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ESWT cost and insurance coverage

Posted by Sue C. on 5/30/03 at 10:11 (120367)

Has anyone had success in getting their insurance to pay for this procedure? Also, can any of the doctors tell me why this procedure is so costly? I'm assuming that it is mostly equipment costs, however, if the procedure was more easily affordable, wouldn't more people have it done which would in turn increase revenue for the doctors?

I have suffered over 10 years with heel spurs and can barely walk when I get out of bed in the morning. I have huge spurs on both heels and am only 39 years old. Favoring my feet in certain ways is also causing a ripple effect of different pains up the front of my legs and knees. I feel like a prisoner to this pain which keeps me almost completely inactive and over the years has caused a substancial weight problem that only makes things worse.

I have 2 small children and cannot afford to pay anything near $5,000. Does anyone have any suggestions??

Re: ESWT cost and insurance coverage

SteveG on 5/30/03 at 10:23 (120369)

Sue - 10 years is a long time. where do you live? You can get it done in Canada for a fraction of the price - this is especially true given the current exchange rate.

Re: ESWT cost and insurance coverage

Sue C. on 5/30/03 at 10:56 (120372)

Thanks Steve... I may just have to go that route. The reason this has gone on so long is that both doctors I have seen have helped me with the cortisone shots but after a period of time, they always push for the custom orthotics. Being that my feet are flat making them a medium to wide width, I find that I can't get my feet into decent shoes using the inserts. So the cycle goes on until I find another doctor who does the same thing. I've only gotten by by wearing Birkenstocks, however, they don't seem to be helping much anymore. I live in Connecticut and haven't found anyone who does ESWT here. When I asked my doc's about it I pretty much got the it's experimental and I don't really see how it would work speach...

Re: ESWT cost and insurance coverage

SteveG on 5/30/03 at 11:28 (120375)

Sue - it sounds like you are a good candidate for the treatment - helped by shots, first step pain in the morning. The claim that it is experimental is hogwash. They have been using this treatment successfully in Europe and Canada for years, and it's FDA approved in the United States. You don't live too far from Canada. I would contact Bayshore and see if there is a location in Eastern Canada that would work well for you. You could also inquire about the cost. Their e-mail address and phone number are listed at the bottom -

http://www.eswt.bayshore.ca/

Re: ESWT cost and insurance coverage

john h on 5/30/03 at 12:00 (120380)

Sue as Steve notes there is nothing experimental about ESWT. It has been around for many years and FDA approved. If you have flat feet I suspect your Doctors are correct in trying to get you into orthotics. Some people do fine with off the shelf type that cost $50 or less. Others like me shelled out the big bucks for the ones your Doctors are offering you

For the Doctors this brings up a question? If you have flat feet what good is a foot cast? I assume there must be some reason or are you just guessing and then adjusting from there?

You will have a number of ESWT options as to type of machine (high energy,low energy). Your insurance may pay and may not. There are a number of ESWT providers not to far from you. It is less expensive in Canada but when you add in air and perhaps a 4 day stay it may not be that much less expensive. Dr. Zuckerman is in Northern N.J. and there are some providers in NYC. Checkout the http://www.bayshore.com or http://www.healthtronics.com or Dr. Z at http://www.thefootspecialist.com to learn more about ESWT and read about it on this board. It is basically painless from my point of view. Some people find great success and some not. Beats surgery every time. Do look into orthotics if you have flat feet. The reason the Birk probably helps you is that it is somewhat of an orthotic footbed in itself.

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 13:04 (120392)

Sue,
By the amount you are quoting I'm going to assume you are talking about having treatment with the Ossatron machine.

I've heard through sources that Healthronics is discounting in some states (wholesaling). This means they are lowering the cost of their fee and working with the surgical centers to lower theirs. The doctors performing the treatment under this agreement have also lowered their fee. I would contact healthronics if that is the machine you were talking about.

Re: ESWT cost and insurance coverage

Scott D. on 5/30/03 at 13:07 (120393)

Sue,

Our Center is in Westchester County near Fairfield County, CT. If I can help you to get treatment here, and it's not too far for you to travel, I'll be happy to do that.

Re: ESWT cost and insurance coverage

BrianG on 5/30/03 at 13:47 (120400)

Hi Sue,

There is an ESWT machine (Dornier) at MGH in Boston. From what I understand, it is moveable, and can be brought to different cities. If you want more information, call Dr. George Theodore, at MGH.

Also, you may have to drive a little further, but you should also get in touch with Scott D, who has also answered you. He may have a better price. I know that MGH was very high priced when the Dornier was first approved.

Have you thought about a pain management center, or doctor?

Regards
BrianG

Re: ESWT cost and insurance coverage

Peter R on 5/30/03 at 14:25 (120403)

Sue, If you post your e-mail address here I'll contact you and give you many site in Conn, where you can be treated. I perfer to do this directly to you and not in public.

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 14:28 (120404)

Scott,
What is the name of your center? Are you on Scott's list of ESWT sites?

Re: ESWT cost and insurance coverage

Scott D. on 5/30/03 at 14:35 (120407)

Yes Pauline, it's Hudson Valley Lithotripsy.

Re: ESWT cost and insurance coverage

Scott D. on 5/30/03 at 14:40 (120409)

Had to go and look, #135 on the list.

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 14:53 (120413)

All this time I thought there was only one center in town:* Glad you told us or we never would have known.

Re: ESWT cost and insurance coverage

Scott D. on 5/30/03 at 15:00 (120415)

That's because I don't come here to advertise..

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 15:04 (120418)

You can say that again and again and again. Your medical advice is still appreciated, maybe more so, by posters because of this.

Re: ESWT cost and insurance coverage

Scott D. on 5/30/03 at 15:10 (120419)

Thanks Pauline, but I don't give medical advice! I'm not a doctor. That is something to be cleared up immediately!

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 15:12 (120421)

I won't hold that against you:*

Re: ESWT cost and insurance coverage

Sue C. on 5/30/03 at 15:27 (120423)

email is (email removed)

Re: ESWT cost and insurance coverage

Sue C. on 5/30/03 at 15:29 (120424)

Please tell me more about your center, prices, etc. if you can. If you prefer, you can email me at (email removed). I do have health insurance and am trying to find out if they cover or not.

Re: ESWT cost and insurance coverage

Dr. Z on 5/30/03 at 15:37 (120428)

The real question is which center is the experienced and which center charges a fair price. Don't you want this information to be known. An educated consumer is an informed consumer.

Re: ESWT cost and insurance coverage

Scott D. on 5/30/03 at 15:45 (120430)

Experience? Well we've done about 10,000 shockwave procedures (yes, most are on kidney stones but it's the same stuff if you are talking about experience), how many have you done?

As for posting or comparing prices here, did you know that the Federal Trade Commission considers that a violation of anti-trust law? Sorry, but I'm not going there Dr Z., you go on without me though by all means..

Re: ESWT cost and insurance coverage

Dr. Z on 5/30/03 at 15:52 (120431)

Ok

Since when is ESWL ( kidney) the same as ESWT experience. Since you asked I have done over 1000 ESWT treatment since 1999. Didn't know that you couldn't compare pricing on the internet. Scott Roberts sure do made aware of this . Take a look at the introduction to the ESWT page.

Re: ESWT cost and insurance coverage

Scott D. on 5/30/03 at 15:59 (120432)

It's not a violation for someone to compare prices on the internet, nor is that what I said. If you are not aware that it is a violation for practitioners to discuss and compare prices then you are taking an enormous risk. As I said, it's one I am not going to take along with you!

If you don't think that ESWL and ESWT are incredibly similar procedures then you must have your head in the sand. Is it a coincidence that the machines used for both are made by the same companies? Or that they work the same way? Or that the same people fix them when they break down?

Re: ESWT cost and insurance coverage

BGCPed on 5/30/03 at 16:02 (120433)

Just a thought, How do the lasik eye people get around posting the price in all of their ads? They used to charge about $5,000 for both eyes now they are down to about $1,200 for both.

Just my .02 but I think while it is same machine Kidneys and feet are a bit different. I would want the person that has done feet over kidneys. What if they changed the rules and a foot dr said ,hey im open to doing kidney stones now, I have been doing feet for a coons age. Its the same machine so dont worry.....?

Re: ESWT cost and insurance coverage

Scott D. on 5/30/03 at 16:14 (120434)

You are right, doing kidneys is much more involved! If you somehow manage to miss your target on the foot (which would be very difficult to do with ultrasound guidance) the end result would be quite a bit different than missing your target in the kidney.

You can post your price anywhere you want to! The violation is in, once again, practitioners comparing prices among themselves. This has been successfully challenged in court and found to be a form of price-fixing. Clearly Dr Z is trying to get me to post our price here in response to his inquiry. To answer would be a violation of FTC law, and thus will not get a response. If you doubt this Dr. Z, ask your Dornier rep about similar issues in the lithotripsy community.

Re: ESWT cost and insurance coverage

Alex on 5/30/03 at 16:35 (120435)

Scott, are you a lawyer?

>To answer would be a violation of FTC law

Perhaps you don't want to risk the appearance of collusion, but don't act like you understand antitrust law when you are clearly winging it.

Re: ESWT cost and insurance coverage

Dr. Z on 5/30/03 at 16:39 (120436)

So if a patient asks me what Excellence Shockwave Therapy Charges and I tell them then this is a FTC violation?. I am not doubting what you say. Why haven't you pointed this out to Scott Roberts, the owner of this site.
The FDA position is that ESWT is more dangerous then ESWT by way of the FDA clasification. I sure wish they would take your position.

Why would I want you to violate FDA regulations if this is what you are concerned about. All I want is for patients to know prices. That is part of what Scott Roberts ESWT site is all about. Just ask Scott he will tell you. So if this is a problem lets talk about it so that this site is in compliance with the FTC. I for one am not trying to break any laws or regulations.

Re: ESWT cost and insurance coverage

Dr. Z on 5/30/03 at 16:41 (120437)

That reminds of the lawyer from Philadelphia who I cured with ESWT. Mr.Siegel. Does anyone remember him.? What we need is for some one like him to help us out with getting insurance companies to pay. I still remember him going after Pa. Blue Shield. He got ALL of his money back.

Re: ESWT cost and insurance coverage

Dr. Z on 5/30/03 at 16:42 (120438)

Pauline,

There a few Dornier Machines out there up in the 7,000 plus range just so you know.

Re: ESWT cost and insurance coverage

john h on 5/30/03 at 17:03 (120441)

I can tell you prices for ESWT in real world experience is all over the board starting with free. If someone is looking for collusion here they are wasting their time. You can get ESWT in Australia for $50 a treatment. You can get an Ossatton treatment from $3000 to $10000. I have seen the Epos for $1600 to $3000. The old Orby ranged from free to $1000 to $2000. ESWT is surely a free market product. The high prices we see are largely a result of the FDA, equipment cost and of course insurance to protect the Doctors against the ever present law suits.

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 17:11 (120444)

Scott,
In a former post, I've asked Dr. Z. what his price was for ESWT treatment and he never responded to that post.

He used to post his price when he was advertising his Orbie, and before he formed his large group, but since then he has not posted it although he asks others like Dr. A and Sunny and now you to post treatment costs.

Although not an attorney, I have to agree with you about doctors who price compare could be breaking FTC law.

A lot of people don't know about this law.

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 17:19 (120445)

Dr. Z,
The law I believe only pertains to doctors comparing prices among themselves (price setting) , not Scott posting prices on his web site. He's not setting prices for treatment. It's easy enough for anyone to check just look up the regulations on the internet. They are in black and white and it can be done without Scott bashing.

I'm sure we have an attorney in the crowd that's willing to explain it to everyone.

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 17:21 (120446)

John,
I don't want to burst your bubble, but I was quoted $1800 for both feet for Ossatron treatment. One or two feet didn't matter. Healthronic fee, surgical centers fee including anesthesia and doctors fees all included.

Re: ESWT cost and insurance coverage

john h on 5/30/03 at 18:49 (120453)

I can tell you prices for ESWT in real world experience is all over the board starting with free. If someone is looking for collusion here they are wasting their time. You can get ESWT in Australia for $50 a treatment. You can get an Ossatton treatment from $3000 to $10000. I have seen the Epos for $1600 to $3000. The old Orby ranged from free to $1000 to $2000. ESWT is surely a free market product. The high prices we see are largely a result of the FDA, equipment cost and of course insurance to protect the Doctors against the ever present law suits.

Re: ESWT cost and insurance coverage

john h on 5/30/03 at 18:58 (120456)

I would like for the Docs to do like the Lawyers in their adds 'If we do not win you do not owe us a thing'. Just change that win to cure.

Re: ESWT cost and insurance coverage

Elizabeth C. on 5/30/03 at 19:13 (120457)

Wow, I sense some hostility in some of these messages. Aren't we trying to help each other out here? I have received two treaments(SONOCUR)at $700.00 a treatment. The tech said my insurance should cover it, if not they will waive the third treatment fee. I feel great after two treatments! I would give up a kidney for this treatment! Just kidding, they'll let me go on a payment plan too (without interest). I am not a doctor, so hopefully what I am saying is legal...

Elizabeth

Re: ESWT cost and insurance coverage

Dr. A on 5/30/03 at 19:55 (120459)

Hey John, with your theory, oncologists would really be in trouble.
I charge $600 for repeat treatments which just covers my overhead, so it is esentially free. Also, I charge $1800 for eswt and I will keep on telling people untill I don't think it is in their best interest.

Dan Adamovsky, St. Louis

Re: ESWT cost and insurance coverage

Scott D on 5/30/03 at 20:38 (120462)

Dr. Z, I wonder if you even bother to fully read and understand a post before responding to it.. Where in anything I have said do I state that you can't tell a patient the price? PRACTITIONERS cannot compare prices, this has nothing to do with telling the consumer the price. If YOU ask ME the price I charge I am not supposed to tell you! Which part of that is confusing? By the way, YOU are not even supposed to ask..

You say 'The FDA position is that ESWT is more dangerous then ESWT by way of the FDA clasification.' After reading that I feel like the duck in the AFLAC commercial when Yogi Berra is talking!! Please at least make some sense?? By the way, the letters FDA and FTC are not interchangable..

Alex, if you have read my posts you know I am not an attorney nor do I profess to knowing all the intricacies of antitrust law. I do however know the law as it pertains to collusion and price-fixing in the medical community. Sit through as many meetings as I have on the topic and then tell me I am winging it. I apologize for the mistype in saying FTD'law' instead of FTC 'policy'. If you ARE an attorney Alex please clear this up for us all.

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 21:55 (120470)

Did you have your treatment in the States or Canada?

Re: ESWT cost and insurance coverage

Pauline on 5/30/03 at 22:30 (120473)

Dr. Z,
You wouldn't be breaking the law by telling a patient how much you charge for ESWT, however, I would be more careful about directing Medicare patients from this board to a group where you have a financial interest especially if you ever plan on billing Medicare for services rendered.

Re: ESWT cost and insurance coverage

Dr. Z on 5/30/03 at 22:52 (120476)

You can post your price anywhere you want to! The violation is in, once again, practitioners comparing prices among themselves. This has been successfully challenged in court and found to be a form of price-fixing. Clearly Dr Z is trying to get me to post our price here in response to his inquiry. To answer would be a violation of FTC law, and thus will not get

Read the above statement by you. To answer ( which is YOU) is a violation . You are trying to say that YOU telling your prices is a violation

Re: ESWT cost and insurance coverage

Dr. Z on 5/30/03 at 23:02 (120479)

I meant ESWL and ESWT. You know exactly the difference or should, when we are talking about FDA classifications. This point is important . YOu point out that ESWL ( kidney) is more dangerous then ESWT. I agree with that statment. The point is that the FDA doesn't at the presence time. Now whether ESWL is more difficult to perform then ESWT is something I have no idea .

Re: ESWT cost and insurance coverage

Dr. Z on 5/30/03 at 23:06 (120481)

Pauline,

Medicare doesn't cover ESWT. Do we know all of the groups on this board that have a finanical interest in ESWT treatments and or own part of an ESWT group. Don't you want to know.? I am the only one that has from the very beginning told this board.

Re: ESWT cost and insurance coverage

john h on 5/31/03 at 13:33 (120526)

As consumers we all need to know the price of a treatment or product. I wonder if it is price fixing when many lawyers advertise they will charge you nothing if they do not win your case. The fact that they all charge nothing seems sort of like collusion.

Re: ESWT cost and insurance coverage

Elizabeth C. on 5/31/03 at 14:37 (120533)

Pauline,
I had my treatment in Oak Brook Terrace, Illinois. My Podiatrist (Dr. Vinci) told me it's the only one of two sonocur machines in the midwest. The practice is M&M Orthopedics, Ltd. If you want the address or phone number, let me know.

Elizabeth

Re: ESWT cost and insurance coverage

Pauline on 5/31/03 at 15:07 (120537)

I think Dr. Ed. is using one so maybe he is the other doctor. I don't need treatment just wondering where you had it. Glad it's helped.

Re: ESWT cost and insurance coverage

Ed Davis, DPM on 6/02/03 at 14:14 (120731)

John:

Well stated. The public needs to understand that some of the 'mechanisms' that have been relied on for protection are ca 'double edged sword.' Look at the free market price for ESWT and then look at the US 'regulated' price. Is the difference really worth the 'protection' that many perceive exists? Are those protection mechanisms actually causing more harm by pricing treatments (devices and drugs) outside the reach of too many people?

Ed

Re: ESWT cost and insurance coverage

Ed Davis, DPM on 6/02/03 at 23:48 (120776)

John:

It is my understanding that docs are not supposed to get together among themselves to set prices as that would be interprested as a form of price fixing. That does not prohibit individual docs from posting prices or fees for specific services.

Ed