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Over Before It got Started

Posted by Peter R on 5/31/03 at 08:37 (120492)

I was exploring the possibility of getting ESWT. From the information that I have obtained it looks like as of July 1 the insurance greedies are going to stop coverage for ESWT. Anyone out there have any more info on this?

Re: Over Before It got Started

Dr. Z on 5/31/03 at 08:52 (120493)

What insurance companies are we talking about.? Are you talking are about Mass Blue Shield.??

Re: Over Before It got Started

Peter R on 5/31/03 at 09:15 (120497)

Yes, when Mass BS(isn't that an appropriate set of initials for them) stops coverage all the others will soon follow suit.

Re: Over Before It got Started

Dr. Z on 5/31/03 at 09:19 (120499)

I heard this also. There are going to be a few that follow. I have been told North Carolina Blue Shield. California Blue Shield. Some local Medicare carriers already are talking about exclusing ALL ESWT coverage.

Re: Over Before It got Started

Peter R on 5/31/03 at 09:45 (120507)

'EXCLUSING' is that another new word in the new Dr. Z english dictionary

Re: Over Before It got Started

Ed Davis, DPM on 5/31/03 at 09:53 (120508)

Pater:

Regence, the Blue Shield of WA, will remove coverage for ESWT as of Oct. 1, 2003 although their current coverage is virtually non-existent. They have a criteria for approval but reject most claims, refusing to follow their own criteria. The WA worker's compensation system (Labor and Industries) removed ESWT coverage as of Feb. 2003.

Other carriers have added coverage. I will not be surprised if the issue winds up in the court system, eventually.

I would rather deal with an insurance company that has a definitive policy as that allows us to move forward with financial arrangements for the patient.

Ed

Ed

Re: Over Before It got Started

Dr. Z on 5/31/03 at 10:04 (120511)

It means no way are we going to pay so get your feet treated now

Re: Over Before It got Started

Peter R on 5/31/03 at 10:09 (120512)

Since when does any ins co. have a definitive policy? Whatever they say always
come with a caveat that states that 'what you have just been told does not constitute a guarantee of coverage'. One possible method of attacking them is too bombard them with such a volume of phone calls, letters of appeals and law suits that it becomes more economically feasable to pay rather than fight. Go to their stockholders meeting and ask ?'s. I have bought a single share of a company's stock so that I could ask embarrassing ?'s at a stockholders meeting.

Re: Over Before It got Started

Dr. Z on 5/31/03 at 12:20 (120516)

I have always though that the statement no guarantee meant that they wouldn't pay for the service if the patients contract was invalid at the time of service . IF you get a pre-certification that does lock the insurance company into payment unless the contract is not effective at the time of service. ie you cancel the contract or the premiums haven't been paid. Make sense,spelling ok, no new Dr. Z words.

Re: Over Before It got Started

Elizabeth C. on 6/01/03 at 08:06 (120590)

This is bad news...I wonder why they are discontinuing coverage. I was told my insurance(Aetna PPO)will cover it. They may deny coverage initially, but the ortho practice I am receiving treatment at is prepared for this. The tech who was administering the treatment said they have a packet of info they have prepared when an insurance company regects coverage. She told me after the insurance company receives this info, they usually cover it. She told me the more info they have, the more likely they will cover it. It is a crime if they don't start recognizing the incredible benefits of ESWT for PF. The tech also told me that the 9/11 tragedy has delayed approval of ESWT with American Medical Association, which in turn is why insurance companies don't want to cover it. She said the (AMA) is a year behind, but assured me that it won't be long before all insurance companies should cover it. I may not know much, but this is what I have been told.

Elizabeth

Re: Over Before It got Started

Ed Davis, DPM on 6/02/03 at 13:53 (120728)

Peter:

They usually have no definitive 'yes' to coverage but I would consider their 'no' to be definitive.

Peter -- I am all for the fight. I see insurance companies make outrageous decisions on a number of issues on a daily basis. They have far too much power. They are placed in a tax advantaged position by government and provide the expectation of comprehensive coverage to their insured.

Ed