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HMT Ossatron....possible good news...

Posted by Christy D on 6/12/01 at hrmin (050536)

Keep your fingers crossed...My insurance company is in the process of attempting to contract with HMT OSSATRON Facility....My Pod said Insurance would not approve this at all. I told him to REQUEST it anyway!!!!

..It's not turned down YET. This is a good sign...Hope this works...They want $4500 in Calif. for one foot. And I have two feet from helllllllllllllllllllllllllll....

Re: HMT Ossatron....possible good news...

Dr. Zuckerman on 6/12/01 at 18:36 (050547)

What kind of insurance do you have. ??

Re: HMT Ossatron....possible good news...

Dr. Marlene Reid on 6/13/01 at 00:13 (050576)

Christy,

More insurances are beginning to approve it. One thing I found helpful was explaining to the insurance company that there are certain FDA mandated requirments that must be met before the OssaTron can be used on an individual. Because the machine is not indepently owned, the physician can not use it on whoever he or she wants to. Certain criteria must be met or Healthtronics will not approve its use. This gives credibility to the company as well as the specific indications. I have explained to insurance companies this will help stop any potential abuse that has occured from other procedures, such as EPF's.

Also, the OssaTron is used in any surgical facility that approves its useage and has made arrangements with Healthtronics. It is not reequired that the facility be an ASC. I know of several hospitals that use it as well.

Re: To: Dr. Z - Re: HMT Ossatron....possible good news...

Christy D. on 6/13/01 at hrmin (050607)

My insurance is an HMO (Health Net)..oh joy! I'm really keeping my finger's crossed. You indicated to me that you can also do Ossatron. If this is NOT approved will we be talking.

Re: To: Dr. Z - Re: HMT Ossatron....possible good news...

Dr. Zuckerman on 6/13/01 at 16:07 (050635)

Yes. I can do either the ossatron or the orbasone. So the choice is yours.

Re: HMT Ossatron....possible good news...

Dr. Zuckerman on 6/13/01 at 20:27 (050659)

I have found this somewhat helpful with the orbasone but alot of companies just won't pay due to the investiginal status that ESWT is currently labeled. Without a CPT code this is a major barrier. I know it takes time but time is what alot of patients in pain don't have. We include detailed office notes with physical examination and documentation of our findings including duration of the heel pain and all of the non-surgical treatments that have been rendered without benefit.

The sad part is the ridiculous documentation and hope that the insurance companies use only in the end to send a standard policy stating that it is still investigational, or isn't a procedure that is part of the policy

US Healthcare was going to start to pay for ESWT until they started getting bills in the amount of $10,000. The problem is that the ESWT in an ASC is just to dam expensive. It must be returned to the office where it started and where it should be . Still can't understand why all FDA studies were done under local anesthesia and now it is being done under IV sedation.

The cost must come down and the only way that is going to happen is it the FDA changes the expensive PMA trials. There is no way around this . We talk about this all day long with insurance companies but without a code there is always going to be an excuse for payment for a procedure that can and has helped thousands of chronic heel spur pain.

We need to post actually payment from insurance companies and which insurance companies are paying.Maybe and I say maybe will other insurance fear the lost of policy holders if we identify the paying companies and the non-paying companies. This would make a great newspaper story. Insurance companies only will pay for surgery and not ESWT

Re: HMT Ossatron....possible good news...

Christy D. on 6/14/01 at hrmin (050707)

Yes I agree Dr. Z. I will keep you informed of the status.

It just makes me mad that this procedure is SO expensive when it's a no-brainer. It takes skill and training to do SURGERY!!! But this procedure, although you must be trained and certified is nothing compared to surgery and yet, they get off by charging 3 times the $$amount. I think it's crazy! You would think they would be like retailers...you drop the price and get many customers, vs having high cost with few customers. I think newspaper articles is a good idea. I can't believe how many people do not know about this problem and how difficult it is to resolve!

Re: HMT Ossatron....possible good news...

Dr. Zuckerman on 6/12/01 at 18:36 (050547)

What kind of insurance do you have. ??

Re: HMT Ossatron....possible good news...

Dr. Marlene Reid on 6/13/01 at 00:13 (050576)

Christy,

More insurances are beginning to approve it. One thing I found helpful was explaining to the insurance company that there are certain FDA mandated requirments that must be met before the OssaTron can be used on an individual. Because the machine is not indepently owned, the physician can not use it on whoever he or she wants to. Certain criteria must be met or Healthtronics will not approve its use. This gives credibility to the company as well as the specific indications. I have explained to insurance companies this will help stop any potential abuse that has occured from other procedures, such as EPF's.

Also, the OssaTron is used in any surgical facility that approves its useage and has made arrangements with Healthtronics. It is not reequired that the facility be an ASC. I know of several hospitals that use it as well.

Re: To: Dr. Z - Re: HMT Ossatron....possible good news...

Christy D. on 6/13/01 at hrmin (050607)

My insurance is an HMO (Health Net)..oh joy! I'm really keeping my finger's crossed. You indicated to me that you can also do Ossatron. If this is NOT approved will we be talking.

Re: To: Dr. Z - Re: HMT Ossatron....possible good news...

Dr. Zuckerman on 6/13/01 at 16:07 (050635)

Yes. I can do either the ossatron or the orbasone. So the choice is yours.

Re: HMT Ossatron....possible good news...

Dr. Zuckerman on 6/13/01 at 20:27 (050659)

I have found this somewhat helpful with the orbasone but alot of companies just won't pay due to the investiginal status that ESWT is currently labeled. Without a CPT code this is a major barrier. I know it takes time but time is what alot of patients in pain don't have. We include detailed office notes with physical examination and documentation of our findings including duration of the heel pain and all of the non-surgical treatments that have been rendered without benefit.

The sad part is the ridiculous documentation and hope that the insurance companies use only in the end to send a standard policy stating that it is still investigational, or isn't a procedure that is part of the policy

US Healthcare was going to start to pay for ESWT until they started getting bills in the amount of $10,000. The problem is that the ESWT in an ASC is just to dam expensive. It must be returned to the office where it started and where it should be . Still can't understand why all FDA studies were done under local anesthesia and now it is being done under IV sedation.

The cost must come down and the only way that is going to happen is it the FDA changes the expensive PMA trials. There is no way around this . We talk about this all day long with insurance companies but without a code there is always going to be an excuse for payment for a procedure that can and has helped thousands of chronic heel spur pain.

We need to post actually payment from insurance companies and which insurance companies are paying.Maybe and I say maybe will other insurance fear the lost of policy holders if we identify the paying companies and the non-paying companies. This would make a great newspaper story. Insurance companies only will pay for surgery and not ESWT

Re: HMT Ossatron....possible good news...

Christy D. on 6/14/01 at hrmin (050707)

Yes I agree Dr. Z. I will keep you informed of the status.

It just makes me mad that this procedure is SO expensive when it's a no-brainer. It takes skill and training to do SURGERY!!! But this procedure, although you must be trained and certified is nothing compared to surgery and yet, they get off by charging 3 times the $$amount. I think it's crazy! You would think they would be like retailers...you drop the price and get many customers, vs having high cost with few customers. I think newspaper articles is a good idea. I can't believe how many people do not know about this problem and how difficult it is to resolve!