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ESWT and California Blue Shield

Posted by Dr. Z on 5/03/03 at 10:59 (117740)

I had a doctor e-mail Dr. Z and ask if I had any information that California Blue, which has a contract with Healthronics,isn't going to continue ESWT coverage starting end of June. Anyone know any information about this.

Re: ESWT and California Blue Shield

Dr. A on 5/04/03 at 13:37 (117789)

Blues are not covering eswt in my area.

GHP backed out of covering ESWT citing the Buchbinder study after reimbursing in St. Louis for 6 months. Guess it was too good to last.

Re: ESWT and California Blue Shield

Dr. Z on 5/04/03 at 13:48 (117792)

Thanks. Sure wish I knew what the story was with California. This was the big Healthronics Contract

Re: ESWT and California Blue Shield

Ed Davis, DPM on 5/05/03 at 20:07 (117856)

Dr. A:

No reasonable person pays much attention to that study. One insurance company in my area stopped paying for ESWT unless done by a particular machine based on that study. A competing company used that study to criticize the machine used in the study in a presentation to that insurer.
I have found that some providers of ESWT in their zeal to compete have done little more than to give the insurance companies ammunition to bash the modality as a whole. I have pleaded with the competing companies to change their tactics.
Ed

Re: ESWT and California Blue Shield

Dr. A on 5/06/03 at 21:22 (117973)

Have you had any success in changing insurance policies in your area?
As stated previously, one of the major insurance carriers in my area stopped covering eswt. I was hoping eswt coverage would increase over time not decrease.

Re: ESWT and California Blue Shield

Ed Davis, DPM on 5/08/03 at 21:22 (118138)

Dr. A:

Our state worker's comp carrier stopped covering ESWT recently. I am not sure that I can take any credit for changing insurance policies in my area as that has been a cooperative effort with multiple providers 'chipping away' at the system.

It is my intention to use the legal appeal process with an injured worker and the help of that worker's attorney to obtain approval from the worker's comp. system. I would like that to be a 'test case' that will facilitate treatment for others in need.
Ed

Re: ESWT and California Blue Shield

Dr. Z on 5/09/03 at 00:23 (118150)

Why do you think that the work compensation system stopped paying for ESWT?