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Open Message to All - Please help us - Survey of insurance claims which have paid for any form of eswt

Posted by Cynthia D on 4/08/01 at 11:46 (043981)

If you have had any experience or know of anyone with the experience of their insurance companies reimbursing or paying for any form of shockwave therapy, please post here, even if you have written about it before. This will help those waiting for treatment or those who have had treatment and would like to get reimbursed. This is a viable option to traditional surgery and these companies have to 'get on the bandwagon' to the 21st century! Thanks for your time.

Re: Open Message to All - Please help us - Survey of insurance claims which have paid for any form of eswt

Kate on 4/08/01 at 21:11 (044033)

While Dr. Z would have more current information, I know of only one insurnace company who reimbursed a patient for approximatly 80% of the cost for ESWT. This was a private union insurance company.
However, while reimbursement on a case by case basis could only be a positive thing for patients needing and having ESWT, I feel, and think Dr. Z would agree, that if managed care and commercial insurance agencies get involved, actually less people will be able to get ESWT, because the costs to provide the treatment will increase. Also, insurnace companies will begin to put restrictions on who can have the treatment based on their diagnosis, what they've done so far, etc. I've found that once managed care gets involved in anything, it is usually the patient who reaps the least reward.

Re: Open Message to All - Please help us - Survey of insurance claims which have paid for any form of eswt

Dr. Zuckerman on 4/09/01 at 13:35 (044099)

Hi,

Nothing so far has changed with insurances in New Jersey. I have found that only medical saving accounts or some private unions are paying for this procedure.

Re: Open Message to All - Please help us - Survey of insurance claims which have paid for any form of eswt

Kim B. on 4/11/01 at hrmin (044317)

Hi Kate,

I agree that managed care is not what it was cracked up to be 10 years ago. I was with one for a while, and all they 'managed', is to keep from meeting sick person's needs.

Now, wee have UnitedHealcare's PPO (Preferred Provider...(Org. or Option?? I really don't know what the 'O' in PPO stands for, but would be glad to learn if someone else does.) It is not like 'managed care' you mentioned, and it is by far, the best kind of insurance curently available. They have docs that are signed up as 'in-network providers', and I get a discount if I choose one of their in-network docs, but I still have the choice to use an out of network doc if I choose to.

The coverage and customer service assistanc has been excellent so far. They pay my doctors promptly and in accordance with the coveage agreement my husbands employers chose. Even back when many other Insurance companies wouldn't even cover the cost of Vioxx, UnitedHealthcare paid for mine, simply because it was prescibed by my doctor and it has FDA approval. They don't allow some obscure medical clerk to second guess a licenced Physican's orders which is a lot of what goes on with 'managed care'.

For many insurance companies, the first questions regarding reimbursement is: Is the prescribing physcian licensed? and, has the drug or procedure been approved by the FDA? So I will point out, for those who wish to have insurance assist with the cost of their ESWT Treatment, you have to know if the procedure you are submitting surely has FDA approval for the way it was used, otherwise, it's an automatic 'NO' right off the bat in most cases. In another post, I mentioned that there are major differences in the various ESWT and this issue is a perfect example. They are paying on a case by case basis, because Some ESWT treatments are approved by the FDA and some are not. I know that FDA approval is a big dividing rod on this issue. They have to cover their butts. If they are nieve enough to pay for something that is not FDA approved and it does you more harm than good, they can be pulled in to a malpratice case simply because they were the ones who made it availiable to you. FDA approval is a huge safety net for them.

Down with 'Managed Care,' YES, but not with traditional health insurance I am extemely pleased with the coverage I am recieveing from our more traditional, health care insurace provider. I am ancious for insurance to begin assisting in paying for this OssaTron ESWT. Because of the numbers of surgeries it will prevent, insurance companies will soon assist in paying, people are going to get better, more people will have the proceedure done, and the prices are going to come down. I appreciate how the insurance companies estabilish what is reasonalbe and cutomary for a service. If the agreed amount is more reasonalble to begin with, my 20% is less.

Regards, Kim B.

Re: Open Message to All - Please help us - Survey of insurance claims which have paid for any form of eswt

Dr. Zuckerman on 4/14/01 at 10:36 (044565)

There has never been any insurance company ask whether it is FDA approved. They ask for the code and since there isn't any code that is where the aproval problem starts.

Now back to United Health Care. As an out of network provider they are good. Use to be part of the network. In fact I was the first podiatric provider when they were Traveler's. They only thing that I can say about them is that they are part of the National lawsuit that the American Medical Association has brought against them for poor payment, delayed payment, no payment, withholding medical care and last but not least their view on ESWT is that it is still experiement due to lack of American Studies . They feel that the FDA means nothing for payment processing for ESWT at this time.

Re: Open Message to All - Please help us - Survey of insurance claims which have paid for any form of eswt

Kate on 4/08/01 at 21:11 (044033)

While Dr. Z would have more current information, I know of only one insurnace company who reimbursed a patient for approximatly 80% of the cost for ESWT. This was a private union insurance company.
However, while reimbursement on a case by case basis could only be a positive thing for patients needing and having ESWT, I feel, and think Dr. Z would agree, that if managed care and commercial insurance agencies get involved, actually less people will be able to get ESWT, because the costs to provide the treatment will increase. Also, insurnace companies will begin to put restrictions on who can have the treatment based on their diagnosis, what they've done so far, etc. I've found that once managed care gets involved in anything, it is usually the patient who reaps the least reward.

Re: Open Message to All - Please help us - Survey of insurance claims which have paid for any form of eswt

Dr. Zuckerman on 4/09/01 at 13:35 (044099)

Hi,

Nothing so far has changed with insurances in New Jersey. I have found that only medical saving accounts or some private unions are paying for this procedure.

Re: Open Message to All - Please help us - Survey of insurance claims which have paid for any form of eswt

Kim B. on 4/11/01 at hrmin (044317)

Hi Kate,

I agree that managed care is not what it was cracked up to be 10 years ago. I was with one for a while, and all they 'managed', is to keep from meeting sick person's needs.

Now, wee have UnitedHealcare's PPO (Preferred Provider...(Org. or Option?? I really don't know what the 'O' in PPO stands for, but would be glad to learn if someone else does.) It is not like 'managed care' you mentioned, and it is by far, the best kind of insurance curently available. They have docs that are signed up as 'in-network providers', and I get a discount if I choose one of their in-network docs, but I still have the choice to use an out of network doc if I choose to.

The coverage and customer service assistanc has been excellent so far. They pay my doctors promptly and in accordance with the coveage agreement my husbands employers chose. Even back when many other Insurance companies wouldn't even cover the cost of Vioxx, UnitedHealthcare paid for mine, simply because it was prescibed by my doctor and it has FDA approval. They don't allow some obscure medical clerk to second guess a licenced Physican's orders which is a lot of what goes on with 'managed care'.

For many insurance companies, the first questions regarding reimbursement is: Is the prescribing physcian licensed? and, has the drug or procedure been approved by the FDA? So I will point out, for those who wish to have insurance assist with the cost of their ESWT Treatment, you have to know if the procedure you are submitting surely has FDA approval for the way it was used, otherwise, it's an automatic 'NO' right off the bat in most cases. In another post, I mentioned that there are major differences in the various ESWT and this issue is a perfect example. They are paying on a case by case basis, because Some ESWT treatments are approved by the FDA and some are not. I know that FDA approval is a big dividing rod on this issue. They have to cover their butts. If they are nieve enough to pay for something that is not FDA approved and it does you more harm than good, they can be pulled in to a malpratice case simply because they were the ones who made it availiable to you. FDA approval is a huge safety net for them.

Down with 'Managed Care,' YES, but not with traditional health insurance I am extemely pleased with the coverage I am recieveing from our more traditional, health care insurace provider. I am ancious for insurance to begin assisting in paying for this OssaTron ESWT. Because of the numbers of surgeries it will prevent, insurance companies will soon assist in paying, people are going to get better, more people will have the proceedure done, and the prices are going to come down. I appreciate how the insurance companies estabilish what is reasonalbe and cutomary for a service. If the agreed amount is more reasonalble to begin with, my 20% is less.

Regards, Kim B.

Re: Open Message to All - Please help us - Survey of insurance claims which have paid for any form of eswt

Dr. Zuckerman on 4/14/01 at 10:36 (044565)

There has never been any insurance company ask whether it is FDA approved. They ask for the code and since there isn't any code that is where the aproval problem starts.

Now back to United Health Care. As an out of network provider they are good. Use to be part of the network. In fact I was the first podiatric provider when they were Traveler's. They only thing that I can say about them is that they are part of the National lawsuit that the American Medical Association has brought against them for poor payment, delayed payment, no payment, withholding medical care and last but not least their view on ESWT is that it is still experiement due to lack of American Studies . They feel that the FDA means nothing for payment processing for ESWT at this time.