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BCBS- Denial

Posted by Gail B. on 10/30/01 at 22:48 (063860)

I received a letter of denial from BCBS last week for ESWT/Ossatron procedure. I am scheduled to see the Orthopedic Surgeon on Nov 5th. In the meantime, I am going to file SS Disability. I am about ready to chop my foot off!!!!!!

I did start going to a chiropractor a few weeks ago. He is doing the active release therapy on my foot. He is amazed that it is not responding what so ever to the therapy.

My $300 custom orthotics hurt my feet, I can't even shop for groceries for my family, not to mention just being able to walk and/or stand!

Thanks so much for all the posts on this site!

Re: BCBS- Denial

marys on 10/31/01 at 18:25 (063894)

Gail,
You sound exactly like me. Except I have it in both feet, after having problems for 2 years. I had ESWT on one foot almost two weeks ago. I'm praying for positive results.
marys

Re: BCBS- Denial

Lynn WW on 11/01/01 at 07:49 (063924)

First off, on what basis did they deny ESWT? Read your policy & APPEAL the denial. 'NO' from an insurance company is a way to not pay for a claim. If your policy states that they cover FDA approved procedures they they legally have to cover ESWT. Also check to be sure that ESWT is being performed in a state licensed /Medicare Conditions of Participation facility. Most insurances won't pay unless the procedure is performed in a licensed facility. Also check with the ortho - what 'code' did they use? Did they use the new updated (although temporary) code released 9/01 that is specific for orthotripsy(it's the code that is accepted by Medicare) or did they submit with a '99' code which requires a narrative, explanation, & is almost always denied. Another drawback to EWST is the billing. There is the surgeon's fee, and the anesthesiologist's fee but not a facility fee. Ossatron 'rents' space from the facility then bills the insurance & there is where the bulk of the conflict (and nonpayment by insurance) comes from. It may also be helpful to speak with a claims supervisor or the contact individual for your health plan(should be available from HR). Don't give up! You can appeal your way all the way to the State Insurance Commissioner. Also, if you mail anything to the insurance (appeal, etc.) send it certified with return of receipt(that way they can't deny receiving it), keep copies of everything you send, and keep a diary of whom you spoke with, the date, the time, & the topic of conversation. I had ESWT yesterday & feel very fortunate that my insurance has agreed to pay their portion of everything including the Ossatron fee. Good Luck!

Re: BCBS- Denial

Dr. Zuckerman on 11/01/01 at 10:47 (063929)

Boy it sounds like you did your home work. ONE very important correction is that the new temporary code which is 0020T is a tracking code for ESWT of the plantar fascia. It isn't covered by Medicare due to being a tracking code. This is a quote from the APMA and Healthronics which is the USA distributor for the ossatron. There is no law that I am aware that forces any insurance company to pay for any elective procedure whether it is FDA approved or not. I just don't want the public to think that this very good information that you provided is going to just make the insurance company pay.. They are under no obligation to pay for any elective procedure whether it is FDA approved or not.

Glad that you are doing so well. Just wish that health insurance was more interested in healthcare instead of profit care

Re: BCBS- Denial

Ed Davis, DPM on 11/01/01 at 16:05 (063949)

I know how frustrating it can be but---don't take 'no' for an answer from your insurance company. Appeal to the medical director of the insurance company and your state's insurance commissioner.

What other treatments have you had for plantar fasciitis?
Ed

Re: BCBS- Denial

Gail B on 11/02/01 at 10:34 (064001)

I had open plantar fascia release surgery 3 years ago on my Left foot which was successful. I am PAIN-FREE in that foot! Praise the Lord!!!

My right foot, I had endoscopic PF release in Dec of 2000, this after receiving injections, stretching, night splints etc......I have never been pain free since. ALSO, recently, my PCP wrote a prescription for the compound discussed on this website....I can't tell any difference using it, but my doc thought it wouldn't hurt to try it.

Right now, I am going to a new orthopedic surgeon and a chiropractor who is using ART Active Release Therapy and have appt to start ultrasound next week. ALSO filing for disability next week.

The new ortho. suggested the ESWT, but we have to get BCBS to approve first. I see them again on Monday and will give them this code.
THANKS!

Re: BCBS- Denial

Ed Davis, DPM on 11/02/01 at 19:56 (064029)

Considering the successful open procedure on your left foot, has your surgeon considered opening the right foot to make sure that the endoscopic procedure completely released the fascia? Same surgeon for both procedures?
You did not mention orthotics.
Ed

Re: Dr. Davis, EPF ?

BrianG on 11/03/01 at 11:34 (064048)

Hi Dr. Davis,

I too had failed EPF surgery. Two pod's that I saw after the fact, told me that most likely not enough of the fascia was cut. This is what you are alluding to also, correct? I was under the impression that the doctor really didn't have too much control of how much of the fascia was cut during an EPF. I know they use a kit, does this kit give them the leeway to cut as much, or as little, as the Pod wants? I was under the impression the kit was set up so that only part of the fascia, like 1/2 or 2/3, would be cut. I didn't think the kit allowed the fascia to be cut 100%, yes - no ????? I'd appreciate your feedback on this, and why so many EPF's are failures. Thanks in advance.

BCG

Re: Dr. Davis, EPF ?

Dr. Zuckerman on 11/03/01 at 11:52 (064050)

Hi

It there is no nerve damage and fascia was cut during the EPF then more needs to be cut. If the doctor is doing EPF a very good idea would be to check not only by viewing the release but by examining the plantar fascia by placing tension on the pf and or comparing it to the opposite foot.

In my opinion this viewing isn't how you know the pf was released it is the feel, sound and physical evaluation during and after the surgery .

A very similiar situation is when we cut bone. We are looking at the bone and sure enough it looks like it was cut completely . Well you take an x-ray and it looks like it was cut completely .But you try and move the bone and you find out that it is still has bone attached on the bottom. So the only way you can tell if the bone was completely cut is to try and move
move the bone if it move it was completely cut if it doesn then you haven't cut the bone completely. This is exactly how all pf releases should be evaluated. Trust me I have done enough and feel, examinatio is the only way. The eye can't be trusted. EPF releases create an illusion of being released without physical examination, you can be sure !!

Re: Dr. Davis, EPF ?

Ed Davis, DPM on 11/03/01 at 14:37 (064058)

Brian:

The goal is to cut either all of the plantar fascia or to cut all but the lateral 1/3 or 1/4. The problem occurs when not all of the medial fibers are cut---something that seems to occur occasionally with EPF. The instrumentation allows one to cut all or part of the fascia.

Concerning failures, I believe that the main reason is potentially innapropriate use of EPF. We have always maintained that cutting the plantar fascia is a last resort. EPF hit the scene with some hype and has been overused. The other issue is the possibility that some meidal fibers are not being cut by EPF.

A friend of mine who practices in Monroe, La. is using a newer approach, termed the 'arch' procedure. That procedure involves cutting the plantar fascia as it moves away from the heel into the arch. He has performed the procedure after failed EPF and noted that medial fibers remained after EPF and the new procedure led to relief. Some medial fibers which fan out over the medial side of the calcaneus can be missed with EPF. Those fibers tend to converge to form a better defined band in the proximal (back) part of the arch so it is possible that that area of the arch may be a better place to do the procedure.
Ed

Re: Instep plantar release.

Dr. Zuckerman on 11/03/01 at 20:14 (064074)

Ed,

I have used the instep plantar release in cases where they was a failed pf release via mis. It works and the scare is very minor. The view of the pf is so clearly seen. I would recommend a slipper cast after this procedure for two weeks.

Re: Dr. Davis, EPF ?

BrianG on 11/04/01 at 10:38 (064095)

Thank you doctors. It seems like this is an issue that should be addressed on a more professional level. We see far too many failed EPF's on this forum. It's a problem that I think the medical industry has to look at. Where would one start?

Regards
BCG

Re: BCBS- Denial

Lynn WW on 11/04/01 at 14:36 (064106)

What I recommended was that she read her individual policy AND if the policy reads that FDA approved procedures are a covered benefit, then the insurance cannot deny treatment on that basis. Yes, I did do my homework & also work in healthcare administration. I am one, apparently of the fortunate few, whose insurance agreed to pay for orthotripsy BECAUSE my individual policy states that FDA approved procedures are a covered benefit. In addition there was 21/2 years of documentation to backup my podiatrist's recommendation for orthotripsy as a resort short of surgery. My intent was not to provide misinformation to the public but rather to have individuals know their benefits (which few do), and how their policies read. Too many individuals who encounter a denial from insurance accept that denial and don't appeal it.

Re: BCBS- Denial

Dr. Zuckerman on 11/04/01 at 16:31 (064114)

I am sorry if I gave the impression that there was mis-information. I just don't see many insurance companies paying for the procedure at the costs that these procedure are going for today.

Could you tell us more about how long it took to appeal the denial and what the insurance company name was. Here is my take on this entire insurance deal. Once the insurance company is caught and has to pay for ESWT if there is an FDA clause then they will restrict the coverage and may even eliminate the procedure to only very few individual policies.There will be increase premium payments to have this insurance feature. In the end someone has to pay for the hugh expense that ESWT entails.

The cost of ESWT today is too expensive for the insurance industry to pay for. There is just no way that this can be done. Now if we had more competition and more ESWT machines in this country the price would come down and the insurance company would then take a look.

Re: Dr. Davis, EPF ?

Ed Davis, DPM on 11/05/01 at 19:48 (064188)

Good question. Not an easy one to answer. My feelings are that the best thing is a well informed medical consumer. Sites like this are valuable and people must educate themselves and do the research on all questions of health care.

In fairness, you will see a number of failed EPF's on this forum because surgery is the last resort and when that fails people are looking for answers. Few people with EPF success stories are posting here, they are happy, healed and going about their business.

Insurance companies and hospitals favor surgical treatment and that tends to drive the politics of healthcare in the direction of surgery. A first glance, logic would have it that insurance companies want to save money by discourage overutilization of surgery. The reality is that they often encourage surgical treatment and discourage conservative treatment. Why? I am not sure but the best analogy is that to oil---when oil prices go up, oil companies make more money as their percentage of the total goes up.
Ed

Re: BCBS- Denial

Gail B on 11/06/01 at 19:22 (064266)

I would be glad for them to open up the right foot and see if they cut enough, but the surgeon who did my first release in the left foot is not practicing due to his health. He has looked at my foot and seen the MRI and agrees that the foot should be opened up and see what's going on. I wish he was able to do it, but he has contracted Hepatitis from a patient. So, I have been searching for a new doctor. I was scheduled to go to a very highly reccomended one yesterday, and the office called because he was sick. So, I will get a new appt date.

I do have orthodics and wearing New Balance's. I am soooo tired of the pain I am ready to take the chainsaw to this foot!

I also am overweight, started gaining when my feet prevented me from walking as I used to. Now I can't even walk around the grocery store. My husband and children go for me. This foot pain can be soo depressing I pray for some good answers soon!

Thanks to everyone on this website!

Re: BCBS- Denial

Gail B. on 11/06/01 at 19:24 (064267)

Good Luck to you! Did your insurance company pay for the ESWT? I will pray for success for your treatment.
Gail

Re: BCBS- Denial

Dr. Zuckerman on 11/07/01 at 16:16 (064329)

If the problem is in the release then Miminial incision pf release will do the trick. Much easier and much less trauma then open release. It just isn't that hard to release the pf at the incision. I have done it so many
times in twenty two years that either you know how to do it or you miss it

Re: BCBS- Denial

RACHAEL T. on 11/07/01 at 22:04 (064369)

I am planning on having ESWT ossatron done in the next few wks. I, too, am concerned about nonpayment by my ins. co.
Pls. advise the best route I can go in order to get them to be responsible for the payment - it sounds like you know alot about this & I would appreciate any help you may be able to offer. Also, I am really wondering - how you are doing since your ossatron treatment - so I might begin to consider where I (& 'my feet') may be in a few weeks as well. Thank you lots!

Re: Scar tissue ?

BrianG on 11/08/01 at 08:54 (064389)

What about scar tissue from the mis surgery, on top of her first procedure? Aren't we looking at another case of TTS? This is why I won't be cut a second time on the same foot. Still wating for ESWT in Boston.

BCG

Re: BCBS- Denial

Dan L on 11/12/01 at 21:20 (064746)

sorry to hear about your experience. I have suffered over 5 years. I've had bilateral partial release surgery and even ESWT. I am no better. Like you, I can stand no more than 5 minutes, can't go for a brief walk with my wife or even the grocery store. If it's any help, you are NOT alone and others like us really DO understand that even though you 'look just fine' the pain and suffering is real. best wishes.

Re: BCBS- Denial

Jen I on 11/13/01 at 08:29 (064749)

I am not sure what type of BCBS coverage you have, but mine covered all of it. I had Ossatron treatment. We are withMessa Blue Cross/Blue Shield. I assume that all BCBS coverage is not equal?

Re: BCBS- Denial

Gail B. on 11/15/01 at 18:49 (064841)

Hey, thanks for the mutual feelings. I went back to see the orthopedic surgeon Monday of this week. He thinks that the endoscopic release went bad and that the doc probably cut the muscle too deep.....shouldn't be cut at all! So, he thinks the Ossatron would be the answer, if we can get the BCBS people to approve pymt. For now, he has put me in a velcro boot up to the knee. At least this keeps it from stretching and making the muscle even bigger.

Thanks for the mutual understanding. I wish you welll.

Gail

Re: BCBS- Denial

Gail B. on 11/15/01 at 18:53 (064842)

I have BCBS- Anthem through Goodyear Tire & Rubber CO. PPO.....

Any information you can give me on your coverage and their pymt on ESWT will be greatly appreciated. My doctor's office told me they would appeal it to BCBS and do all the necessary paperwork. So now I am just waiting.
Patiently with a boot on my foot.

Thanks for the info.

you can email me at (email removed)

Thanks again,Gail

Re: BCBS- Denial

Patty C on 12/08/01 at 02:56 (066499)

BC/BS denied me three times, and arbitration denied me as well. Yesterday I had a fasciotomy. I can only hope and pray that I do not develop an infection (like I did in my other foot after surgery six years ago), because I am now diabetic. I would think BC/BS would have liked to avoid that possibility. They consider ESWT investigational, and have no intention of covering it anytime soon. I have BC/BS Blue Advantage of Illinois. In addition, since my podiatrist no longer performs fasciotomy, I had to go to another podiatrist, rather than the one I've gone to for seven years. I'm not at all happy with BC/BS.

Re: BCBS- Denial

marys on 10/31/01 at 18:25 (063894)

Gail,
You sound exactly like me. Except I have it in both feet, after having problems for 2 years. I had ESWT on one foot almost two weeks ago. I'm praying for positive results.
marys

Re: BCBS- Denial

Lynn WW on 11/01/01 at 07:49 (063924)

First off, on what basis did they deny ESWT? Read your policy & APPEAL the denial. 'NO' from an insurance company is a way to not pay for a claim. If your policy states that they cover FDA approved procedures they they legally have to cover ESWT. Also check to be sure that ESWT is being performed in a state licensed /Medicare Conditions of Participation facility. Most insurances won't pay unless the procedure is performed in a licensed facility. Also check with the ortho - what 'code' did they use? Did they use the new updated (although temporary) code released 9/01 that is specific for orthotripsy(it's the code that is accepted by Medicare) or did they submit with a '99' code which requires a narrative, explanation, & is almost always denied. Another drawback to EWST is the billing. There is the surgeon's fee, and the anesthesiologist's fee but not a facility fee. Ossatron 'rents' space from the facility then bills the insurance & there is where the bulk of the conflict (and nonpayment by insurance) comes from. It may also be helpful to speak with a claims supervisor or the contact individual for your health plan(should be available from HR). Don't give up! You can appeal your way all the way to the State Insurance Commissioner. Also, if you mail anything to the insurance (appeal, etc.) send it certified with return of receipt(that way they can't deny receiving it), keep copies of everything you send, and keep a diary of whom you spoke with, the date, the time, & the topic of conversation. I had ESWT yesterday & feel very fortunate that my insurance has agreed to pay their portion of everything including the Ossatron fee. Good Luck!

Re: BCBS- Denial

Dr. Zuckerman on 11/01/01 at 10:47 (063929)

Boy it sounds like you did your home work. ONE very important correction is that the new temporary code which is 0020T is a tracking code for ESWT of the plantar fascia. It isn't covered by Medicare due to being a tracking code. This is a quote from the APMA and Healthronics which is the USA distributor for the ossatron. There is no law that I am aware that forces any insurance company to pay for any elective procedure whether it is FDA approved or not. I just don't want the public to think that this very good information that you provided is going to just make the insurance company pay.. They are under no obligation to pay for any elective procedure whether it is FDA approved or not.

Glad that you are doing so well. Just wish that health insurance was more interested in healthcare instead of profit care

Re: BCBS- Denial

Ed Davis, DPM on 11/01/01 at 16:05 (063949)

I know how frustrating it can be but---don't take 'no' for an answer from your insurance company. Appeal to the medical director of the insurance company and your state's insurance commissioner.

What other treatments have you had for plantar fasciitis?
Ed

Re: BCBS- Denial

Gail B on 11/02/01 at 10:34 (064001)

I had open plantar fascia release surgery 3 years ago on my Left foot which was successful. I am PAIN-FREE in that foot! Praise the Lord!!!

My right foot, I had endoscopic PF release in Dec of 2000, this after receiving injections, stretching, night splints etc......I have never been pain free since. ALSO, recently, my PCP wrote a prescription for the compound discussed on this website....I can't tell any difference using it, but my doc thought it wouldn't hurt to try it.

Right now, I am going to a new orthopedic surgeon and a chiropractor who is using ART Active Release Therapy and have appt to start ultrasound next week. ALSO filing for disability next week.

The new ortho. suggested the ESWT, but we have to get BCBS to approve first. I see them again on Monday and will give them this code.
THANKS!

Re: BCBS- Denial

Ed Davis, DPM on 11/02/01 at 19:56 (064029)

Considering the successful open procedure on your left foot, has your surgeon considered opening the right foot to make sure that the endoscopic procedure completely released the fascia? Same surgeon for both procedures?
You did not mention orthotics.
Ed

Re: Dr. Davis, EPF ?

BrianG on 11/03/01 at 11:34 (064048)

Hi Dr. Davis,

I too had failed EPF surgery. Two pod's that I saw after the fact, told me that most likely not enough of the fascia was cut. This is what you are alluding to also, correct? I was under the impression that the doctor really didn't have too much control of how much of the fascia was cut during an EPF. I know they use a kit, does this kit give them the leeway to cut as much, or as little, as the Pod wants? I was under the impression the kit was set up so that only part of the fascia, like 1/2 or 2/3, would be cut. I didn't think the kit allowed the fascia to be cut 100%, yes - no ????? I'd appreciate your feedback on this, and why so many EPF's are failures. Thanks in advance.

BCG

Re: Dr. Davis, EPF ?

Dr. Zuckerman on 11/03/01 at 11:52 (064050)

Hi

It there is no nerve damage and fascia was cut during the EPF then more needs to be cut. If the doctor is doing EPF a very good idea would be to check not only by viewing the release but by examining the plantar fascia by placing tension on the pf and or comparing it to the opposite foot.

In my opinion this viewing isn't how you know the pf was released it is the feel, sound and physical evaluation during and after the surgery .

A very similiar situation is when we cut bone. We are looking at the bone and sure enough it looks like it was cut completely . Well you take an x-ray and it looks like it was cut completely .But you try and move the bone and you find out that it is still has bone attached on the bottom. So the only way you can tell if the bone was completely cut is to try and move
move the bone if it move it was completely cut if it doesn then you haven't cut the bone completely. This is exactly how all pf releases should be evaluated. Trust me I have done enough and feel, examinatio is the only way. The eye can't be trusted. EPF releases create an illusion of being released without physical examination, you can be sure !!

Re: Dr. Davis, EPF ?

Ed Davis, DPM on 11/03/01 at 14:37 (064058)

Brian:

The goal is to cut either all of the plantar fascia or to cut all but the lateral 1/3 or 1/4. The problem occurs when not all of the medial fibers are cut---something that seems to occur occasionally with EPF. The instrumentation allows one to cut all or part of the fascia.

Concerning failures, I believe that the main reason is potentially innapropriate use of EPF. We have always maintained that cutting the plantar fascia is a last resort. EPF hit the scene with some hype and has been overused. The other issue is the possibility that some meidal fibers are not being cut by EPF.

A friend of mine who practices in Monroe, La. is using a newer approach, termed the 'arch' procedure. That procedure involves cutting the plantar fascia as it moves away from the heel into the arch. He has performed the procedure after failed EPF and noted that medial fibers remained after EPF and the new procedure led to relief. Some medial fibers which fan out over the medial side of the calcaneus can be missed with EPF. Those fibers tend to converge to form a better defined band in the proximal (back) part of the arch so it is possible that that area of the arch may be a better place to do the procedure.
Ed

Re: Instep plantar release.

Dr. Zuckerman on 11/03/01 at 20:14 (064074)

Ed,

I have used the instep plantar release in cases where they was a failed pf release via mis. It works and the scare is very minor. The view of the pf is so clearly seen. I would recommend a slipper cast after this procedure for two weeks.

Re: Dr. Davis, EPF ?

BrianG on 11/04/01 at 10:38 (064095)

Thank you doctors. It seems like this is an issue that should be addressed on a more professional level. We see far too many failed EPF's on this forum. It's a problem that I think the medical industry has to look at. Where would one start?

Regards
BCG

Re: BCBS- Denial

Lynn WW on 11/04/01 at 14:36 (064106)

What I recommended was that she read her individual policy AND if the policy reads that FDA approved procedures are a covered benefit, then the insurance cannot deny treatment on that basis. Yes, I did do my homework & also work in healthcare administration. I am one, apparently of the fortunate few, whose insurance agreed to pay for orthotripsy BECAUSE my individual policy states that FDA approved procedures are a covered benefit. In addition there was 21/2 years of documentation to backup my podiatrist's recommendation for orthotripsy as a resort short of surgery. My intent was not to provide misinformation to the public but rather to have individuals know their benefits (which few do), and how their policies read. Too many individuals who encounter a denial from insurance accept that denial and don't appeal it.

Re: BCBS- Denial

Dr. Zuckerman on 11/04/01 at 16:31 (064114)

I am sorry if I gave the impression that there was mis-information. I just don't see many insurance companies paying for the procedure at the costs that these procedure are going for today.

Could you tell us more about how long it took to appeal the denial and what the insurance company name was. Here is my take on this entire insurance deal. Once the insurance company is caught and has to pay for ESWT if there is an FDA clause then they will restrict the coverage and may even eliminate the procedure to only very few individual policies.There will be increase premium payments to have this insurance feature. In the end someone has to pay for the hugh expense that ESWT entails.

The cost of ESWT today is too expensive for the insurance industry to pay for. There is just no way that this can be done. Now if we had more competition and more ESWT machines in this country the price would come down and the insurance company would then take a look.

Re: Dr. Davis, EPF ?

Ed Davis, DPM on 11/05/01 at 19:48 (064188)

Good question. Not an easy one to answer. My feelings are that the best thing is a well informed medical consumer. Sites like this are valuable and people must educate themselves and do the research on all questions of health care.

In fairness, you will see a number of failed EPF's on this forum because surgery is the last resort and when that fails people are looking for answers. Few people with EPF success stories are posting here, they are happy, healed and going about their business.

Insurance companies and hospitals favor surgical treatment and that tends to drive the politics of healthcare in the direction of surgery. A first glance, logic would have it that insurance companies want to save money by discourage overutilization of surgery. The reality is that they often encourage surgical treatment and discourage conservative treatment. Why? I am not sure but the best analogy is that to oil---when oil prices go up, oil companies make more money as their percentage of the total goes up.
Ed

Re: BCBS- Denial

Gail B on 11/06/01 at 19:22 (064266)

I would be glad for them to open up the right foot and see if they cut enough, but the surgeon who did my first release in the left foot is not practicing due to his health. He has looked at my foot and seen the MRI and agrees that the foot should be opened up and see what's going on. I wish he was able to do it, but he has contracted Hepatitis from a patient. So, I have been searching for a new doctor. I was scheduled to go to a very highly reccomended one yesterday, and the office called because he was sick. So, I will get a new appt date.

I do have orthodics and wearing New Balance's. I am soooo tired of the pain I am ready to take the chainsaw to this foot!

I also am overweight, started gaining when my feet prevented me from walking as I used to. Now I can't even walk around the grocery store. My husband and children go for me. This foot pain can be soo depressing I pray for some good answers soon!

Thanks to everyone on this website!

Re: BCBS- Denial

Gail B. on 11/06/01 at 19:24 (064267)

Good Luck to you! Did your insurance company pay for the ESWT? I will pray for success for your treatment.
Gail

Re: BCBS- Denial

Dr. Zuckerman on 11/07/01 at 16:16 (064329)

If the problem is in the release then Miminial incision pf release will do the trick. Much easier and much less trauma then open release. It just isn't that hard to release the pf at the incision. I have done it so many
times in twenty two years that either you know how to do it or you miss it

Re: BCBS- Denial

RACHAEL T. on 11/07/01 at 22:04 (064369)

I am planning on having ESWT ossatron done in the next few wks. I, too, am concerned about nonpayment by my ins. co.
Pls. advise the best route I can go in order to get them to be responsible for the payment - it sounds like you know alot about this & I would appreciate any help you may be able to offer. Also, I am really wondering - how you are doing since your ossatron treatment - so I might begin to consider where I (& 'my feet') may be in a few weeks as well. Thank you lots!

Re: Scar tissue ?

BrianG on 11/08/01 at 08:54 (064389)

What about scar tissue from the mis surgery, on top of her first procedure? Aren't we looking at another case of TTS? This is why I won't be cut a second time on the same foot. Still wating for ESWT in Boston.

BCG

Re: BCBS- Denial

Dan L on 11/12/01 at 21:20 (064746)

sorry to hear about your experience. I have suffered over 5 years. I've had bilateral partial release surgery and even ESWT. I am no better. Like you, I can stand no more than 5 minutes, can't go for a brief walk with my wife or even the grocery store. If it's any help, you are NOT alone and others like us really DO understand that even though you 'look just fine' the pain and suffering is real. best wishes.

Re: BCBS- Denial

Jen I on 11/13/01 at 08:29 (064749)

I am not sure what type of BCBS coverage you have, but mine covered all of it. I had Ossatron treatment. We are withMessa Blue Cross/Blue Shield. I assume that all BCBS coverage is not equal?

Re: BCBS- Denial

Gail B. on 11/15/01 at 18:49 (064841)

Hey, thanks for the mutual feelings. I went back to see the orthopedic surgeon Monday of this week. He thinks that the endoscopic release went bad and that the doc probably cut the muscle too deep.....shouldn't be cut at all! So, he thinks the Ossatron would be the answer, if we can get the BCBS people to approve pymt. For now, he has put me in a velcro boot up to the knee. At least this keeps it from stretching and making the muscle even bigger.

Thanks for the mutual understanding. I wish you welll.

Gail

Re: BCBS- Denial

Gail B. on 11/15/01 at 18:53 (064842)

I have BCBS- Anthem through Goodyear Tire & Rubber CO. PPO.....

Any information you can give me on your coverage and their pymt on ESWT will be greatly appreciated. My doctor's office told me they would appeal it to BCBS and do all the necessary paperwork. So now I am just waiting.
Patiently with a boot on my foot.

Thanks for the info.

you can email me at (email removed)

Thanks again,Gail

Re: BCBS- Denial

Patty C on 12/08/01 at 02:56 (066499)

BC/BS denied me three times, and arbitration denied me as well. Yesterday I had a fasciotomy. I can only hope and pray that I do not develop an infection (like I did in my other foot after surgery six years ago), because I am now diabetic. I would think BC/BS would have liked to avoid that possibility. They consider ESWT investigational, and have no intention of covering it anytime soon. I have BC/BS Blue Advantage of Illinois. In addition, since my podiatrist no longer performs fasciotomy, I had to go to another podiatrist, rather than the one I've gone to for seven years. I'm not at all happy with BC/BS.