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Am i a good candidate?

Posted by bediem on 7/17/01 at hrmin (053503)

I am a 5 year PF sufferer in both feet.I am a fairly active 42 YO male. I am a typical story of soeone that has tried everything. Stretching , Physical therapy, asprin (allergic to Motrin), orthodics, taping. now im praying for some non-evavsive treatment that works. I have more a general burning pain in both feet after standing for more than 5-10 minutes in my arch and heel area. I have bad heel pain the morning when i wake up very specific area in AM on right foot.
Otherwise just allot of burning allover. Am i a good candidate. Specifically what type of releif can a person like my get on average? If so i need to colect some information on effectiveness rates and studies as well as status on FDA approval to submitt to Aetna US Health for a review. If anyone can provide me with info i would appreciaciate it
please help..

Re: Am i a good candidate?

Steve P on 7/17/01 at 20:07 (053536)

Hi. I'm a layman (non-medical), but it seems to me you may well be an ESWT candidate based on your description & the fact that conservative treatments have failed.

Get in touch with an ESWT doc & get an evaluation!

Good luck..........Steve

Re: Am i a good candidate?

Dr. Marlene Reid on 7/18/01 at 22:28 (053649)

As long as you have now health problems that would proclude (sp??) you, you are a candidate. It seems that the sucess rate is somewhere around 85% but for MANY people, it is relief that they have been looking for for a long time. Once you see a OssaTron certified podiatrist (or ortho in some areas) Healthtronics will start the approval process.

Re: Am i a good candidate?

Tim H on 7/19/01 at hrmin (053741)

How long has ESWT been in use? Do people who had the treatment 2-3 years ago still see benefits, or does the problem tend to reoccur?

Re: Am i a good candidate?

Dr. Zuckerman on 7/19/01 at 16:35 (053751)

Hi,

I have patients post ESWT that are painfree after 20 months treatment. I know patients that are much longer that have had treatment in Europe and or Canada.

Re: Am i a good candidate?

Dr. Zuckerman on 7/19/01 at 16:39 (053752)

I hate to rain on the insurance approval parade but I know for a fact that US Healthcare will not approval ESWT due the high cost. I have spoke with one of the regional podiatric medical director and this is the official policy of US healthcare. They were considering to pay for ESWT due the cost became the denial factor.

Sorry!!!

Re: Am i a good candidate?

Dr. Marlene Reid on 7/19/01 at 21:58 (053776)

I don't see US Healthcare. We are getting about 50% of our patients approved.

Re: Am i a good candidate?

Nancy f on 7/22/01 at 12:01 (053967)

Approved from who? What about cigna ?

Re: Am i a good candidate?

Dr. Zuckerman on 7/22/01 at 12:34 (053972)

Cigna is another insurance company that isn't paying for ESWT. In general if you have an HMO insurance poliyc such as US healthcare or Cigna or Oxford Blue shields then ESWT isn't going to pay for this revolutionary non-invasion treatment. This is very similiar to Lasik surgery. Very slow to get coverage and in most cases no coverage. Heel pain is considered elective and most insurance companies don't place most coverage money for the treatment of the foot. There are even insurance companies that won't pay for orthosis, steriod injections and in some cases x-ray.
Sorry just trying to explain this in simple terms and giving facts that I have experienced over the past twenty years and in the past twenty months in the ESWT field.

Re: Am i a good candidate?

Dr. Marlene Reid on 7/22/01 at 22:42 (053990)

I would have to check in the office. It is true that HMO's probably won't approve, but different parts of the country have different insurances. The Cigna that I see in Chicago is usually a PPO. Most of my patients are PPO's, POS's or indemnity plans, which all allow you to go to any doctor you wish (with variations in benefits). For those of you with HMO's, you should be contacting your insurance co directly and demand they pay for the service.

Re: Am i a good candidate? Insurance

Lisa C on 7/23/01 at 01:41 (053995)

I have PPO but its Blue Shield. Any chance it would cover ESW?

Re: Am i a good candidate? Insurance

Dr. Zuckerman on 7/26/01 at 14:39 (054380)

In general no Blue Shield covers the ESWT treatment. This is national policy.

Re: Am i a good candidate? Insurance

Lisa C. on 7/27/01 at 02:14 (054433)

Re: Blue Shield. Thanks for letting me know. :o(

Re: Am i a good candidate? Insurance

Dr. Marlene Reid on 7/30/01 at 23:26 (054889)

I was just told that BC/BS of Michigan and California are going to be payiong for ESW. We had a patient of BC/BS of IL get it approved as well.

Re: Am i a good candidate? Insurance *DR. REID BC/BS*

Lisa C. on 7/31/01 at 06:18 (054907)

Is that Blue Cross/Blue Shield? Is that some special kind of combined insurance coverage? Please forgive my ignorance. I am in California & I have Blue Shield PPO (self employed) and Dr. Z said thay have never covered yet (national policy). If ESW would be covered I would have it done immediatly!

Re: Doctors responsiblity explaining ESWT fees to patients

Dr. Zuckerman on 7/31/01 at 09:00 (054927)

I repeat . I have never had Blue Cross Blue Shield Cover ESWT. They quoted me a national policy that it is still considered investigational.

Now with the ossatron as you know there are more then one fee . There is the doctor's fees. The ASC/Surgical Center fee and the anesthesiafee

Very important that when they say it is covered that you know which part of the fee they are talking about. My motto has always been inform before you perform and it is very important that patient understands the fees and what will happen if the insurance company turns around and won't pay for the ESWT procedure. ESWT and the ossatron is a revolutionary procedure but patients must and should understand that there is no guarantee of payment from the insurance company until they actually pay. This is just the facts

I am sure that many ESWT doctors will work with you and really try to help you get this procedure done, but until there is a CPT code specific for ESWT this is going to be a very long and hard struggle. Read all the forms you are asked to sign and understand that you the patient are repsonsible for the bill if your insurance company refuses to pay in the end. ESWT doctors should explain to you all fees that are being charged whether it is by the doctor or the surgical center. There should be a written list of these fees for the patient to see and completely understand. You are entited to know what each and every fee is and what the charge for that service is regardless of what the insurance company pays. This is usually standard state law and if you were never told what the fees were BEFORE the procedure then in the state of NEW JERSEY you have no responsibity toward the fee.

Re: Am i a good candidate? Insurance *DR. REID BC/BS*

Dr. Marlene Reid on 7/31/01 at 22:51 (055028)

BC/BS is very different state to state, in fact, patients in Illinois with BCBS from other states often have better benefits then the IL BCBS patients. I heard through healthtronics that BC will be paying in CA and Michigan, but I don't have anything in writing, ask your doctor to find out with healthtronics.

Re: Am i a good candidate?

Steve P on 7/17/01 at 20:07 (053536)

Hi. I'm a layman (non-medical), but it seems to me you may well be an ESWT candidate based on your description & the fact that conservative treatments have failed.

Get in touch with an ESWT doc & get an evaluation!

Good luck..........Steve

Re: Am i a good candidate?

Dr. Marlene Reid on 7/18/01 at 22:28 (053649)

As long as you have now health problems that would proclude (sp??) you, you are a candidate. It seems that the sucess rate is somewhere around 85% but for MANY people, it is relief that they have been looking for for a long time. Once you see a OssaTron certified podiatrist (or ortho in some areas) Healthtronics will start the approval process.

Re: Am i a good candidate?

Tim H on 7/19/01 at hrmin (053741)

How long has ESWT been in use? Do people who had the treatment 2-3 years ago still see benefits, or does the problem tend to reoccur?

Re: Am i a good candidate?

Dr. Zuckerman on 7/19/01 at 16:35 (053751)

Hi,

I have patients post ESWT that are painfree after 20 months treatment. I know patients that are much longer that have had treatment in Europe and or Canada.

Re: Am i a good candidate?

Dr. Zuckerman on 7/19/01 at 16:39 (053752)

I hate to rain on the insurance approval parade but I know for a fact that US Healthcare will not approval ESWT due the high cost. I have spoke with one of the regional podiatric medical director and this is the official policy of US healthcare. They were considering to pay for ESWT due the cost became the denial factor.

Sorry!!!

Re: Am i a good candidate?

Dr. Marlene Reid on 7/19/01 at 21:58 (053776)

I don't see US Healthcare. We are getting about 50% of our patients approved.

Re: Am i a good candidate?

Nancy f on 7/22/01 at 12:01 (053967)

Approved from who? What about cigna ?

Re: Am i a good candidate?

Dr. Zuckerman on 7/22/01 at 12:34 (053972)

Cigna is another insurance company that isn't paying for ESWT. In general if you have an HMO insurance poliyc such as US healthcare or Cigna or Oxford Blue shields then ESWT isn't going to pay for this revolutionary non-invasion treatment. This is very similiar to Lasik surgery. Very slow to get coverage and in most cases no coverage. Heel pain is considered elective and most insurance companies don't place most coverage money for the treatment of the foot. There are even insurance companies that won't pay for orthosis, steriod injections and in some cases x-ray.
Sorry just trying to explain this in simple terms and giving facts that I have experienced over the past twenty years and in the past twenty months in the ESWT field.

Re: Am i a good candidate?

Dr. Marlene Reid on 7/22/01 at 22:42 (053990)

I would have to check in the office. It is true that HMO's probably won't approve, but different parts of the country have different insurances. The Cigna that I see in Chicago is usually a PPO. Most of my patients are PPO's, POS's or indemnity plans, which all allow you to go to any doctor you wish (with variations in benefits). For those of you with HMO's, you should be contacting your insurance co directly and demand they pay for the service.

Re: Am i a good candidate? Insurance

Lisa C on 7/23/01 at 01:41 (053995)

I have PPO but its Blue Shield. Any chance it would cover ESW?

Re: Am i a good candidate? Insurance

Dr. Zuckerman on 7/26/01 at 14:39 (054380)

In general no Blue Shield covers the ESWT treatment. This is national policy.

Re: Am i a good candidate? Insurance

Lisa C. on 7/27/01 at 02:14 (054433)

Re: Blue Shield. Thanks for letting me know. :o(

Re: Am i a good candidate? Insurance

Dr. Marlene Reid on 7/30/01 at 23:26 (054889)

I was just told that BC/BS of Michigan and California are going to be payiong for ESW. We had a patient of BC/BS of IL get it approved as well.

Re: Am i a good candidate? Insurance *DR. REID BC/BS*

Lisa C. on 7/31/01 at 06:18 (054907)

Is that Blue Cross/Blue Shield? Is that some special kind of combined insurance coverage? Please forgive my ignorance. I am in California & I have Blue Shield PPO (self employed) and Dr. Z said thay have never covered yet (national policy). If ESW would be covered I would have it done immediatly!

Re: Doctors responsiblity explaining ESWT fees to patients

Dr. Zuckerman on 7/31/01 at 09:00 (054927)

I repeat . I have never had Blue Cross Blue Shield Cover ESWT. They quoted me a national policy that it is still considered investigational.

Now with the ossatron as you know there are more then one fee . There is the doctor's fees. The ASC/Surgical Center fee and the anesthesiafee

Very important that when they say it is covered that you know which part of the fee they are talking about. My motto has always been inform before you perform and it is very important that patient understands the fees and what will happen if the insurance company turns around and won't pay for the ESWT procedure. ESWT and the ossatron is a revolutionary procedure but patients must and should understand that there is no guarantee of payment from the insurance company until they actually pay. This is just the facts

I am sure that many ESWT doctors will work with you and really try to help you get this procedure done, but until there is a CPT code specific for ESWT this is going to be a very long and hard struggle. Read all the forms you are asked to sign and understand that you the patient are repsonsible for the bill if your insurance company refuses to pay in the end. ESWT doctors should explain to you all fees that are being charged whether it is by the doctor or the surgical center. There should be a written list of these fees for the patient to see and completely understand. You are entited to know what each and every fee is and what the charge for that service is regardless of what the insurance company pays. This is usually standard state law and if you were never told what the fees were BEFORE the procedure then in the state of NEW JERSEY you have no responsibity toward the fee.

Re: Am i a good candidate? Insurance *DR. REID BC/BS*

Dr. Marlene Reid on 7/31/01 at 22:51 (055028)

BC/BS is very different state to state, in fact, patients in Illinois with BCBS from other states often have better benefits then the IL BCBS patients. I heard through healthtronics that BC will be paying in CA and Michigan, but I don't have anything in writing, ask your doctor to find out with healthtronics.