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ESWT Denial by HMO After FDA Approval

Posted by walter w. on 6/12/02 at 06:33 (087240)

My wife has been suffering with Plantar Fasciitis for years and has had all the treatments recommended in the past, including cortisone injections, orthotics, various exercises etc.. Her doctors have told her that the only thing left is surgery, and they don't recommend it. They told her that there is a prolonged recovery time and also the chances of success are not good. Then along came ESWT, something that looks like the answer! We belong to an HMO in Dutchess County, New York, by the name of MVP and they decided that ESWT is EXPERIMENTAL and DANGEROUS! This is AFTER the procedure was approved by the FDA. It's obvious that al they care about is the money and they could care less about the patients well being.

My question is, does anyone out there know of an Insurance Company, nationally recognized, i.e. Blue Cross/Blue Shield, that will pay, either entirely or partially, for this procedure to be performed? We live in New York, but were planning on having it done by a Dr. Zuckermann in New Jersey. At this time there are not any Doctors in New York, that we know of, that can perform the procedure. Certainly there are none with the experience of Dr. Zuckermann. Also, if anyone else is experiencing the same problem with an HMO, I'd like to hear about it.

Re: ESWT Denial by HMO After FDA Approval

john h on 6/12/02 at 09:57 (087281)

One of the major Health Providers in California recently started providing coverage for ESWT. Dr. Zuckerman is a good choice in your area I have been to him 4 times from Arkansas. Certainly the procedure should not be described as dangerous. It is not.

Re: ESWT Denial by HMO After FDA Approval

Tim V. on 6/12/02 at 13:56 (087330)

My understanding is that Blue Cross/Blue Shield of Oregon is now covering ESWT. Within the last 6 months there
are now 40+ doctors offering ESWT out of Portland. So at least some of the large carriers are starting to recognize
this and cover it.

I know this is not much help in New York. But keep pursuing treatment/coverage; I think I can only help your wife's
condition.

Re: ESWT Denial by HMO After FDA Approval

Carol S on 6/13/02 at 22:03 (087527)

United health Care will pay for eswt.

Re: ESWT Denial by HMO After FDA Approval

Ed Davis, DPM on 6/14/02 at 15:17 (087608)

The insurers will have to get in line, slowly but surely. Unfortunately, it may not be fast enough for many who need the treatment.

DO NOT TAKE 'NO' FOR AN ANSWER.... keep appealing, all the way to your state's insurance commissioner. Use the resources on this site to build a reference file on the effectiveness of ESWT and send it to your insurer.
Ed

Re: ESWT Denial by HMO After FDA Approval

Jean P. on 6/19/02 at 18:55 (088049)

I went to see Dr. Theodore today at Mass General. He says Blue Cross in MA accepts it. Unfortunately I don't think my carrier will - for Aetna US Health care - see link below for details.

bbv.cgi?n=88044

Re: ESWT Denial by HMO After FDA Approval

Lisa D. on 7/10/02 at 12:14 (089410)

Jean, I have BCBS of MI, and so far, they say they don't cover ESWT. Do you know for sure that BC of MA covers it? Maybe I can argue that fact with my company.

Re: ESWT Denial by HMO After FDA Approval

Jean P. on 7/11/02 at 21:15 (089513)

Dr. Theodore of Mass General told me that they cover it. I am going to call his office Monday to see if they have heard from my insurance yet. I will ask his secretary for confirmation and see if I can get their number -maybe that will help you. He did tell me that BCBS coverage varies by state. Let me know if the phone number will help or just what info. you need and I will help if I am able.

Re: ESWT Denial by HMO After FDA Approval

Jean P. on 7/18/02 at 16:47 (090001)

I double checked and BC of MA does cover it. She does not know about BC coverage in other states. Check out Dr. Lee's post of 7/17 and he lists companies that cover the west coast. Good luck on your appeal.

Re: ESWT Denial by HMO After FDA Approval

john h on 6/12/02 at 09:57 (087281)

One of the major Health Providers in California recently started providing coverage for ESWT. Dr. Zuckerman is a good choice in your area I have been to him 4 times from Arkansas. Certainly the procedure should not be described as dangerous. It is not.

Re: ESWT Denial by HMO After FDA Approval

Tim V. on 6/12/02 at 13:56 (087330)

My understanding is that Blue Cross/Blue Shield of Oregon is now covering ESWT. Within the last 6 months there
are now 40+ doctors offering ESWT out of Portland. So at least some of the large carriers are starting to recognize
this and cover it.

I know this is not much help in New York. But keep pursuing treatment/coverage; I think I can only help your wife's
condition.

Re: ESWT Denial by HMO After FDA Approval

Carol S on 6/13/02 at 22:03 (087527)

United health Care will pay for eswt.

Re: ESWT Denial by HMO After FDA Approval

Ed Davis, DPM on 6/14/02 at 15:17 (087608)

The insurers will have to get in line, slowly but surely. Unfortunately, it may not be fast enough for many who need the treatment.

DO NOT TAKE 'NO' FOR AN ANSWER.... keep appealing, all the way to your state's insurance commissioner. Use the resources on this site to build a reference file on the effectiveness of ESWT and send it to your insurer.
Ed

Re: ESWT Denial by HMO After FDA Approval

Jean P. on 6/19/02 at 18:55 (088049)

I went to see Dr. Theodore today at Mass General. He says Blue Cross in MA accepts it. Unfortunately I don't think my carrier will - for Aetna US Health care - see link below for details.

bbv.cgi?n=88044

Re: ESWT Denial by HMO After FDA Approval

Lisa D. on 7/10/02 at 12:14 (089410)

Jean, I have BCBS of MI, and so far, they say they don't cover ESWT. Do you know for sure that BC of MA covers it? Maybe I can argue that fact with my company.

Re: ESWT Denial by HMO After FDA Approval

Jean P. on 7/11/02 at 21:15 (089513)

Dr. Theodore of Mass General told me that they cover it. I am going to call his office Monday to see if they have heard from my insurance yet. I will ask his secretary for confirmation and see if I can get their number -maybe that will help you. He did tell me that BCBS coverage varies by state. Let me know if the phone number will help or just what info. you need and I will help if I am able.

Re: ESWT Denial by HMO After FDA Approval

Jean P. on 7/18/02 at 16:47 (090001)

I double checked and BC of MA does cover it. She does not know about BC coverage in other states. Check out Dr. Lee's post of 7/17 and he lists companies that cover the west coast. Good luck on your appeal.