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Subortholen?? (orthotic material) and Insurance

Posted by Nancy N on 2/09/01 at 12:25 (038539)

Richard--

I just talked to the C.Ped in my area, and he tells me he makes his orthotics out of something called Subortholen (I don't know if I'm spelling that right, he said it's a plastic material that originated in Germany and it may be a brand name like Kleenex or Xerox). Are you familiar with this stuff? Is it good? I got a good impression of him from the discussion we had, so I may schedule a time to go meet with him and discuss my options. He works very near where I live, which is good.

On the insurance side, I wanted to see if he was interested in signing up with my insurance company so I would be able to have them cover the orthotics. He says that they've tried to sign up with everyone in creation, but that the insurance companies confuse the pedorthists with orthotists and therefore reject the pedorthist, thinking that they already have enough providers in an area. Have you experienced this phenomenon? Any suggestions for how to deal with the insurance folks? I have an out-of-network benefit, but I could buy two sets of orthotics for the amount of the deductible I have to fulfill before the benefit kicks in.

Thanks much!

Re: Subortholen?? (orthotic material) and Insurance

Richard, C.Ped on 2/09/01 at 13:08 (038546)

Hi Nancy,
I have not used subortholene in quite a while, so I don't know to much about it anymore. I am pretty sure that the UCBL type of orthosis can be made from it. If I remember correctly (I also just called Sean to verify), that material is still hard, but has more give than the hard plastic carboplast material. I am not sure how long it will last. Some people do not post the subortholene with another material, so again, I am not sure how long the support will last. Also, ask to see a sample and try to judge it from there.

Sorry to hear about the insurance. I have been told that there are not enough policy holders in the area to be worth their while to add me to the provider list. What????

It is hard to say what to do insurance wise if you already know what and how they will pay. Send me your casts, I will gladly help you meet your deductible!! :-) Just kidding. I guess it you try to change insurance companies, you may have run into the pre-existing conditions.

When I run into someone with your situation, I usually try to split the
charges to make it easier on their pockets.

Richard

Re: Subortholen?? (orthotic material) and Insurance

Nancy N on 2/09/01 at 14:02 (038554)

Richard--

So is the subortholene still better than the hard plastic? Does it sound to you like it would be OK to go with this guy?

I am thinking about going to see him sometime in the next few weeks just to see what he thinks he can do for me, how much it will cost, etc. I am going to try to find your list of orthotics questions to take with me--or do you think that's not necessary since he is a C.Ped?

The insurance problem is really stupid. I work for a local university and right there that means that a large number of people are covered by this plan. Hmmm....dunno what to do about that.

Thanks much for your input.

Re: Subortholen?? (orthotic material) and Insurance

Richard, C.Ped on 2/10/01 at 07:53 (038599)

It is hard to say. I don't mean to sound so vague in my response, but again, I have not used it in quite a while. I only used it in school, and not on a patient. I know it is useful in some situations, and it all depends on what is going on with your feet.

Always ask questions. Always see samples. I want you (and everyone else) to receive the best treatment avaliable.....but unfortunatly, I can't be everywhere at once....JUST KIDDING!!! Sorry, if you guys knew me, you would know how hard it is for me to stay serious for very long. I like to have fun at what I do. :-)

Anyway, I really do want everyone to receive the best possible treatment and service. Everyone is different, and by that, I am not bad mouthing the guy you will be seeing at all.

If you have any questions about what you were told after asking the questions, please let me know.

Insurance can drive me crazy. When dealing with footwear, they can think like the rest of us. Our feet are the furthest things from our mind.

Good luck,
Richard

Re: Subortholen?? (orthotic material) and Insurance

brian g CPed on 2/10/01 at 08:37 (038601)

Subortholen is ok , usually used for pediatric smo, afo etc. It is half rigid and half flexible depending on thickness. It can work well, depends on the posting or lack of as well as the quality of the original cast. If the CPed you are dealing with seems good try it. He can always modify it later.

INSURANCE BAHHH!! I will only bill insurance for work comp or auto accident that give prior authorization for payment. The problem in my area is that 2 big O&P companies spend lots of time and money trying to become the ONLY provider for insurance company. This forces the patient to have no choice when getting orthotics. I have tried in the past to become a provider, being a small operation it is useless.

In my facilty I charge around $200 or less. I also make them while they wait. The patient is seen in an hour, leaves with the orthotic. has their footwear evaluated. Many times they leave with a orthotic and a shoe for less than they would pay for an orthotic alone

The insurance companies are stupid. STUPID. They will pay the big guys $350 to $400 a pair, takes 3 weeks to get. Another thing that I find in my area. Many Blue Cross will say it is covered if it is attached to a brace. So some poor old lady with flat feet will agree to have an orthotic made, and shoes and have them attached to a metal afo (so she wont have to pay a dime) The smart insurance company thats trying to save money by only using one proveider is getting screwed and the patient is getting screwed.

This my sound like I am ranting, and this type of thing is not rampant but it does happen more times than it should. My point of this is to let some patients know. They sometimes get mad at me for not being able to bill for it. After I explain it and tell them I will be happy to give them an invoice with l-code etc 99% are more than happy to go ahead.

I also encourage them when they do submit to remind the insurance that they are only asking to be reimbursed for $200 and that they should pay it since they are used to paying $350 plus a pair to their 'contract provider' This whole thing is anti american. No competition, no freedom to choose, no choice. A patient should have a right to choose whoever they want. THERE I AM OFF OF MY SOAPBOX

Re: Subortholen?? (orthotic material) and Insurance

Richard, C.Ped on 2/10/01 at 08:59 (038603)

Call me a glutton for punishment, but I will bill the insurance company no matter what. I know that they really do not give a darn, but I want them to see how many people come to me that need these things covered. Hopefully they keep a record of these things. I do the same with Medicare. They only cover if the patient is diabetic. Maybe I am wasting my time and the cost of a stamp, but you never know.

I have not had any problems with BC/BS here. They usually pay within two weeks. I take insurance because I put myself in the patient's position. Could I afford $200 - $300 right out of my pocket? No way.

Richard

Re: (orthotic material) and Insurance

Donna SL on 2/10/01 at 10:29 (038612)

Hi Everyone,

If someone gives you a good orthotic, then $200.00 $300.00 is really not that much. Think of what a pair of prescription eye glasses cost today, or a crown from the dentist. (you need to mortgage your house in my area for what the dentist charge here), a couple of pairs of fancy running shoes that only last 6 months, etc. Well you get the idea. If they give you great comfort for several years then they are worth every penny.

The problem is when someone pays $300.00 to $500.00, and more to a pod, and they make some horrid pair of plastic ice scrapers that you can't wear, and you have thrown out money then that's wrong. On top of that at least where I live the pods pad the bill with all kinds of things like muscle testing, biomech exams, casting charges, etc. Before you know it the bill is around $1100.00 for the first visit for orthotics. I've had this happen on at least 3 occassions, and thank god I had insurance. All adjustments on the orthotics were also charged for too. The last doctor I saw was charging between $200.00 to $300.00 for an office visit, and insurance was paying around 85% of that. I still had hundreds of dollars in copays With my type of foot you could adjust hard plastic from today to tommorrow, and they still will be painful.

Insurance companies would be better off just paying someone like a cped or orthotist who is up to the minute on state of the art materials, who fairly charge an average of $200.00 to $300.00 for the devices, and doesn't try to take advantage of them.

If it wasn't for this board, I would have never know what a Cped was, let alone EVA. I had read about other soft materials used in combination for strength, and asked my current pod if he could make something out of that, or try EVA, when the plastic ones weren't working, but he really wasn't interested, and just hoped I would dissapear. He went to the other extreme, and gave me some temporary piece of junk made out of plastazote that lasted around a month to shut me up. I have since learned plaztozote on it's own is usually only used for diabetics, not for functional orthotics. My insurance only pays for orthotics once every three years, so all future orthotics are now coming out of my pocket anyway. The pod got paid for something that was totally useless to me, and my insurance benefit was wasted.

Hopefully I'll have better luck now. There are only a couple of cpeds in my area, and I'm seeing a cped/orthotist today for casting who is very reasonable, I feel I could have him make many different types of orthotics for me, because his fees are not outrageous.. The first pair he's making are not going to be EVA, but a combination of around 5 different materials, because my foot is still sensitive. I'm praying he is able to make a good pair of orthotics for me, because I never want to have to deal with a pod again for these devices. I hope this one cped works out, because the other one here is charging as much as the pods, plus adjustments.

I'm sure there are some wonderful ethical pods out there that make, or prescribe good orthotics. Unforutunately, I haven't had the pleasure in meeting them yet.

Donna

Re: Subortholen?? (orthotic material) and Insurance

Richard, C.Ped on 2/09/01 at 13:08 (038546)

Hi Nancy,
I have not used subortholene in quite a while, so I don't know to much about it anymore. I am pretty sure that the UCBL type of orthosis can be made from it. If I remember correctly (I also just called Sean to verify), that material is still hard, but has more give than the hard plastic carboplast material. I am not sure how long it will last. Some people do not post the subortholene with another material, so again, I am not sure how long the support will last. Also, ask to see a sample and try to judge it from there.

Sorry to hear about the insurance. I have been told that there are not enough policy holders in the area to be worth their while to add me to the provider list. What????

It is hard to say what to do insurance wise if you already know what and how they will pay. Send me your casts, I will gladly help you meet your deductible!! :-) Just kidding. I guess it you try to change insurance companies, you may have run into the pre-existing conditions.

When I run into someone with your situation, I usually try to split the
charges to make it easier on their pockets.

Richard

Re: Subortholen?? (orthotic material) and Insurance

Nancy N on 2/09/01 at 14:02 (038554)

Richard--

So is the subortholene still better than the hard plastic? Does it sound to you like it would be OK to go with this guy?

I am thinking about going to see him sometime in the next few weeks just to see what he thinks he can do for me, how much it will cost, etc. I am going to try to find your list of orthotics questions to take with me--or do you think that's not necessary since he is a C.Ped?

The insurance problem is really stupid. I work for a local university and right there that means that a large number of people are covered by this plan. Hmmm....dunno what to do about that.

Thanks much for your input.

Re: Subortholen?? (orthotic material) and Insurance

Richard, C.Ped on 2/10/01 at 07:53 (038599)

It is hard to say. I don't mean to sound so vague in my response, but again, I have not used it in quite a while. I only used it in school, and not on a patient. I know it is useful in some situations, and it all depends on what is going on with your feet.

Always ask questions. Always see samples. I want you (and everyone else) to receive the best treatment avaliable.....but unfortunatly, I can't be everywhere at once....JUST KIDDING!!! Sorry, if you guys knew me, you would know how hard it is for me to stay serious for very long. I like to have fun at what I do. :-)

Anyway, I really do want everyone to receive the best possible treatment and service. Everyone is different, and by that, I am not bad mouthing the guy you will be seeing at all.

If you have any questions about what you were told after asking the questions, please let me know.

Insurance can drive me crazy. When dealing with footwear, they can think like the rest of us. Our feet are the furthest things from our mind.

Good luck,
Richard

Re: Subortholen?? (orthotic material) and Insurance

brian g CPed on 2/10/01 at 08:37 (038601)

Subortholen is ok , usually used for pediatric smo, afo etc. It is half rigid and half flexible depending on thickness. It can work well, depends on the posting or lack of as well as the quality of the original cast. If the CPed you are dealing with seems good try it. He can always modify it later.

INSURANCE BAHHH!! I will only bill insurance for work comp or auto accident that give prior authorization for payment. The problem in my area is that 2 big O&P companies spend lots of time and money trying to become the ONLY provider for insurance company. This forces the patient to have no choice when getting orthotics. I have tried in the past to become a provider, being a small operation it is useless.

In my facilty I charge around $200 or less. I also make them while they wait. The patient is seen in an hour, leaves with the orthotic. has their footwear evaluated. Many times they leave with a orthotic and a shoe for less than they would pay for an orthotic alone

The insurance companies are stupid. STUPID. They will pay the big guys $350 to $400 a pair, takes 3 weeks to get. Another thing that I find in my area. Many Blue Cross will say it is covered if it is attached to a brace. So some poor old lady with flat feet will agree to have an orthotic made, and shoes and have them attached to a metal afo (so she wont have to pay a dime) The smart insurance company thats trying to save money by only using one proveider is getting screwed and the patient is getting screwed.

This my sound like I am ranting, and this type of thing is not rampant but it does happen more times than it should. My point of this is to let some patients know. They sometimes get mad at me for not being able to bill for it. After I explain it and tell them I will be happy to give them an invoice with l-code etc 99% are more than happy to go ahead.

I also encourage them when they do submit to remind the insurance that they are only asking to be reimbursed for $200 and that they should pay it since they are used to paying $350 plus a pair to their 'contract provider' This whole thing is anti american. No competition, no freedom to choose, no choice. A patient should have a right to choose whoever they want. THERE I AM OFF OF MY SOAPBOX

Re: Subortholen?? (orthotic material) and Insurance

Richard, C.Ped on 2/10/01 at 08:59 (038603)

Call me a glutton for punishment, but I will bill the insurance company no matter what. I know that they really do not give a darn, but I want them to see how many people come to me that need these things covered. Hopefully they keep a record of these things. I do the same with Medicare. They only cover if the patient is diabetic. Maybe I am wasting my time and the cost of a stamp, but you never know.

I have not had any problems with BC/BS here. They usually pay within two weeks. I take insurance because I put myself in the patient's position. Could I afford $200 - $300 right out of my pocket? No way.

Richard

Re: (orthotic material) and Insurance

Donna SL on 2/10/01 at 10:29 (038612)

Hi Everyone,

If someone gives you a good orthotic, then $200.00 $300.00 is really not that much. Think of what a pair of prescription eye glasses cost today, or a crown from the dentist. (you need to mortgage your house in my area for what the dentist charge here), a couple of pairs of fancy running shoes that only last 6 months, etc. Well you get the idea. If they give you great comfort for several years then they are worth every penny.

The problem is when someone pays $300.00 to $500.00, and more to a pod, and they make some horrid pair of plastic ice scrapers that you can't wear, and you have thrown out money then that's wrong. On top of that at least where I live the pods pad the bill with all kinds of things like muscle testing, biomech exams, casting charges, etc. Before you know it the bill is around $1100.00 for the first visit for orthotics. I've had this happen on at least 3 occassions, and thank god I had insurance. All adjustments on the orthotics were also charged for too. The last doctor I saw was charging between $200.00 to $300.00 for an office visit, and insurance was paying around 85% of that. I still had hundreds of dollars in copays With my type of foot you could adjust hard plastic from today to tommorrow, and they still will be painful.

Insurance companies would be better off just paying someone like a cped or orthotist who is up to the minute on state of the art materials, who fairly charge an average of $200.00 to $300.00 for the devices, and doesn't try to take advantage of them.

If it wasn't for this board, I would have never know what a Cped was, let alone EVA. I had read about other soft materials used in combination for strength, and asked my current pod if he could make something out of that, or try EVA, when the plastic ones weren't working, but he really wasn't interested, and just hoped I would dissapear. He went to the other extreme, and gave me some temporary piece of junk made out of plastazote that lasted around a month to shut me up. I have since learned plaztozote on it's own is usually only used for diabetics, not for functional orthotics. My insurance only pays for orthotics once every three years, so all future orthotics are now coming out of my pocket anyway. The pod got paid for something that was totally useless to me, and my insurance benefit was wasted.

Hopefully I'll have better luck now. There are only a couple of cpeds in my area, and I'm seeing a cped/orthotist today for casting who is very reasonable, I feel I could have him make many different types of orthotics for me, because his fees are not outrageous.. The first pair he's making are not going to be EVA, but a combination of around 5 different materials, because my foot is still sensitive. I'm praying he is able to make a good pair of orthotics for me, because I never want to have to deal with a pod again for these devices. I hope this one cped works out, because the other one here is charging as much as the pods, plus adjustments.

I'm sure there are some wonderful ethical pods out there that make, or prescribe good orthotics. Unforutunately, I haven't had the pleasure in meeting them yet.

Donna