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Successful insurance appeal!

Posted by Karen K. on 3/06/02 at 16:13 (075850)

I just got the call I've been approved! The 'in writing' part should be at my door by Friday. They are paying for all physician and vendor fees. I went through the whole appeal process including finally standing(sitting) in front of the board of appeals pleading my case. The whole appeal process took about 3 months. I was fortunate enough to have had a treatment before and was able to explain to the board how much worse I was before my first treatment.

I hope I've done my part in convincing the Ins. company that this works and should be an option for all sufferers before fascia release surgery. I'll be having ESWT with Dr. Moran in NJ on March 28.

Good luck to all,
KK

Re: Successful insurance appeal!

LynK on 3/06/02 at 19:54 (075872)

Please tell me the name of your insurance company so I can refer mine to it?

Re: Successful insurance appeal!

Marc W on 3/07/02 at 00:15 (075882)

KK thanks for the encouragement. What insurance carrier do you have?
(email removed)

Re: Successful insurance appeal!

Karen K. on 3/07/02 at 07:48 (075890)

I have Harvard Pilgrim Health Care.

Best of luck!
KK

Re: Successful insurance appeal!

BrianG on 3/07/02 at 16:36 (075921)

Thank you Karen, I believe this helps everyone in the long run. Good luck with it.

BrianG

Re: Successful insurance appeal!

LaurieL on 3/10/02 at 18:21 (076129)

I had my first ESWT procedure done on January 10th. I have been incapacitated with PF and suffering with it for 3 yearswith one year of unsuccessful treatment. What is the % success rate your dr said. My procedure has not helped to date and the dr is recommending another treatment at 12 weekws. Laurie L

Re: Successful insurance appeal!

DR Zuckerman on 3/10/02 at 18:59 (076140)

IF you are not getting any relief, a second treatment could help you.

Re: Successful insurance appeal!

LaurieL on 3/11/02 at 16:50 (076199)

thanks for the info. I have been riding a reclining bike to take off more weight. Is that ok? Am basically not ambulatory due to severe pain. Riding a scooter to be able to continue to work.Also been reading not suppose to ice only heat right now. I've been icing.

Re: ESWT in office procedure

LaurieL on 3/11/02 at 17:27 (076203)

How are you able to do the ESWT procedure in the office? My procedure was under IV sedation in the OR for $5000. Does 2nd tx need to be done sooner than 12 weeks apart? Over last several months my pain has changed to burning across bottoms of feet instead of morning pain upon arising, could this be another and different condition. Am staying at a 8 to 10 pain level if I walk at all at school where I teach (concrete floors) Tylenol #3 doesn't help much. Afraid I will have to quit my job. Don't know if you received my other messages - I am not great on the computer stuff but have gotten alot of info off of the heelspur web site.

Re: ESWT in office procedure

Paula T on 3/14/02 at 19:54 (076448)

My Dr. does ESWT in his office. The machine is only brought is when he has a procedure scheduled. He uses the same I.V. sedation when he does the ulta-sound guided cortisone infections. I've had three injections...very nice sedation...I'd recomend it ;)

Re: ESWT in office procedure

DR Zuckerman on 3/14/02 at 21:43 (076456)

Which machine and where is this being done. ESWT in the office with IV sedatin.

Re: ESWT in office procedure

Paula T on 3/15/02 at 07:44 (076474)

My Dr. gave me a brochure from ossaTron so should I assume that is the machine he'd use? He said the machine would be brought in to his office if I went ahead with it. I've had three cortisone injections with iv sed. in his office and he said it would be the same for eswt. His office is in the south suburbs of Chicago.
I feel fairly confidant in the dr.'s ability...he's tried just about every treatment in the book...orthodics, ultra-sound, e-stim, ice, immobilization boot, P.T., cortisone inj., . I am definately not to the point of sx, especially after finding this site, and would definately get a second opinion, or third. What resources are out there to find a Dr. with eswt experience in my location?

Re: ESWT in office procedure

Julie on 3/15/02 at 08:10 (076480)

Paula, if you live in the Chicago area, you may be in luck. Drs Marlene Reid, one of the doctors who answers questions here, practises in the Chicago area. She and her husband/partner, also a podiatrist, have done a great many ESWT procedures. You'll find their telephone number at the top of the 'Ask the Foot Doctors' message board. It would certainly be worth your getting in touch with them, getting your second opinion from one of them, and discussing ESWT with them.

Re: ESWT in office procedure

Paula T on 3/15/02 at 08:33 (076489)

Julie,
THANKS!!! I'll check it out. You made my day.
Paula T

Re: ESWT in office procedure

DR Zuckerman on 3/15/02 at 14:53 (076529)

Go for the ESWT procedure. Check the cost make sure you are given all of the fees and then have the procedure done.

Re: Successful insurance appeal!

LynK on 3/06/02 at 19:54 (075872)

Please tell me the name of your insurance company so I can refer mine to it?

Re: Successful insurance appeal!

Marc W on 3/07/02 at 00:15 (075882)

KK thanks for the encouragement. What insurance carrier do you have?
(email removed)

Re: Successful insurance appeal!

Karen K. on 3/07/02 at 07:48 (075890)

I have Harvard Pilgrim Health Care.

Best of luck!
KK

Re: Successful insurance appeal!

BrianG on 3/07/02 at 16:36 (075921)

Thank you Karen, I believe this helps everyone in the long run. Good luck with it.

BrianG

Re: Successful insurance appeal!

LaurieL on 3/10/02 at 18:21 (076129)

I had my first ESWT procedure done on January 10th. I have been incapacitated with PF and suffering with it for 3 yearswith one year of unsuccessful treatment. What is the % success rate your dr said. My procedure has not helped to date and the dr is recommending another treatment at 12 weekws. Laurie L

Re: Successful insurance appeal!

DR Zuckerman on 3/10/02 at 18:59 (076140)

IF you are not getting any relief, a second treatment could help you.

Re: Successful insurance appeal!

LaurieL on 3/11/02 at 16:50 (076199)

thanks for the info. I have been riding a reclining bike to take off more weight. Is that ok? Am basically not ambulatory due to severe pain. Riding a scooter to be able to continue to work.Also been reading not suppose to ice only heat right now. I've been icing.

Re: ESWT in office procedure

LaurieL on 3/11/02 at 17:27 (076203)

How are you able to do the ESWT procedure in the office? My procedure was under IV sedation in the OR for $5000. Does 2nd tx need to be done sooner than 12 weeks apart? Over last several months my pain has changed to burning across bottoms of feet instead of morning pain upon arising, could this be another and different condition. Am staying at a 8 to 10 pain level if I walk at all at school where I teach (concrete floors) Tylenol #3 doesn't help much. Afraid I will have to quit my job. Don't know if you received my other messages - I am not great on the computer stuff but have gotten alot of info off of the heelspur web site.

Re: ESWT in office procedure

Paula T on 3/14/02 at 19:54 (076448)

My Dr. does ESWT in his office. The machine is only brought is when he has a procedure scheduled. He uses the same I.V. sedation when he does the ulta-sound guided cortisone infections. I've had three injections...very nice sedation...I'd recomend it ;)

Re: ESWT in office procedure

DR Zuckerman on 3/14/02 at 21:43 (076456)

Which machine and where is this being done. ESWT in the office with IV sedatin.

Re: ESWT in office procedure

Paula T on 3/15/02 at 07:44 (076474)

My Dr. gave me a brochure from ossaTron so should I assume that is the machine he'd use? He said the machine would be brought in to his office if I went ahead with it. I've had three cortisone injections with iv sed. in his office and he said it would be the same for eswt. His office is in the south suburbs of Chicago.
I feel fairly confidant in the dr.'s ability...he's tried just about every treatment in the book...orthodics, ultra-sound, e-stim, ice, immobilization boot, P.T., cortisone inj., . I am definately not to the point of sx, especially after finding this site, and would definately get a second opinion, or third. What resources are out there to find a Dr. with eswt experience in my location?

Re: ESWT in office procedure

Julie on 3/15/02 at 08:10 (076480)

Paula, if you live in the Chicago area, you may be in luck. Drs Marlene Reid, one of the doctors who answers questions here, practises in the Chicago area. She and her husband/partner, also a podiatrist, have done a great many ESWT procedures. You'll find their telephone number at the top of the 'Ask the Foot Doctors' message board. It would certainly be worth your getting in touch with them, getting your second opinion from one of them, and discussing ESWT with them.

Re: ESWT in office procedure

Paula T on 3/15/02 at 08:33 (076489)

Julie,
THANKS!!! I'll check it out. You made my day.
Paula T

Re: ESWT in office procedure

DR Zuckerman on 3/15/02 at 14:53 (076529)

Go for the ESWT procedure. Check the cost make sure you are given all of the fees and then have the procedure done.