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INSURANCE NIXES ESWT

Posted by Tom C on 4/01/03 at 21:04 (115131)

WELL what do I do now??

Good old ins co denies coverage for ESWT......experimental ya know!

being prown to DVT's and PE's, which I can tell you are no fun, my POD
says that (in my case)invasive surgery is playing Russian Roulet and my Greenfield filter is no garrentee that a clot wouldn't get by.

well as a result i have initiated a disability claim.

as I told human services, Iv'e been with the company for nine years
and I cover many stores when the managers are off etc.
I'M NOT trying to stick it to the company but after a couple of years of these spurs, it's not worth the job to go thru this pain every day.

just sitting here for a half hour makes me dread getting to my feet.

Well it's strange they won't pay for the procedure but will pay for
disability........ priorities are way out of wack somewhere.

Thanks for letting me cry on your shoulder!

Tom

Re: INSURANCE NIXES ESWT

Dr. Z on 4/01/03 at 21:13 (115133)

Hi,

What is the name of your insurance company. ESWT is an FDA approved procedure. IF you tell me the name of your company I may be able to advice and or help you. If you don't wish to discuss this on the web e-mail DR. Z at (email removed)

DR. Z

Re: INSURANCE NIXES ESWT

Tom C on 4/02/03 at 20:53 (115226)

The insurance carrier that I am working with is Cigna, they have been one of the most difficult companies to work with that i have ever experenced.

I did not mention the co name origionaly as i did not know if it was proper on this group.

I have been working on this since the end of January and am now going to take a four mounth temp total disibilty.
Life isn't always fair and at 60 i don't care to fight the system any more.

Tom

Re: INSURANCE NIXES ESWT

Dr. Z on 4/02/03 at 21:45 (115229)

This is a tough one. We just lost a full panel review with one of the posters on this board. I couldn't believe their comments. 'Only the FDA studies show are that the machine can shoot a sound wave. They wouldn't
comprehend that this was a double blind study. You may have to report them to the state health insurance commissioner or take them to small claims court

Re: INSURANCE NIXES ESWT

BrianG on 4/02/03 at 22:44 (115238)

At the very least, you should take advantage of any appeals process due you! Don't give up yet, surgery can be a terrible option.

Regards
BrianG, not a doc

Re: INSURANCE NIXES ESWT

Mar on 4/03/03 at 12:10 (115303)

What a surprise that it was CIGNA!! (said sarcastically!) I got the address of the State Insurance Commission and am going to write a letter as soon as I get time. I was the recent loser! Dr Z - I'm going to email you and ask for key phrases that were said at the hearing, such as the one you wrote here. I should have written down what they said. Brian -- don't give up -- don;t give them the satisfaction! Mar

Re: INSURANCE NIXES ESWT

Ed Davis, DPM on 4/03/03 at 17:35 (115342)

Tom:
Health insurance companies only look at a 'slice' of the picture -- direct medical costs. The HR department should look at the 'big picture,' that is, direct medical costs + time loss/disability payments + lost productivity costs to the company. ESWT may be a little bit cheaper to the health insurance company BUT is MUCH cheaper to the HR department. The HR department can place pressure on the health insurer to provide such treatment -- copnsider approaching them.
Ed

Re: INSURANCE NIXES ESWT

Mar on 4/03/03 at 18:22 (115349)

oops - i meant Tom not Brian -- sorry -- Mar

Re: INSURANCE NIXES ESWT

Mar on 4/03/03 at 18:40 (115352)

HR - what is that? It isn;t clicking -- Mar

Re: INSURANCE NIXES ESWT

Dr. Z on 4/03/03 at 19:40 (115359)

Human Resources.

Re: INSURANCE NIXES ESWT

Tom C on 4/03/03 at 22:02 (115368)

Well i thought you might like Cigna Health Care's reasoning,

'Information does not establish the medical necessity of OssaTron therapy
for treatment of plantar faciitis. The evidence does not show that this therapy provides improve health outcomes. it is unproven.'

Then they suggest i seek alternate treatment.

Appeals are allowed, at 61 this summer and the lenght of time that appears take, I feel that i will take the dissability nhow because normal early retirement is only a year away. Now if i can only get these darn things to lower to a decent level. Thank you everyone for your thoughts.

Tom

Re: INSURANCE NIXES ESWT

Mar on 4/04/03 at 05:18 (115372)

That CIGNA statement sounds exactly like what they wrote in my letter. Guess it's their standard reply no matter what your situation. Creeps!! Yeah, seek alternate treatment, which would be???? Insurance is getting way out of control - I had another treatment program stopped this week because of my new insurance company - so much frustration and annoyance. Good luck, Tom -- Mar

Re: INSURANCE NIXES ESWT

Ed Davis, DPM on 4/04/03 at 10:12 (115382)

Tom:

I would file a complaint with your state's insurance commissioner. Include all the abstracts on this site (I have used them the same way) in your letter of complaint. Cigna does not have a leg to stand on. Their statement is blatantly incorrect.
Ed