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NEVER just assume it's taken care of....always follow up

Posted by Carmen on 4/05/02 at 10:43 (078574)

Just found out after four calls and two letter from the insurance comp. that the ESWT is NOT 100% covered. BEWARE of this happeneing to you.
The doctors office does cover the procedure 100% (pay co-pay only)BUT the facility supplying the Orthotripsy is not 100% covered b/c it's a travelling machine which is only covered 70% on a PPO. WHICH means I would be responsible for $300.00 deductible PLUS $4,000 minimum (30% of charges allowed).
So if you plan on getting the ESWT and have ben told it's 100% covered....COVER your A$% nd triple check it and get it in writing.
Thank god for my common sense....not much in the book sense dept. but WHEW did I almost put myself into a bad $ sitch.

Re: NEVER just assume it's taken care of....always follow up

Dr. Zuckerman on 4/05/02 at 11:08 (078582)

We do the procedure without facility charge. It is so dam stupid to make the patient go to he surgical center for a quick non-invaasive procedure.

Re: NEVER just assume it's taken care of....always follow up

john h on 4/05/02 at 11:32 (078588)

Amen Dr. Z! Facility charges just do not get it and is a waste of valuable resources in the case of PF. Even in the case of the OssaTron how do you justify the risk associated with anathesia for a procedure that can be done with an ankle block. I think there are a number of major invasive surgeries that are done with blocks as opposed to general anathesia. I would sure like to hear the FDA justification of this.

Re: NEVER just assume it's taken care of....always follow up

Carmen on 4/05/02 at 16:08 (078597)

I almost shed a tear over the whole stinkin frickin darndin stupid mess...(I didn't cuss...now THAT wasan accomplishment) but I didn't.
Gotta keep on moving on and find another way.

Re: NEVER just assume it's taken care of....always follow up

Suzanne D on 4/05/02 at 20:02 (078623)

So sorry this happened, Carmen, but so glad you found out BEFORE. So much of insurance seems to be 'double-talk'; my assistant at school had a similar situation with her husband who was scheduled for open heart surgery. Insurance would pay for the surgery at the hospital nearest here - or so she was told. She thought, like you, that she should triple-check as she had checked twice, but then found out that insurance would pay only for the catherization, but not the procedure! So just days before the surgery, they had to cancel and start all over again and get a dr. who would perform surgery at the hospital where insurance WOULD pay. If she hadn't been so persistent, she could have been stuck with thousands and thousands of dollars to pay, and her husband would have been so upset, he might not have survived the procedure. There seem to be so many loopholes...

I'm glad your intelligence and persistence kept you from being out a lot of money. I DO wish for you to be able to have the procedure.

Take care,
Suzanne :-)

Re: NEVER just assume it's taken care of....always follow up

Nancy N on 4/06/02 at 08:12 (078653)

Carmen--

Have you thought about going to Canada, to the Bayshore Clinic? I understand it's quite a lot less expensive, even if you include the travel costs. Just a thought--ignore if you've already considered it.

Re: NEVER just assume it's taken care of....always follow up

Julie on 4/07/02 at 16:36 (078760)

Sounded remarkably like cussing to me, Carmen! :)

Re: NEVER just assume it's taken care of....always follow up

Carmen on 4/10/02 at 07:56 (079028)

hmmm...noooo....you should HEAR me cuss Julie! ha ha
that is nothing compared to my sailor mouth when I get VERY VERY upset. thankfully it's not often.

Re: NEVER just assume it's taken care of....always follow up

Dr. Zuckerman on 4/05/02 at 11:08 (078582)

We do the procedure without facility charge. It is so dam stupid to make the patient go to he surgical center for a quick non-invaasive procedure.

Re: NEVER just assume it's taken care of....always follow up

john h on 4/05/02 at 11:32 (078588)

Amen Dr. Z! Facility charges just do not get it and is a waste of valuable resources in the case of PF. Even in the case of the OssaTron how do you justify the risk associated with anathesia for a procedure that can be done with an ankle block. I think there are a number of major invasive surgeries that are done with blocks as opposed to general anathesia. I would sure like to hear the FDA justification of this.

Re: NEVER just assume it's taken care of....always follow up

Carmen on 4/05/02 at 16:08 (078597)

I almost shed a tear over the whole stinkin frickin darndin stupid mess...(I didn't cuss...now THAT wasan accomplishment) but I didn't.
Gotta keep on moving on and find another way.

Re: NEVER just assume it's taken care of....always follow up

Suzanne D on 4/05/02 at 20:02 (078623)

So sorry this happened, Carmen, but so glad you found out BEFORE. So much of insurance seems to be 'double-talk'; my assistant at school had a similar situation with her husband who was scheduled for open heart surgery. Insurance would pay for the surgery at the hospital nearest here - or so she was told. She thought, like you, that she should triple-check as she had checked twice, but then found out that insurance would pay only for the catherization, but not the procedure! So just days before the surgery, they had to cancel and start all over again and get a dr. who would perform surgery at the hospital where insurance WOULD pay. If she hadn't been so persistent, she could have been stuck with thousands and thousands of dollars to pay, and her husband would have been so upset, he might not have survived the procedure. There seem to be so many loopholes...

I'm glad your intelligence and persistence kept you from being out a lot of money. I DO wish for you to be able to have the procedure.

Take care,
Suzanne :-)

Re: NEVER just assume it's taken care of....always follow up

Nancy N on 4/06/02 at 08:12 (078653)

Carmen--

Have you thought about going to Canada, to the Bayshore Clinic? I understand it's quite a lot less expensive, even if you include the travel costs. Just a thought--ignore if you've already considered it.

Re: NEVER just assume it's taken care of....always follow up

Julie on 4/07/02 at 16:36 (078760)

Sounded remarkably like cussing to me, Carmen! :)

Re: NEVER just assume it's taken care of....always follow up

Carmen on 4/10/02 at 07:56 (079028)

hmmm...noooo....you should HEAR me cuss Julie! ha ha
that is nothing compared to my sailor mouth when I get VERY VERY upset. thankfully it's not often.