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ESWT is Unnecessary and Explorartory

Posted by Scott Reeves on 2/17/03 at 19:25 (109562)

Those are the exact words used by my insurance company - Aetna. As with many others, this insurance company has been zero help to me for treating my heel pain with ESWT.

Tired of the appeals and the run around. CEO gets stock bonus and I get a lighter wallet.

And I have done all of the other non-invasive treatments on one foot and surgery on the other (PF and nerve release in Feb 2001). The 'traditional' surgery, while helpful, did not eliminate the heel pain. And I am strongly convinced that being on crutches brought the pain on in the weight-bearing foot (right one).

So I am just going to pay for it myself and see what happens. Cannot take it anymore - over three years now with my dogs constantly barking.

I am going in to do my right foot (non-surgery foot) on February 26.

Thanks to everyone for all of the great posts and to the doctors for being here to help all of us out. I don't post as much anymore, but I still lurk.

Re: ESWT is Unnecessary and Explorartory

Dr. Z on 2/17/03 at 19:57 (109568)

Good luck. So long as you have insertional plantar fasciitis with or without heel spur and you limp when first getting up especially in the AM, ESWT is a great choice.

Re: ESWT is Unnecessary and Explorartory

Ed Davis, DPM on 2/17/03 at 19:59 (109570)

Scott:

That response is incorrect and Aetna knows it is incorrect. Certainly go ahead with ESWT on a self pay basis but be sure to file a complaint with your states' insurance commissioner.
Ed

Re: ESWT is Unnecessary and Explorartory

Dr. Z on 2/17/03 at 20:08 (109572)

We know this is incorrect but how to you stop an insurance Co. from excluding an elective procedure from it contracts. If an insurance company must cover all medical procedures that are indeed approved and are medically necessity then that is a different story. Ed is this a state law in your state

Re: ESWT is Unnecessary and Explorartory

Ed Davis, DPM on 2/17/03 at 22:11 (109596)

Dr. Z:

I do not believe that we have a law in WA State that addresses this issue.

Employers or patients, when obtaining health insurance policies, need to be able to assume that coverage will be there for them when needed. When one considers the thousands of conditions and potential treatments covered by a health insurance policy it is not possible to delve into the fine details before hand and understand how such plans will formulate exclusions. I think the issue is one of 'good faith.' One has the right to expect that an insurer will act in good faith to cover recognized treatments nedded to treat a verified condition.
Ed

Re: ESWT is Unnecessary and Explorartory

Scott Reeves on 2/17/03 at 22:41 (109607)

Dr. Z,

Yes that is what I have. It's no fun getting up at night to go to the bathroom. I have done so many different kinds of treatment and had all the tests.

Re: ESWT is Unnecessary and Explorartory

Scott Reeves on 2/17/03 at 22:44 (109608)

Thanks for the info. I plan to do just that. I was going to fight it before and try to get approval, but the doctor is giving me a great deal and had an appointment available for next week so I am jumping - I mean limping at the chance.

Hopefully, I can recover something. This doctor is out of my network, so I was hoping Aetna would meet me somewhere in the middle. The Podiatrist I have been seeing for the last two years does not do ESWT - he's a great doctor and helped me a lot with my other foot.

I live in southern CA and that is where I am having the treatment done.

Re: ESWT is Unnecessary and Explorartory

Scott Reeves on 2/17/03 at 22:47 (109609)

What I am hoping for is success with ESWT and then I can use it as a comparison to my left foot surgery. Though I may have different problems, I would say to Aetna that the traditional surgery helped but did not cure me but the ESWT was successful.

Plus, Aetna payed over $8,000 for my other surgery, but they won't pay a portion of $2500. What gives?

Keeping my toes crossed.

Re: ESWT is Unnecessary and Explorartory

Ed Davis, DPM on 2/17/03 at 22:54 (109613)

Scott:

Good luck with ESWT. I really don't try to understand the logic behind such insurance company decisions. My best guess is that they feel while ESWT is less costly, more people will opt for that than surgery. As such they see higher rates of utilization for ESWT than surgery thus possibly more dollars spent. Irrespective of this, it is a decision based on economics, not on what is best or appropriate for the patient (in my opinion -- legal disclaimer -- hah)
Ed

Re: ESWT is Unnecessary and Explorartory

Bev N on 2/18/03 at 07:38 (109635)

We all feel for you Scott, all of my doctors do not believe in ESWT and the ins. pooh-pooh it too. Please keep us posted as to how you are doing and how the ESWT does for you, we are all here for you even if the ins. companies are not. Bev

Re: ESWT is Unnecessary and Explorartory

Dr. Z on 2/18/03 at 07:59 (109636)

You are on the right track. Good luck and we are here to help you !!

Re: ESWT is Unnecessary and Explorartory

Mar on 2/18/03 at 16:42 (109719)

When insurance covers procedures that are 'medically necessary', Who determines 'medical necessity' -- the doctor or the insurance company? Or does it vary from state to state? Mar

Re: ESWT is Unnecessary and Explorartory

Dr. Z on 2/18/03 at 17:45 (109724)

It should be the doctor at the insurance company. The medically necasary terms is very hard to define. Is the insurance doctor using the criteria setup by the insurance or is he or she using treatment standards set up by the standards of care. Most ESWT denials are determined by information that is supplied by the insurance company not the standards from the medical profession

Re: ESWT is Unnecessary and Explorartory

Mar on 2/18/03 at 17:59 (109726)

Yes, that's what i thought. So when a policy says that medically necessary procedures are covered 100% that really doesn;t mean a hill of beans! I'm trying to also determine if my insurance would cover the RFL if I opt for it. I haven't called them yet -- as i know I'll just get a run around anyway!! This is a different insurance company than I had when i had ESWT, but I think it is worse! Just filed my second appeal to CIGNA for the ESWT -- we'll see... Mar

Re: ESWT is Unnecessary and Explorartory

Dr. Z on 2/18/03 at 18:06 (109729)

I have seen some Cigna policies pay in the past. RFL:First you need the code.I have no idea what is it. This will determine if the benefits are available. You will also need to match the procedure with the diagnosis with probaby nerve pain or nerve entrapement or something like that. I doubt very much if plantar fasciitis is the correct diagnosis. Remember with RFL we aren't addressing the pf we are treating nerve pain. does make sense.
Now after you finally get to this point and they say that benefits are available then you ask the question is pre-certification needed. This means medial necessity. After that get everything in writing. Ask for a fast track due to pain. They will fax this to you sometimes. Good luck..

Re: ESWT is Unnecessary and Explorartory

Mar on 2/18/03 at 20:18 (109753)

But if my nerve conduction test was normal, then I don;t have nerve pain. Would RFL still be helpful for the PF pain? I know all pain is conducted through the nerves, but if it isn;t specifically nerve pain, is there still a chance that it would correct the PF pain? Do you know what I'm saying? I still haven't heard from Dr Coz and I notice that he hasn;t been on the board for quite awhile; hope he's okay. Mar

Re: ESWT is Unnecessary and Explorartory

Dr. Z on 2/18/03 at 21:29 (109764)

This has nothing to do with a nerve conduction testing. The RFL stops the nerve conduction. It does cure any plantar fasciitis. You can have local nerve problems with a normal nerve conduction testing . The nerve conduction testing doesn't address the small nerves. You need to call Dr. Cozz office and let him examine you

Re: ESWT is Unnecessary and Explorartory

elainek on 2/19/03 at 05:43 (109778)

Hi Scott

I too have Aetna, and have appealed and appealed to no avail. My doctor has gotten me into a research program where I receive the treatment for free. At first you don't know whether you received the placebo or the real thing but after 12 weeks everyone receives the treatment. If you did receive the tretment and need another you will receive it. Maybe you should check around and ask your doctor if he knows of any such program. I live in Massachusetts.

Elaine

Re: ESWT is Unnecessary and Explorartory

Mar on 2/19/03 at 06:50 (109780)

OK - I get it -- thanks Dr Z -- Mar

Re: ESWT is Unnecessary and Explorartory

Bev N on 2/19/03 at 08:09 (109785)

Mar,
Are you considering to have surgery now or more ESWT ? How is the snow there ? Are you able to go to work ? Have a nice day. Bev

Re: ESWT is Unnecessary and Explorartory

Ed Davis, DPM on 2/19/03 at 11:05 (109824)

Bev:

Doctors have an obligation to keep current with current modes of diagnosis and treatment. I was skeptical when I first encountered ESWT but did the research and have become convinced of its effectiveness. I think docs wh do not 'believe' in an accepted and proven mode of treatment may not be doing their homework.
Ed

Re: ESWT is Unnecessary and Explorartory

deb s. on 2/19/03 at 14:13 (109855)

I had ESWT this summer and it did not work. In fact, while I was having the procedure I had a complication and I had to to intibated. I was hoping for a miracle but it didn't come. On Dec.30th I had surgery for TTS and PF. I am recovering, but it is a very slow process. I thought I'd be much better by now. But, when I look from where I came, the future looks bright. Is there anybody out there who has had both problems. Maybe the ESWT didn't work because I had both problems, I just don't know.
I was very positive about the ESWT as was my Doctor. Perhaps it depends on how serious your problem is, I don't know. Any feedback on unsucccessful experiences with the ESWT.

Re: ESWT is Unnecessary and Explorartory

Dr. Z on 2/19/03 at 15:26 (109863)

ESWT isn't indicated for TTS at this time. It won't work on nerve problems. Please tell us more. Were you under a general anesthetic when you had ESWT?

Re: ESWT is Unnecessary and Explorartory

Mar on 2/19/03 at 16:54 (109876)

Bev -

I just started Russian Stim today for 3 weeks. Surgery is not an option for me (even my pod agrees) as my body did not tolerate bunion surgery -- that is what started all my problems. My pod says if the Russian Stim doesn;t help, he will consider a 3rd ESWT. I am also looking into RFL although my pod is not really in favor of it, but I am just gathering info right now for the future. We're finally plowed out here but everything is slow going. No work this week fortunately :-) Mar

Re: ESWT is Unnecessary and Explorartory

deb s. on 2/19/03 at 17:43 (109882)

I was under general anesthetic and had not eaten since midnight the night before. My ESWT was done at 2 PM so I would think my stomach was empty.I guess I starated to vomit when they had to manuever me. Anyway, it was not a great experience. I believe at the time I had this done, my DR. was not aware of the TTS. After I had the ESWT I had an MRI. I almost think I should have had the MRI first. But, I'm not the Dr. I tried everything before having surgery. I would like to know how long it really takes before you feel like your old self. I used like to walk for excercise and that has stopped for almost a year. My problem came on suddenly. I remember exactly when it happened. And, I know this sounds strange, but it happened when I took a walk wearing new Nike gym shoes. I don't know if that had something to do with it, or was it the straw that broke the camels back. Thanks for answering me, any input you have would be greatly appreciated. I work on my feet and have been off since Dec. 30th, but I am hoping to get back soon. I'm not taking any pain meds. I developed an ulcer in October from taking Advil. So, it hasn't been easy. The Dr. put me on pain patches, which were almost useless, because one of the side effects was excessive perspiration and they would just fall off of me, even when we taped them on. Then I was on hydrocodine elixir, but that started making me sick, too. Fortunately, I can endure the pain and I have a tens unit that helps alot. I also have been icing it. I think I am concerned about keeping things under control once I'm back to work on my feet. Right now I am able to rest my foot alot. I have orthotics in my
Birkenstocks and will be getting them for my shoes as well. I've been noticing on this sight that there are some shoes that work better than others with Orthotics. Any recommendations?

Re: ESWT is Unnecessary and Explorartory

Dr. Z on 2/19/03 at 18:01 (109884)

I am not in favor of any type of general anesthesia for foot surgery. I can't think of any reason to use a general anesthesia for ESWT. I use a local anesthetic in hundreds and hundreds of ESWT cases without any type of serious complications.

You have had alot of foot surgery and will need to rest, reduce your time on your feet. Physical therapy may be helpful at some point in time.
Have they talked about a suppository route for taking a pain medication?

I am not sure sure what an MRI would show except maybe some type of lesion in the tarsal tunnel or rule out a stress fracture in the heel pain.

So take it easy and try to REST.

Re: ESWT is Unnecessary and Explorartory

deb s. on 2/19/03 at 18:13 (109885)

The MRI showed the plantar fas. as very thick. Dr. said that I had alot of inflamation when she did the surgery. I also had general ansth. for the foot surgery with no problems. Don't have a clue why they,put me under for the ESWT. I thought that's the way it was done. I probably should have found this web site before the surgery, not after. No, they didn't mention suppositories for pain. I will suggest it because I'm sure when I get back to work I will need something to help with the pain.

Thanks

Re: ESWT is Unnecessary and Explorartory

Dr. Z on 2/19/03 at 18:26 (109887)

There is no reason to have general anesthesia for foot surgery today. MAC is what is used. It is a combination of local anesthesia plus IV sedation. Are you sure this is what you had and not general anesthesia. It doesn't matter it's over and you are on your way to recovery. I would be curious if it was general just not use to any anesthologist in the year 2003 doing this for foot surgery

Re: ESWT is Unnecessary and Explorartory

deb s. on 2/19/03 at 18:41 (109890)

Maybe it wasn't general anesthesia, but I know I was knocked out. I will ask my Dr. what it was for sure.

Re: ESWT is Unnecessary and Explorartory

DrMan on 2/19/03 at 21:03 (109924)

Elaine, I'm in NYC. We are one of three groups in the country conducting an FDA study on a new ESWT device. This is an electrohydrolic, spark-gap, high power ESWT device. This is similar to the OssaTron yet slightly different than the Dornier units. This device has been used in clinical practice for over three years and is now undergoing final FDA clinical trials. This is a double-blinded, placebo study. The patient must have proximal plantar fasciitis for at lease six months and failed conservative care consisting of at least three modalities. The patient must be in good health. Follow-up is for 12 weeks. This is not a crossover study, however. This means you would have a 50% chance of receiving the ESWT and a 50% chance of receiving the placebo. If, after 12 weeks, you find out you received the placebo, the study is finished, you will not automatically receive the actual ESWT. This is different than the study you referenced in your post. If you did receive the actual ESWT there would be no financial obligation to you. If you are interested or have questions E-Mail Dr. John E. Mancuso: (email removed)

Re: ESWT is Unnecessary and Explorartory

elainek on 2/20/03 at 05:14 (109970)

I am in Massachusetts.

The device used for my treatment was Wolf Piezoson 300 ESWT. I believe this is a new machine and it zones in on the affected area. At least I think that is what I was told. I have to clarify this. I have been given a daily activity log to keep,along with a daily medication log. I had exhausted all other means of treatment for the pf. I don't know whether I received the real treatment or the placebo. I will receive the treatment at the end of the twelve weeks, if I was given the placebo.. This is at no costr to me. I have Aetna insurance, and that should tell you something.I am awaiting my post ESWT appointment,as we were also buried in two feet of snow, and my appointment had to be canceled. I thought after all this suffering, I would be able to tell if I got the treatment or not. My foot is to sore to tell. It is hurting all over now.

It is sure funny that the insurance company would rather pay for dozens of appointments and all the other treatments, than just pay for the ESWT. I am sure it is because so many people are suffering from pf, that it would really cost a fortune to pay for ESWT.

Keep you posted. If you have any other questions please feel free to contact me.

Elaine

Re: Dr. Z, general anesthesia

Ed Davis, DPM on 2/21/03 at 14:57 (110193)

Dr. Z:

There are definitely strong regional variations in anesthesia usage. The podiatrists in my area use general anesthesia almost exclusively for foot surgery. Having been trained on the East Coast, I requested MAAC, local with IV sedation and the anesthesiologists initially looked at me as if I was from Mars but slowly came around to my point of view. I assured them that there are significant differences between New Jersey and Mars.

I have found Bier blocks (less filling, tastes better) to be a great option for ESWT. The advantages include rapid onset of anesthesia, no nerve block risk (albeit small), and the patient can ambulate without numbness immediately after the procedure is done. Some antesthesiologists have better technique than others with Bier blocks.
Ed

Re: How is placebo ESWT treatment administered?

Ed Davis, DPM on 2/21/03 at 22:24 (110266)

Dr. Man:

How is the placebo treatment adminstered?
Ed

Re: How is placebo ESWT treatment administered?

elainek on 2/25/03 at 13:49 (110714)

To my understanding, a paddng is placed over the area of treatment. All the same steps are followed as if the real treatment is being given. Whether the soreness as I now have is part of the placebo or the ESWT, I do not know. I went for my post ESWT appointment, filled out the appropiate paper work and I will go back in six weeks. I do have my podiatrist, who is the one that got me involve with this research, because my insurance would not pay for the ESWT.

Elaine

Re: How is placebo ESWT treatment administered?

Dr. Z on 2/25/03 at 16:36 (110734)

I don't remember if I asked you this. Is this an FDA study for the Wolf ESWT machine?

Re: How is placebo ESWT treatment administered?

DrMan on 2/25/03 at 22:01 (110782)

In the Big 'O' study all perameters and set-up is the same in both procedure and placebo except the hydro chamber is not filled with any water. The spark-gap plug is ignited in an air chamber so no shock wave is propagated.