Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Still Battling with Insurance Company

Posted by Judy W. on 7/02/02 at 07:27 (088904)

My Healthcare Provider, an HMO is Dutchess County, New York by the name of MVP has turned me down for ESWT, stating that it is experimental and dangerous! I have appealed their decision and it has been turned down again. My husband works for IBM and he has appealed to the Benefits Department who oversees the various Medical Plans that IBM provides and they also have turned me down, stating that they support the decision of MVP. I have contacted the NYS Attorney Generals Office also. I don't understand why some Insurance Companies pay for the procedure and others will not! Where do they come off calling it experimental and dangerous if it has been approved by the FDA for use with Plantar Fasciitis?

Re: Still Battling with Insurance Company

David G. on 7/02/02 at 08:19 (088909)

I have Oxford Freedom Plan. I'm anxiously awaiting their decision. I'll let you know.

Re: Still Battling with Insurance Company

Joe S on 7/02/02 at 20:53 (088967)

I had a patient in a similar situation as you. After about 3 months we finally got him approved. Ossatron (Healthtronics) gave up after the initial rejection. We wrote letters for our patient. I even believe he sought legal counsel. He went directly to the administrator of his plan (this was a very determined man and also kind of a big guy) and basically laid it on the line. His comment was 'If I have the open surgery, I will be out of work for 4 weeks on each foot whereas if I have ESWT I can be back at work much quicker and therefore continue to be productive'. The plan administrator realized what it would ultimately cost his company and went to work for our patient which was ultimately approved for Bilateral ESWT. The point being is you have to be persistent. Keep bugging them.

Re: Still Battling with Insurance Company

Scott D. on 7/03/02 at 13:11 (089040)

Judy.. We've had some luck dealing with MVP on lithotripsy cases and I know some people there. I'm quite sure we're the closest ESWT site to you as well (we're in Westchester County). If I can be of any help please let me know. 914-345-2130

Re: Still Battling with Insurance Company

Ed Davis, DPM on 7/15/02 at 14:38 (089697)

Judy:

Appealing to the Benefits Dept. at IBM was a good idea since they are the ones who pay your ins. co. It is likely that the Benefits was provided with innaccurate information from MVP concerning the safety and efficacy of ESWT. Use this site and as many references listed in this site as possible to put together an information packet to present to the Benefits Dept. in order to have them re-consider their decision. They need the right info.
Ed

Re: Still Battling with Insurance Company

David G. on 7/02/02 at 08:19 (088909)

I have Oxford Freedom Plan. I'm anxiously awaiting their decision. I'll let you know.

Re: Still Battling with Insurance Company

Joe S on 7/02/02 at 20:53 (088967)

I had a patient in a similar situation as you. After about 3 months we finally got him approved. Ossatron (Healthtronics) gave up after the initial rejection. We wrote letters for our patient. I even believe he sought legal counsel. He went directly to the administrator of his plan (this was a very determined man and also kind of a big guy) and basically laid it on the line. His comment was 'If I have the open surgery, I will be out of work for 4 weeks on each foot whereas if I have ESWT I can be back at work much quicker and therefore continue to be productive'. The plan administrator realized what it would ultimately cost his company and went to work for our patient which was ultimately approved for Bilateral ESWT. The point being is you have to be persistent. Keep bugging them.

Re: Still Battling with Insurance Company

Scott D. on 7/03/02 at 13:11 (089040)

Judy.. We've had some luck dealing with MVP on lithotripsy cases and I know some people there. I'm quite sure we're the closest ESWT site to you as well (we're in Westchester County). If I can be of any help please let me know. 914-345-2130

Re: Still Battling with Insurance Company

Ed Davis, DPM on 7/15/02 at 14:38 (089697)

Judy:

Appealing to the Benefits Dept. at IBM was a good idea since they are the ones who pay your ins. co. It is likely that the Benefits was provided with innaccurate information from MVP concerning the safety and efficacy of ESWT. Use this site and as many references listed in this site as possible to put together an information packet to present to the Benefits Dept. in order to have them re-consider their decision. They need the right info.
Ed