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workman's comp woes

Posted by Scott R on 8/25/01 at 10:40 (057916)

i know there are a lot of jobs out there causing harm, but without a journal article stating jobs can cause it, there are a lot of people withut a defense. i've received several requests from insurance companies in austrailia and canada but haven't been able to lead them anywhere where they could justify reimbursing claims. He an email this morning
=============
Hello,
I am still interested in this list. I have heelspurs(diagnosed by me). I
bought a pair ofBirkenstock shoes for work. ( I am a nurse) and that has
helped some. I never knew I had heel spurs until I returned to nursing in April after a four year hiatus to work in the family business part time and raise children. Now I work on a huge 44 bed unit that is strung out on 3 sides of the hospital. Someone that designed it was obviously not anyone that ever worked a hospital unit. My feet kill me when I wake up and of course after a shift. Now it is much better with my shoes.
......
I tried the most expensive nursing shoes and running shoes you can buy but
the Birks are hands down the ONLY shoes that help.
Try the heel cushions made out of the same material they use on horses heels
also!
Good luck.
Melissa

Re: workman's comp woes

Julie on 8/25/01 at 12:01 (057923)

Perhaps one of 'our' doctors could write such an article. Didn't Dr Ed Davis say very recently that 75% of his PF patients work in jobs that require them to stand and walk all day on hard surfaces?

That such jobs cause or contribute to PF seems so utterly self-evident that one has to suspect there is a huge (insurance) conspiracy dedicated to denying it.

Re: workman's comp woes

BG CPed on 8/25/01 at 12:21 (057928)

That is tough. There was a study done on inserts with postal workers that was rather impressive. Showed help in a large percent, also improved complaints on backs and knee. I think one aspect with reluctance of insurance coverage on orthotics is that they got hosed for several years by scammers doing orthotics.

Unfortunatly it was not uncommon for some to make a poor fo out of prefab or close to prefab shell, cover with leather that had the guys name on it and bill for $350 + . Poor device x high cost x poor results = no payee.

It could be compared to a Doctor writing scripts for meds when he owns a pharmacy next door, paying peter to pay paul more. I realize Stark Law eliminates most of that. The insurance co instead of weeding out the ones that were costing them and ripping them AND the patient off they just said hey we wont cover orthotics unless they are attached to a brace or you are a diabetic.

Between the Docs that refer to me I save several pt a week from having surg, that saves lots of money in the long run. That said I am fortunate that my referal base are very ethical guys and are too busy to begin with, they dont need to cut on every pt that walks thru the door.

The reason I dont bill at my facility is that it is too much hassle in my neck of the woods. I only do bill for work comp and auto. To give you an example I did 25 of these types of claims between january and may. As of last week I have been paid on 8 of them. I had my billing person call all the outstanding providers and out of the 18 unpaid about 6 said 'mail it again, we never got your invoice' Some of those had been called and rebilled more than once in that time. It is not uncommon to wait over 90 days for some to pay. What other business can you provide a service have a rep from the company tell you it is covered then have to sometimes wait months and send several bills to get paid? You cant do that at the Grocery or auto repair, why should it be different.

They use the standard stall and play dumb to earn interest on the money and to encourage some to write it off. I would like to have a law inacted that the same folks that process and send out bills to collect insurance premiums be the same folks that pay out claims. For some odd reason one department is MUCH more efficent than the other...wonder why?

So we need a few more studies done that will prove that proper orthotic treatment is a viable and cost saving treatment. One problem is that orthotic care is not standard, like drug prescription were you can go anywhere in the country and get same consistant script filled.

Orthotics are not standardized. Thats why there are so many varied results with orthotics. I hate gov regualation but maybe there needs to be a standard practice sode writen. Needs to be evaluated fitted by a certain professional. Needs to be made a certain way etc. And have hugh nasty penalties for ones that violate it
my .02 which is really about .01 canadian

Re: workman's comp woes

Ed Davis, DPM on 8/25/01 at 13:33 (057933)

BG-- you have hit the nail on the head again! Agree 100%. I was involved in the legislative aspect of my profession for years before I had kids and had to cut back time committments. I have made countless requests for better studies and standardization in the orthotic marketplace for 2 decades.

A lot of the misunderstandings that posters have would clear up if the differences between orthotic devices were clearly explained, standardized and at least 'self-regulated' in a manner that people really know exactly what they are getting. I have patients coming in all the time with bags of inserts, bogus orthotics and various worthless stuff totally frustrated. They trusted someone to give them relief, paid money and got little in return. I then have to work harder to re-establish their trust.

Insurance companies need to know exactly what they are paying for--the standards under which the devices they are paying for are produced.
Ed

Re: workman's comp woes

BG CPed on 8/25/01 at 14:00 (057945)

Thanks Dr Davis. I get frustrated when I see people with stuff that has no functional difference than a $30 prefab and they paid $300. Or the trial and error stuff that has 10 pieces of cork,plastic,eva glued all over it.

Another thing i see pften is a typical older lady with ptti and valgus knee. All she needs is a good fo and solid x depth off shelf shoe. They come in and have a custom made ugly shoe attached to metal AFO. The provider (weasel)says Oh Mrs Johnson your insurance wont cover foot orthotics unless it is attached to a brace. Mrs Johnson wanting relief and being of limited income says ok your the expert and if its free what the heck.

So by avoiding having to pay 2-300 dollars they get hosed for a custom shoe afo combo (about $1300 +) It is big and bulky and hard to handle so 1/2 end up in a closet. I am not saying afo/shoe is bad. It is indicated in many cases but a policy like that encourages this type of ripoff. I cant remember how many times I have seen this. It is great to hear somebodys mom or grandmother say you mean i can wear a regular shoe? I dont have to wear this thing anymore?

I could make much more money than I do if I was inclined. I make them for $175 to $200 and make them while the pt waits. I can often get pt in a shoe and orthotic for under $300.

Maybe we need to start an organization something like aofas for orthotic providers. Have a standard set. A individual or facility could apply to become a member. They would have to be CPed DPM MD DO etc. For a reasonable fee they would become a member. They would have to submit samples of work or lab they use. This group could lobby ins to assure they are not getting jerked.

If it was peer reviewed and run and kept free of political influence by big groups that provide poor service or devices it may work. Not to butt heads with american board of pedorthics or orthotics but to align with them to clean up and regulate the industry. You have to be licsensed to cut hair but not provide orthotic that could in some cases be more harmful than a bad haircut.

Anybody have any ideas??

Re: workman's comp woes

Julie on 8/25/01 at 12:01 (057923)

Perhaps one of 'our' doctors could write such an article. Didn't Dr Ed Davis say very recently that 75% of his PF patients work in jobs that require them to stand and walk all day on hard surfaces?

That such jobs cause or contribute to PF seems so utterly self-evident that one has to suspect there is a huge (insurance) conspiracy dedicated to denying it.

Re: workman's comp woes

BG CPed on 8/25/01 at 12:21 (057928)

That is tough. There was a study done on inserts with postal workers that was rather impressive. Showed help in a large percent, also improved complaints on backs and knee. I think one aspect with reluctance of insurance coverage on orthotics is that they got hosed for several years by scammers doing orthotics.

Unfortunatly it was not uncommon for some to make a poor fo out of prefab or close to prefab shell, cover with leather that had the guys name on it and bill for $350 + . Poor device x high cost x poor results = no payee.

It could be compared to a Doctor writing scripts for meds when he owns a pharmacy next door, paying peter to pay paul more. I realize Stark Law eliminates most of that. The insurance co instead of weeding out the ones that were costing them and ripping them AND the patient off they just said hey we wont cover orthotics unless they are attached to a brace or you are a diabetic.

Between the Docs that refer to me I save several pt a week from having surg, that saves lots of money in the long run. That said I am fortunate that my referal base are very ethical guys and are too busy to begin with, they dont need to cut on every pt that walks thru the door.

The reason I dont bill at my facility is that it is too much hassle in my neck of the woods. I only do bill for work comp and auto. To give you an example I did 25 of these types of claims between january and may. As of last week I have been paid on 8 of them. I had my billing person call all the outstanding providers and out of the 18 unpaid about 6 said 'mail it again, we never got your invoice' Some of those had been called and rebilled more than once in that time. It is not uncommon to wait over 90 days for some to pay. What other business can you provide a service have a rep from the company tell you it is covered then have to sometimes wait months and send several bills to get paid? You cant do that at the Grocery or auto repair, why should it be different.

They use the standard stall and play dumb to earn interest on the money and to encourage some to write it off. I would like to have a law inacted that the same folks that process and send out bills to collect insurance premiums be the same folks that pay out claims. For some odd reason one department is MUCH more efficent than the other...wonder why?

So we need a few more studies done that will prove that proper orthotic treatment is a viable and cost saving treatment. One problem is that orthotic care is not standard, like drug prescription were you can go anywhere in the country and get same consistant script filled.

Orthotics are not standardized. Thats why there are so many varied results with orthotics. I hate gov regualation but maybe there needs to be a standard practice sode writen. Needs to be evaluated fitted by a certain professional. Needs to be made a certain way etc. And have hugh nasty penalties for ones that violate it
my .02 which is really about .01 canadian

Re: workman's comp woes

Ed Davis, DPM on 8/25/01 at 13:33 (057933)

BG-- you have hit the nail on the head again! Agree 100%. I was involved in the legislative aspect of my profession for years before I had kids and had to cut back time committments. I have made countless requests for better studies and standardization in the orthotic marketplace for 2 decades.

A lot of the misunderstandings that posters have would clear up if the differences between orthotic devices were clearly explained, standardized and at least 'self-regulated' in a manner that people really know exactly what they are getting. I have patients coming in all the time with bags of inserts, bogus orthotics and various worthless stuff totally frustrated. They trusted someone to give them relief, paid money and got little in return. I then have to work harder to re-establish their trust.

Insurance companies need to know exactly what they are paying for--the standards under which the devices they are paying for are produced.
Ed

Re: workman's comp woes

BG CPed on 8/25/01 at 14:00 (057945)

Thanks Dr Davis. I get frustrated when I see people with stuff that has no functional difference than a $30 prefab and they paid $300. Or the trial and error stuff that has 10 pieces of cork,plastic,eva glued all over it.

Another thing i see pften is a typical older lady with ptti and valgus knee. All she needs is a good fo and solid x depth off shelf shoe. They come in and have a custom made ugly shoe attached to metal AFO. The provider (weasel)says Oh Mrs Johnson your insurance wont cover foot orthotics unless it is attached to a brace. Mrs Johnson wanting relief and being of limited income says ok your the expert and if its free what the heck.

So by avoiding having to pay 2-300 dollars they get hosed for a custom shoe afo combo (about $1300 +) It is big and bulky and hard to handle so 1/2 end up in a closet. I am not saying afo/shoe is bad. It is indicated in many cases but a policy like that encourages this type of ripoff. I cant remember how many times I have seen this. It is great to hear somebodys mom or grandmother say you mean i can wear a regular shoe? I dont have to wear this thing anymore?

I could make much more money than I do if I was inclined. I make them for $175 to $200 and make them while the pt waits. I can often get pt in a shoe and orthotic for under $300.

Maybe we need to start an organization something like aofas for orthotic providers. Have a standard set. A individual or facility could apply to become a member. They would have to be CPed DPM MD DO etc. For a reasonable fee they would become a member. They would have to submit samples of work or lab they use. This group could lobby ins to assure they are not getting jerked.

If it was peer reviewed and run and kept free of political influence by big groups that provide poor service or devices it may work. Not to butt heads with american board of pedorthics or orthotics but to align with them to clean up and regulate the industry. You have to be licsensed to cut hair but not provide orthotic that could in some cases be more harmful than a bad haircut.

Anybody have any ideas??