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Sonocur Insurance Coverage

Posted by DJ on 11/14/02 at 15:59 (100165)

I just received my third Sonocur treatment in Baltimore. My insurance did cover the treatment. So far I don't notice any results but this was a long shot for me anyway since I've been diagnosed by two doctors with a nerve entrapment.

I saw a doctor in charlotte, NC who is seeing very positve results from his Sonocur machine. Also, he said his patients have all been able to obtain insurance coverage for the treatment.

Re: Sonocur Insurance Coverage

Dr. Z on 11/14/02 at 21:34 (100185)

They must be stating that it is FDA approved when it isn't There is no insurance coverage for any procedure that isn't FDA approved when others are in fact FDA approved. Don't be surprise when the insurance does an audit and ask for the monies back

Re: Sonocur Insurance Coverage

Steve on 11/14/02 at 21:44 (100188)

What was the charge and the insurance allowed amount for the treatment. Did the doctor in Charlotte say what their charge was and how much insurance was allowing? I agree with Dr. Z in that non-approved use likely will result in insurance denial.

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/14/02 at 22:55 (100201)

Numerous insurance companies have extended coverage to low energy ESWT treatments realizing the tremendous benefit. Insurers do not necessarily place all their eggs in the FDA basket. Many insurers pay for non-FDA approved treatments -- off label use of prescription drugs is a good example.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/14/02 at 22:56 (100202)

Wrong again Steve. Insurers are not as hung up on the FDA issue as you are. Insurers routinely pay for non-FDA approved uses of drugs.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/14/02 at 23:04 (100205)

DJ:

I wish you the best of luck. Most doctors using the Sonocur are seeing tremendous successes. Besides its effectiveness, the Sonocur represents a price breakthrough which has the competition scared enough to stir up a lot of controversy.

It takes 7 to 12 weeks after completion of treatment to see what the treatment will do for you. It is possible that your problem could be of a mixed etiology -- if so, the component that is due to PF may be mitigated.
Ed

Re: Sonocur Insurance Coverage

DJ on 11/15/02 at 08:51 (100233)

The procedure cost 700 a treatment in Baltimore. I haven't received my insurance statement yet so I don't know what the allowed amount is. The clinic was able to get pre-approval for the treatment from my insurance company. I made absolute sure I wouldn't be stuck with the bill. The Charlottle clinic that has the Sonorex is the Miller Clinic. I'm not sure what the costs are per treatment there.

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 10:56 (100247)

I understand but if they are using a non-FDA approved machine for pf it does matter. Eventually the insurance is going to find out that the treatment is non-FDA approved.

Insurance companies have audits. When they find out that this shouldn't been approved they will ask for the money back. If they paid you they will ask you for the check back

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 10:58 (100249)

Which insurance companies are paying for low energy ESWT .?? From my experience all major insurance company want to see that FDA approval even with that they are at times calling this experimental.

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 11:01 (100251)

Let's stick to the issue. ESWT, FDA approval and whice insurance companies. I am not hung up with FDA approval as my past experience has shown. I am only expressing what the insurance companies position is. Now if you could tell us which companies aren't hung up on FDA approval I am sure the heel spur posters would love to know. They could switch to these plans

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 11:02 (100252)

Please tell us the insurance companies that are paying for low energy eswt. This would be a great help to the posters on this board

Re: Sonocur Insurance Coverage

DJ on 11/15/02 at 11:11 (100261)

My insurance coverage which I have had tremendous success with is Blue Cross/Blue Shield.

Re: Sonocur Insurance Coverage

DJ on 11/15/02 at 11:30 (100270)

I'd also add that this seems to be a very recent trend that insurance companies have started picking up the bill. Just three months ago, I was not able to get coverage. Now, both clinics I have talked to have reported that they have been able to recieved coverage and the have had excellent results. The procedure was as simple as getting ultrasound or electric stim treatment. It took about 10 minutes and I was out of there.

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 11:30 (100271)

This is the roughest when it comes to finding out a mistake and then asking for money back. I have seen this done before with ESWT

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 11:32 (100272)

Both clinic are soncur clinics which are probaby using the same billing methods. IT takes anywhere from three to six months for the audit to show. up

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 16:24 (100302)

Both of the Blues in my state are. We contacted both companies to discuss low vs. high energy and they indicated that they felt both were effective and would not distinguish between the two. I am in communication with a number of clinics using the Sonocur and they seem to be getting similar responses.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 16:29 (100303)

Insurers, for the most part, may have policies allowing ESWT or not. We have not encountered any insurers who have insisted on high energy or low energy. I have encountered insurers who appear confused over some of the billing arrangements that occur when they recieve bills from the limited partnerships that manage the Ossatron. One company stated that they favored in office use without commenting on energy level or protocol.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 16:33 (100304)

Most of the insurers in my area are aware of the current status of the various machines and protocols. The large ortho clinics buying the Soncour have made it very clear to insurers what is being used. Once the treatment is pre-certified, patients should not have to worry about the financial liabilities you have stated.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 16:42 (100306)

Dr. Z:

With all due respects, I really don't think patients need to be frightened about the prospects of an insurance 'audit.' I am in contact with a network of individuals billing for Sonocur treatments and it is being made very clear to the insurance company what treatment is being supplied and how. Insurers, like the IRS, reserve the right to audit providers but your repeated suggestions that Sonocur use is somehow more likely to trigger an audit is placing an unneccessary burden on patients and is based on speculation. The fact that insurers are aware of the treatment being provided up front and have reviewed and approved the treatment gives them little reason to initiate an audit.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 17:27 (100314)

Dr. Z:

You are a pioneer in this area with the introduction of Orbasone. I am not sure that you should let your experience with the Orbasone unduly influence your thinking though. Not only did the Orbasone people perhaps try to shortcut the FDA approval process but there was no acceptance of ESWT as a modality by third parties. I recently had a long discussion with an official at Regence Blue Shield about this topic. It was his feeling that ESWT has been proven safe and effective and as such stated that the doctor should be left with the freedom to decide which protocol and machine to use without interference. Interestingly they are still reviewing use of ESWT on lateral epicondylitis.
Ed

Re: Sonocur Insurance Coverage

Dr. Z on 11/16/02 at 10:02 (100379)

Must be the different areas of the country. I know of many cases where the FDA/PMA number is being asked by the Blues not at the pre-certification time by after the billing cycle has started If takes time for insurance to review payments and whether they were correctly paid. To protect themselves patients should be know to get everything in writing . Most in writing letters from the insurance always states that this procedure is approved but there is no guarantee of coverage something like that

I agree that back in 1999 there were few if no insurance companies paying for ESWT. Back then and now we were still getting for this procedure that it is experimental and therefore no coverage. Providing a PMA number is what corrected this problem. The soncur has no pma number for plantar fasciitis unless you are using the pma number for elbows. When we use the epos for achilles tendonitis we don't and can't use the pma number that we use for pf because there is no pma number

All of this is going to come to the surface in either direction so lets just see where it turns.

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/18/02 at 09:04 (100552)

You are right let's move on with other discussion. Time will be the answer.

Re: Sonocur Insurance Coverage

Dr. Z on 11/14/02 at 21:34 (100185)

They must be stating that it is FDA approved when it isn't There is no insurance coverage for any procedure that isn't FDA approved when others are in fact FDA approved. Don't be surprise when the insurance does an audit and ask for the monies back

Re: Sonocur Insurance Coverage

Steve on 11/14/02 at 21:44 (100188)

What was the charge and the insurance allowed amount for the treatment. Did the doctor in Charlotte say what their charge was and how much insurance was allowing? I agree with Dr. Z in that non-approved use likely will result in insurance denial.

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/14/02 at 22:55 (100201)

Numerous insurance companies have extended coverage to low energy ESWT treatments realizing the tremendous benefit. Insurers do not necessarily place all their eggs in the FDA basket. Many insurers pay for non-FDA approved treatments -- off label use of prescription drugs is a good example.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/14/02 at 22:56 (100202)

Wrong again Steve. Insurers are not as hung up on the FDA issue as you are. Insurers routinely pay for non-FDA approved uses of drugs.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/14/02 at 23:04 (100205)

DJ:

I wish you the best of luck. Most doctors using the Sonocur are seeing tremendous successes. Besides its effectiveness, the Sonocur represents a price breakthrough which has the competition scared enough to stir up a lot of controversy.

It takes 7 to 12 weeks after completion of treatment to see what the treatment will do for you. It is possible that your problem could be of a mixed etiology -- if so, the component that is due to PF may be mitigated.
Ed

Re: Sonocur Insurance Coverage

DJ on 11/15/02 at 08:51 (100233)

The procedure cost 700 a treatment in Baltimore. I haven't received my insurance statement yet so I don't know what the allowed amount is. The clinic was able to get pre-approval for the treatment from my insurance company. I made absolute sure I wouldn't be stuck with the bill. The Charlottle clinic that has the Sonorex is the Miller Clinic. I'm not sure what the costs are per treatment there.

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 10:56 (100247)

I understand but if they are using a non-FDA approved machine for pf it does matter. Eventually the insurance is going to find out that the treatment is non-FDA approved.

Insurance companies have audits. When they find out that this shouldn't been approved they will ask for the money back. If they paid you they will ask you for the check back

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 10:58 (100249)

Which insurance companies are paying for low energy ESWT .?? From my experience all major insurance company want to see that FDA approval even with that they are at times calling this experimental.

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 11:01 (100251)

Let's stick to the issue. ESWT, FDA approval and whice insurance companies. I am not hung up with FDA approval as my past experience has shown. I am only expressing what the insurance companies position is. Now if you could tell us which companies aren't hung up on FDA approval I am sure the heel spur posters would love to know. They could switch to these plans

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 11:02 (100252)

Please tell us the insurance companies that are paying for low energy eswt. This would be a great help to the posters on this board

Re: Sonocur Insurance Coverage

DJ on 11/15/02 at 11:11 (100261)

My insurance coverage which I have had tremendous success with is Blue Cross/Blue Shield.

Re: Sonocur Insurance Coverage

DJ on 11/15/02 at 11:30 (100270)

I'd also add that this seems to be a very recent trend that insurance companies have started picking up the bill. Just three months ago, I was not able to get coverage. Now, both clinics I have talked to have reported that they have been able to recieved coverage and the have had excellent results. The procedure was as simple as getting ultrasound or electric stim treatment. It took about 10 minutes and I was out of there.

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 11:30 (100271)

This is the roughest when it comes to finding out a mistake and then asking for money back. I have seen this done before with ESWT

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/15/02 at 11:32 (100272)

Both clinic are soncur clinics which are probaby using the same billing methods. IT takes anywhere from three to six months for the audit to show. up

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 16:24 (100302)

Both of the Blues in my state are. We contacted both companies to discuss low vs. high energy and they indicated that they felt both were effective and would not distinguish between the two. I am in communication with a number of clinics using the Sonocur and they seem to be getting similar responses.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 16:29 (100303)

Insurers, for the most part, may have policies allowing ESWT or not. We have not encountered any insurers who have insisted on high energy or low energy. I have encountered insurers who appear confused over some of the billing arrangements that occur when they recieve bills from the limited partnerships that manage the Ossatron. One company stated that they favored in office use without commenting on energy level or protocol.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 16:33 (100304)

Most of the insurers in my area are aware of the current status of the various machines and protocols. The large ortho clinics buying the Soncour have made it very clear to insurers what is being used. Once the treatment is pre-certified, patients should not have to worry about the financial liabilities you have stated.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 16:42 (100306)

Dr. Z:

With all due respects, I really don't think patients need to be frightened about the prospects of an insurance 'audit.' I am in contact with a network of individuals billing for Sonocur treatments and it is being made very clear to the insurance company what treatment is being supplied and how. Insurers, like the IRS, reserve the right to audit providers but your repeated suggestions that Sonocur use is somehow more likely to trigger an audit is placing an unneccessary burden on patients and is based on speculation. The fact that insurers are aware of the treatment being provided up front and have reviewed and approved the treatment gives them little reason to initiate an audit.
Ed

Re: Sonocur Insurance Coverage

Ed Davis, DPM on 11/15/02 at 17:27 (100314)

Dr. Z:

You are a pioneer in this area with the introduction of Orbasone. I am not sure that you should let your experience with the Orbasone unduly influence your thinking though. Not only did the Orbasone people perhaps try to shortcut the FDA approval process but there was no acceptance of ESWT as a modality by third parties. I recently had a long discussion with an official at Regence Blue Shield about this topic. It was his feeling that ESWT has been proven safe and effective and as such stated that the doctor should be left with the freedom to decide which protocol and machine to use without interference. Interestingly they are still reviewing use of ESWT on lateral epicondylitis.
Ed

Re: Sonocur Insurance Coverage

Dr. Z on 11/16/02 at 10:02 (100379)

Must be the different areas of the country. I know of many cases where the FDA/PMA number is being asked by the Blues not at the pre-certification time by after the billing cycle has started If takes time for insurance to review payments and whether they were correctly paid. To protect themselves patients should be know to get everything in writing . Most in writing letters from the insurance always states that this procedure is approved but there is no guarantee of coverage something like that

I agree that back in 1999 there were few if no insurance companies paying for ESWT. Back then and now we were still getting for this procedure that it is experimental and therefore no coverage. Providing a PMA number is what corrected this problem. The soncur has no pma number for plantar fasciitis unless you are using the pma number for elbows. When we use the epos for achilles tendonitis we don't and can't use the pma number that we use for pf because there is no pma number

All of this is going to come to the surface in either direction so lets just see where it turns.

Re: Sonocur Insurance Coverage

Dr. Zuckerman on 11/18/02 at 09:04 (100552)

You are right let's move on with other discussion. Time will be the answer.