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

My insurance company won't cover E.S.W.T

Posted by Tabetha R. on 11/04/02 at 16:31 (099321)

My insurance company won't cover the cost of E.S.W.T because they say it is still an experimental procedure. My doctor has told me this is the best option for getting rid of 2 heel spurs I have on my left foot, other wise, I will have to have surgery and physical therapy. I'm trying to appeal the insurance company's decision. So what I need to know is, I know that E.S.W.T has FDA approval, but is it still considered and experimental procedure? I've done a lot of research on this procedure, and so far this is the only question I can't seem to get answered. Please help. Thank you.

Re: My insurance company won't cover E.S.W.T

caryn z on 11/04/02 at 16:41 (099322)

have you read through the ESWT message post section? There seems to be a lot of information throughout but you might find others who have had treatments like eswt writing in the specific section. Just a thought is all. Hope y ou find the answer.

Cheers, Caryn

Re: My insurance company won't cover E.S.W.T

BrianG on 11/04/02 at 17:40 (099333)

Hi Tabetha,

As far as we know, some ESWT is no longer experimental for PF in the United States. Why not write to the FDA yourself, and ask them. You will be able to use the answer at your appeal. You can write to them at http://www.fda.gov
I'm pretty sure there is a search feature at the bottom of the home page, which should help you.

Good luck
BrianG, not a doc

Re: My insurance company won't cover E.S.W.T

Ed Davis, DPM on 11/04/02 at 21:19 (099359)

Definitely not experimental but all of the infighting among 'providers' is going to give third parties a lot of excuses not to cover this modality.

Ed

Re: My insurance company won't cover E.S.W.T

Dr. Marlene Reid on 11/04/02 at 22:44 (099378)

We're finding that more insurance companies are starting to pay for it again and often you need to be very active in complaining to them because it is NOT experimental. The ins co's were using that line because there was not a code for it and there is (sort of) now.

Re: My insurance company won't cover E.S.W.T

Dr. Zuckerman on 11/05/02 at 08:45 (099402)

You will need to provide the pma approval number for the specific machine to your insurance company. There is usually two parts to this denial. One is medical need and two does your specific insurance company cover this specific procedure. If we are talking about Aetna US Healthcare then they
won't pay due to their own policy of non-coverage

Re: My insurance company won't cover E.S.W.T

caryn z on 11/04/02 at 16:41 (099322)

have you read through the ESWT message post section? There seems to be a lot of information throughout but you might find others who have had treatments like eswt writing in the specific section. Just a thought is all. Hope y ou find the answer.

Cheers, Caryn

Re: My insurance company won't cover E.S.W.T

BrianG on 11/04/02 at 17:40 (099333)

Hi Tabetha,

As far as we know, some ESWT is no longer experimental for PF in the United States. Why not write to the FDA yourself, and ask them. You will be able to use the answer at your appeal. You can write to them at http://www.fda.gov
I'm pretty sure there is a search feature at the bottom of the home page, which should help you.

Good luck
BrianG, not a doc

Re: My insurance company won't cover E.S.W.T

Ed Davis, DPM on 11/04/02 at 21:19 (099359)

Definitely not experimental but all of the infighting among 'providers' is going to give third parties a lot of excuses not to cover this modality.

Ed

Re: My insurance company won't cover E.S.W.T

Dr. Marlene Reid on 11/04/02 at 22:44 (099378)

We're finding that more insurance companies are starting to pay for it again and often you need to be very active in complaining to them because it is NOT experimental. The ins co's were using that line because there was not a code for it and there is (sort of) now.

Re: My insurance company won't cover E.S.W.T

Dr. Zuckerman on 11/05/02 at 08:45 (099402)

You will need to provide the pma approval number for the specific machine to your insurance company. There is usually two parts to this denial. One is medical need and two does your specific insurance company cover this specific procedure. If we are talking about Aetna US Healthcare then they
won't pay due to their own policy of non-coverage