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insurance

Posted by Allan on 3/16/01 at 01:08 (041598)

My doctor and I are trying to get medical insurance coverage for the OssaTron shock wave treatment. So far no luck. Has anyone out there gotten their insurance company to pay for this treatment and what company might that be? Thanx

Re: insurance

Dr. Zuckerman on 3/16/01 at 02:15 (041603)

Hi,
What was the reason that your insurance gave for not covering ESWT. What insurance do you have.?

Re: insurance

johnw on 3/16/01 at 08:12 (041615)

call devonne at healthtronics. she can give you the names of several.

Re: insurance

Dorron Shapow on 3/16/01 at 12:25 (041623)

I have had one patient whos insurance paid, after long correspondence, I believe it happend for two reasons. One, our persistance that it is a pain modification device and the second which is the more likely explanation it was a mistake. Once FDA approval is granted for the treatment of PF then things will fall in place, it is a very expensive and tedious process...till then we wait

Re: insurance

Dr. Zuckerman on 3/16/01 at 15:25 (041637)

When checking for insurance coverage make sure if they say it is covered to get it in writing from the specific insurance company. In addition get what is called a pre-determination of the coverage and what is the patients out of pocket expense.

In addition to if the procedure is covered ask what your responsibility will be for the cost of the surgical center, the use of the machine, the anesthiologist fee. Many plans only pay a percentage of the total fee.

Re: insurance

Dr. Zuckerman on 3/16/01 at 15:35 (041639)

The FDA has approved the ossatron for the treatment for chronic, proximal insertional heel pain. The FDA isn't the reason for lack of insurance coverage. There are two reasons in my opinion

1. The cost of the machines which has made the cost to the insurance companies expense, and maybe too expense a treatment for universal coverage to all subscribers of a major insurance company.

2. Insurance companies want USA outcome studies beside FDA studies.

What this means is that although there are many thousands of ESWT procedure that have been done in Europe and Canada the US insurance positon is that we want American Studies.

So the bottom line is there is going to be some insurances that want to coverage ESWT and some that won't /

When a NEW specific cpt code for orthopedic ESWT becomes available then you will see univeral insurance coverage.

When this happens then Medicare will cover orthopedic ESWT and then the major Blue Shields will knick in.

So time is the answer. More doctors doing ESWT and more USA published results and then CPT codes and then maybe insurance coverage.

Re: Dr. Z: How long do you think this might take?

Beverly on 3/16/01 at 16:11 (041647)

Dr. Z,

Now that EWST is FDA approved, how long do you think it might take to get it's own orthopedic code?
Thanks,
Beverly

Re: Dr. Z: How long do you think this might take?

Dr. Zuckerman on 3/16/01 at 16:33 (041649)

If I knew this or the companies knew this there would be alot more machines out there. I have read and been told anywhere from 18 months to five years is the average time frame for a new cpt code to be introduced after the procedure has been introduced into the USA.

Re: Dr. Z went and asked an expert for an answer with this question

Dr. Zuckerman on 3/17/01 at 12:14 (041708)

Last Login: Mar 09 09:33 AM Package: Silver Anniversary: Dec 27, 2000 Active Contract: 12 months Login: zuckerman
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ESWT Coding
Author: Mark Tompkins (---.dsla1n1.sat.texas.net)
Date: 02-22-01 18:25

Does anyone have any input or information on the status of
developing codes for use with extracorporeal shockwave therapy?

I have been told that there may not be a code designated for the
procedure for up to one year. How is the procedure being currently
billed, and what has been the experience of clinicians on being
reimbursed by third party payers?

Thanks!

Mark H. Tompkins, D.P.M.
San Antonio, TX



Reply To This Message
ESWT Coding
Author: Terrance Mueller (ForumMail)
Date: 02-23-01 10:20

<< I have been told that there may not be a code designated for
the procedure for up to one year. How is the procedure being
currently billed, and what has been the experience of clinicians
on being reimbursed by third party payers?

Thanks!

Mark H. Tompkins, D.P.M. >>

Last week, I received a letter from United Healthcare, stating that
they consider ESWT to be 'experimental', and will, therefore, not
cover the service.

Terrance J. Mueller, DPM
St. Louis, MO

Reply To This Message
ESWT Coding
Author: Walter Pedowitz (---.sumt1.nj.home.com)
Date: 02-23-01 19:38

A tracking, level 3, code is to be issued for ECSWT. The AMA
CPT Committee will not issue an official code until adequate
peer reviewed American literature is available.

Billing at this time is subject to negotiations between the carrier
and the individual physician.

Walter J Pedowitz MD
New Jersey

-Original Message-

Does anyone have any input or information on the status of
developing codes for use with extracorporeal shockwave therapy?

I have been told that there may not be a code designated for the
procedure for up to one year. How is the procedure being currently
billed, and what has been the experience of clinicians on being
reimbursed by third party payers?

Thanks!

Mark H. Tompkins, D.P.M.
San Antonio, TX

Reply To This Message
ESWT Coding
Author: David Zuckerman (---.delval.adsl.bellatlantic.net)
Date: 03-09-01 09:35

What is a 'tracking, level 3' code?

David Zuckerman, DPM
Woodbury, NJ

-Previous Message-

A tracking, level 3, code is to be issued for ECSWT. The AMA
CPT Committee will not issue an official code until adequate
peer reviewed American literature is available.

Billing at this time is subject to negotiations between the carrier
and the individual physician.

Walter J Pedowitz MD
New Jersey

Reply To This Message
ESWT Coding
Author: Walter Pedowitz (---.wt.luc.edu)
Date: 03-11-01 14:14

A tracking code is a new code to be issued for promising
new procedures that have not as yet created enough of a
literature base to justify a full CPT code. It tells the
insurance companies that we think it has merit, but more
information is needed.

Walter J Pedowitz MD
New Jersey

-Previous Message-

What is a 'tracking, level 3' code?

David Zuckerman, DPM
Woodbury, NJ

-Previous Message-

A tracking, level 3, code is to be issued for ECSWT. The AMA
CPT Committee will not issue an official code until adequate
peer reviewed American literature is available.

Billing at this time is subject to negotiations between the carrier
and the individual physician.

Walter J Pedowitz MD
New Jersey

Reply To This Message

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Reply To This Message
Your Name: David Zuckerman
Your Email: footcare@home.com
Subject:

Re: for john w

john h on 3/20/01 at 17:59 (041992)

healthtronics should be building a good data base on the success/failure of the ossatron treatments. any of this data available to the public?

Re: insurance

Dr. Marlene Reid on 3/26/01 at hrmin (042465)

I can tell you that we are getting about 70% of our patients approved on the first round of requests. Some insurance co's are finding any excuse they can, and then are backing down and approving. Healthtronics does all the preapproval and appeals for our office and they are very sucessful (usually). We have only have a handful of denials that we could not get turned around. I do not know what the U/C will be yet, because we have not received any payments in yet. If you go to a participating provider, they will have to accept whatever the U/C is, whether it is $1400 or $400.

Re: insurance

Dr. Zuckerman on 3/16/01 at 02:15 (041603)

Hi,
What was the reason that your insurance gave for not covering ESWT. What insurance do you have.?

Re: insurance

johnw on 3/16/01 at 08:12 (041615)

call devonne at healthtronics. she can give you the names of several.

Re: insurance

Dorron Shapow on 3/16/01 at 12:25 (041623)

I have had one patient whos insurance paid, after long correspondence, I believe it happend for two reasons. One, our persistance that it is a pain modification device and the second which is the more likely explanation it was a mistake. Once FDA approval is granted for the treatment of PF then things will fall in place, it is a very expensive and tedious process...till then we wait

Re: insurance

Dr. Zuckerman on 3/16/01 at 15:25 (041637)

When checking for insurance coverage make sure if they say it is covered to get it in writing from the specific insurance company. In addition get what is called a pre-determination of the coverage and what is the patients out of pocket expense.

In addition to if the procedure is covered ask what your responsibility will be for the cost of the surgical center, the use of the machine, the anesthiologist fee. Many plans only pay a percentage of the total fee.

Re: insurance

Dr. Zuckerman on 3/16/01 at 15:35 (041639)

The FDA has approved the ossatron for the treatment for chronic, proximal insertional heel pain. The FDA isn't the reason for lack of insurance coverage. There are two reasons in my opinion

1. The cost of the machines which has made the cost to the insurance companies expense, and maybe too expense a treatment for universal coverage to all subscribers of a major insurance company.

2. Insurance companies want USA outcome studies beside FDA studies.

What this means is that although there are many thousands of ESWT procedure that have been done in Europe and Canada the US insurance positon is that we want American Studies.

So the bottom line is there is going to be some insurances that want to coverage ESWT and some that won't /

When a NEW specific cpt code for orthopedic ESWT becomes available then you will see univeral insurance coverage.

When this happens then Medicare will cover orthopedic ESWT and then the major Blue Shields will knick in.

So time is the answer. More doctors doing ESWT and more USA published results and then CPT codes and then maybe insurance coverage.

Re: Dr. Z: How long do you think this might take?

Beverly on 3/16/01 at 16:11 (041647)

Dr. Z,

Now that EWST is FDA approved, how long do you think it might take to get it's own orthopedic code?
Thanks,
Beverly

Re: Dr. Z: How long do you think this might take?

Dr. Zuckerman on 3/16/01 at 16:33 (041649)

If I knew this or the companies knew this there would be alot more machines out there. I have read and been told anywhere from 18 months to five years is the average time frame for a new cpt code to be introduced after the procedure has been introduced into the USA.

Re: Dr. Z went and asked an expert for an answer with this question

Dr. Zuckerman on 3/17/01 at 12:14 (041708)

Last Login: Mar 09 09:33 AM Package: Silver Anniversary: Dec 27, 2000 Active Contract: 12 months Login: zuckerman
logout

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ESWT Coding
Author: Mark Tompkins (---.dsla1n1.sat.texas.net)
Date: 02-22-01 18:25

Does anyone have any input or information on the status of
developing codes for use with extracorporeal shockwave therapy?

I have been told that there may not be a code designated for the
procedure for up to one year. How is the procedure being currently
billed, and what has been the experience of clinicians on being
reimbursed by third party payers?

Thanks!

Mark H. Tompkins, D.P.M.
San Antonio, TX



Reply To This Message
ESWT Coding
Author: Terrance Mueller (ForumMail)
Date: 02-23-01 10:20

<< I have been told that there may not be a code designated for
the procedure for up to one year. How is the procedure being
currently billed, and what has been the experience of clinicians
on being reimbursed by third party payers?

Thanks!

Mark H. Tompkins, D.P.M. >>

Last week, I received a letter from United Healthcare, stating that
they consider ESWT to be 'experimental', and will, therefore, not
cover the service.

Terrance J. Mueller, DPM
St. Louis, MO

Reply To This Message
ESWT Coding
Author: Walter Pedowitz (---.sumt1.nj.home.com)
Date: 02-23-01 19:38

A tracking, level 3, code is to be issued for ECSWT. The AMA
CPT Committee will not issue an official code until adequate
peer reviewed American literature is available.

Billing at this time is subject to negotiations between the carrier
and the individual physician.

Walter J Pedowitz MD
New Jersey

-Original Message-

Does anyone have any input or information on the status of
developing codes for use with extracorporeal shockwave therapy?

I have been told that there may not be a code designated for the
procedure for up to one year. How is the procedure being currently
billed, and what has been the experience of clinicians on being
reimbursed by third party payers?

Thanks!

Mark H. Tompkins, D.P.M.
San Antonio, TX

Reply To This Message
ESWT Coding
Author: David Zuckerman (---.delval.adsl.bellatlantic.net)
Date: 03-09-01 09:35

What is a 'tracking, level 3' code?

David Zuckerman, DPM
Woodbury, NJ

-Previous Message-

A tracking, level 3, code is to be issued for ECSWT. The AMA
CPT Committee will not issue an official code until adequate
peer reviewed American literature is available.

Billing at this time is subject to negotiations between the carrier
and the individual physician.

Walter J Pedowitz MD
New Jersey

Reply To This Message
ESWT Coding
Author: Walter Pedowitz (---.wt.luc.edu)
Date: 03-11-01 14:14

A tracking code is a new code to be issued for promising
new procedures that have not as yet created enough of a
literature base to justify a full CPT code. It tells the
insurance companies that we think it has merit, but more
information is needed.

Walter J Pedowitz MD
New Jersey

-Previous Message-

What is a 'tracking, level 3' code?

David Zuckerman, DPM
Woodbury, NJ

-Previous Message-

A tracking, level 3, code is to be issued for ECSWT. The AMA
CPT Committee will not issue an official code until adequate
peer reviewed American literature is available.

Billing at this time is subject to negotiations between the carrier
and the individual physician.

Walter J Pedowitz MD
New Jersey

Reply To This Message

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Reply To This Message
Your Name: David Zuckerman
Your Email: footcare@home.com
Subject:

Re: for john w

john h on 3/20/01 at 17:59 (041992)

healthtronics should be building a good data base on the success/failure of the ossatron treatments. any of this data available to the public?

Re: insurance

Dr. Marlene Reid on 3/26/01 at hrmin (042465)

I can tell you that we are getting about 70% of our patients approved on the first round of requests. Some insurance co's are finding any excuse they can, and then are backing down and approving. Healthtronics does all the preapproval and appeals for our office and they are very sucessful (usually). We have only have a handful of denials that we could not get turned around. I do not know what the U/C will be yet, because we have not received any payments in yet. If you go to a participating provider, they will have to accept whatever the U/C is, whether it is $1400 or $400.