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Uncooperative insurance

Posted by Maggie L. on 2/19/02 at 14:56 (074317)

I'm interested in ESWT, and my Podiatrist (at Kaiser Permanente, in Oakland, CA) tells me that he wouldn't be able to refer me out to get the treatment because I have not 'exhausted all of my treatment options' at Kaiser. He considers surgery one of the treatment options I would need to exhaust. I think this is ridiculous, as ESWT would be instead of surgery, not in addition. I want to be proactive about this, but would like to avoid paying for the treatment out-of-pocket. I want to find out if Kaiser is considering purchasing the ESWT equipment, but I'm not sure who to contact.
I) Does anyone know what the title of the person might be who could tell me about new treatments/equipment being considered at an HMO?
2) And also, does anyone know what the title of the person might be who I would plead my case to about getting referrals to a non-Kaiser facility?
Additional info on me is that I've had this for about 5 years, and have tried everything else. My podiatrist recommends surgery and from what I've read that does NOT sound like a good option. Thanks for any information.

Re: Uncooperative insurance

john h on 2/20/02 at 10:11 (074395)

Maggie: This is a no brainer. Surgery could possible leave you with more pain than before and us cannot be undone. ESWT at worst will leave you just like you are. Problem is that Kaiser probably only pays around $300-$400 for surgery.

Re: Uncooperative insurance

BrianG on 2/20/02 at 10:43 (074399)

Hi Maggie,

It sounds like you should find your HMO insurance plan and take a look at it. Most plans that I know of have an appeals process if you want something they are not ready to give you. I went that way, for an MRI with my HMO, and won. I got the MRI after being turned down twice. Time to read the small print. Good luck

BrianG

PS Do everything you can to get the ESWT, before the surgery.

Re: Uncooperative insurance

john h on 2/20/02 at 10:11 (074395)

Maggie: This is a no brainer. Surgery could possible leave you with more pain than before and us cannot be undone. ESWT at worst will leave you just like you are. Problem is that Kaiser probably only pays around $300-$400 for surgery.

Re: Uncooperative insurance

BrianG on 2/20/02 at 10:43 (074399)

Hi Maggie,

It sounds like you should find your HMO insurance plan and take a look at it. Most plans that I know of have an appeals process if you want something they are not ready to give you. I went that way, for an MRI with my HMO, and won. I got the MRI after being turned down twice. Time to read the small print. Good luck

BrianG

PS Do everything you can to get the ESWT, before the surgery.