will diligently provide necessary clinical evidence in their fight for approval.
An AMA Current Procedural Coding category change does not dictate coverage policy changes.
Dr. Lomas may be able to provide you with information to use in your appeal. Years ago, Dr. Kwon, also at Mayo MN, ordered something for my husband which came back with an insurance denial on the basis that it was "experimental," and Dr. Kwon's team gave us a packet of information to use in our appeal. (This was back when patients got packets of paper and not electronic versions. I suspect things have changed by now on that front.) It sure can't hurt to ask Dr. Lomas for appeal insights and advice, as well as materials to back up your appeal.