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insurance coverage

Posted by charles f. on 7/16/01 at hrmin (053328)

are any ESWT treatments covered by insurance.(ie.medicare,medicaid,commerical carriers)

Re: insurance coverage

Dr. Marlene Reid on 7/16/01 at 10:25 (053346)

Yes, private insurers are starting to cover. Not all, but more and more are approving it. Medicare and medicaid do not pay for it, at least in Illinois.

Re: insurance coverage

Dr. Ed Davis on 7/16/01 at 20:49 (053408)

Medicare does pay for ECSWT. It is a national policy but, as you know, the local carriers can be slow to act. Medicare allows $300 for the treatment, a significant reduction from the 'asking' price.
Ed

Re: insurance coverage

Dr. Zuckerman on 7/16/01 at 20:53 (053410)

I have heard of this before . Seems to me that you need to go from the FDA classification of investigional and have a cpt for this to be national. policy. It is a shame if this is true because there is no way that any ESWT provider can do this procedure at this price. So it looks like the senior citizen is out of the non-surgical ESWT loop. But you know the seniors they will picket HFCA until they wake up .

Has anyone actually seen this 'National Policy' cause I haven't seen it.

Re: insurance coverage

Dr. Ed Davis on 7/16/01 at hrmin (053418)

Dr. Z:
Medicare is utilizing a HCPCS Level 2 code as opposed to a CPT code for the procedure. The memorandum concerning coverage came out in late April--will try to get a copy. We only have one Ossatron in the area and the service is not being 'offered' to Medicare patients. The politics, as usual, is that there is an appearance of providing comprehensive coverage but by doing so at a 'below market' rate, providers are forced to restrict services to beneficiaries.

Re: insurance coverage

Dr. Zuckerman on 7/16/01 at 23:51 (053433)

Are you using the ossatron. ??? Its ashame that medicare pateints won't ge this very benefical treatment. !!

Re: insurance coverage

Ed Davis, DPM on 7/18/01 at hrmin (053621)

A six man orthopedic group in Auburn, WA, about 15 minutes away from the town I practice in, Puyallup, WA obtained the first and only Ossatron in the state late last year. I started referring patients to them in February and became certified in March. I had about 8 patients who had not responded to conservative therapy, about 3 had insurance rejection for the treatment, 2 still waiting on insurance approval and 3 who had the treatment. Two out of the three have not seen improvement with the treatment. One had contemplated returning for a second treatment after 12 weeks but elected surgery instead.

Two of the above actually had successful surgery on the opposite foot but opted for Ossatron so they would not have to miss time from work.

There is a Healthsouth surgery center in Auburn which will obtain the second Ossatron within the next few months which will be open to use by the podiatrists in the area. The orthopods have gladly accepted our referrals and allowed us to become certified on their machine but have not let us use their machine for our patients.

They use the same protocol irrespective of the size of the patient. Surprising, since one of the patients I referred weighed 300 lb. and had very thick plantar fascia. I have a diagnostic ultrasound machine in the office and can take measurements of the fascia. I think that the protocol will need some refinement.

How are things going with your Orbasone?
Ed

Re: insurance coverage

Dr. Marlene Reid on 7/16/01 at 10:25 (053346)

Yes, private insurers are starting to cover. Not all, but more and more are approving it. Medicare and medicaid do not pay for it, at least in Illinois.

Re: insurance coverage

Dr. Ed Davis on 7/16/01 at 20:49 (053408)

Medicare does pay for ECSWT. It is a national policy but, as you know, the local carriers can be slow to act. Medicare allows $300 for the treatment, a significant reduction from the 'asking' price.
Ed

Re: insurance coverage

Dr. Zuckerman on 7/16/01 at 20:53 (053410)

I have heard of this before . Seems to me that you need to go from the FDA classification of investigional and have a cpt for this to be national. policy. It is a shame if this is true because there is no way that any ESWT provider can do this procedure at this price. So it looks like the senior citizen is out of the non-surgical ESWT loop. But you know the seniors they will picket HFCA until they wake up .

Has anyone actually seen this 'National Policy' cause I haven't seen it.

Re: insurance coverage

Dr. Ed Davis on 7/16/01 at hrmin (053418)

Dr. Z:
Medicare is utilizing a HCPCS Level 2 code as opposed to a CPT code for the procedure. The memorandum concerning coverage came out in late April--will try to get a copy. We only have one Ossatron in the area and the service is not being 'offered' to Medicare patients. The politics, as usual, is that there is an appearance of providing comprehensive coverage but by doing so at a 'below market' rate, providers are forced to restrict services to beneficiaries.

Re: insurance coverage

Dr. Zuckerman on 7/16/01 at 23:51 (053433)

Are you using the ossatron. ??? Its ashame that medicare pateints won't ge this very benefical treatment. !!

Re: insurance coverage

Ed Davis, DPM on 7/18/01 at hrmin (053621)

A six man orthopedic group in Auburn, WA, about 15 minutes away from the town I practice in, Puyallup, WA obtained the first and only Ossatron in the state late last year. I started referring patients to them in February and became certified in March. I had about 8 patients who had not responded to conservative therapy, about 3 had insurance rejection for the treatment, 2 still waiting on insurance approval and 3 who had the treatment. Two out of the three have not seen improvement with the treatment. One had contemplated returning for a second treatment after 12 weeks but elected surgery instead.

Two of the above actually had successful surgery on the opposite foot but opted for Ossatron so they would not have to miss time from work.

There is a Healthsouth surgery center in Auburn which will obtain the second Ossatron within the next few months which will be open to use by the podiatrists in the area. The orthopods have gladly accepted our referrals and allowed us to become certified on their machine but have not let us use their machine for our patients.

They use the same protocol irrespective of the size of the patient. Surprising, since one of the patients I referred weighed 300 lb. and had very thick plantar fascia. I have a diagnostic ultrasound machine in the office and can take measurements of the fascia. I think that the protocol will need some refinement.

How are things going with your Orbasone?
Ed