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Insurance coverage

Posted by ToFare on 6/24/03 at 08:11 (122792)

I have Aetna , Is this treatment covered. Has anyone been covered by their plan?

Re: Insurance coverage

Scott D. on 6/24/03 at 08:30 (122793)


Aetna has a blanket policy NOT to cover ESWT.


Re: Insurance coverage

elliott on 6/24/03 at 09:00 (122797)

Interesting link. Thanks. I'm curious as to whether the docs here accept Aetna's summary of the 3-month results of the Dornier Epos Ultra study as provided in the link. (At least some of their references are beyond reproach--two are I believe from our very own Dr. Wander!!). Aetna claims that while there was a statistically significant difference in pain improvement, there wasn't in function. Suggest everyone read the whole passage in the link, but here are the relevant paragraphs:


Although there was a modest, statistically significant difference in improvement in VAS pain scores from baseline (the primary study endpoint) between active and sham treatment groups at three months, this was not accompanied by a significant improvement of function. In the active group, the pain score decreased by an average of 56.5% by the end of three months; in the sham roup, the average pain score decreased by 46.6%. Patients in the active group were more likely (56%) than patients in the sham group (45%) to report an improvement in VAS pain scores of 60% or more from baseline; however, this difference was not statistically significant.

There was a statistically significant difference in patient satisfaction (Roles and Maudsley pain scores) between treatment groups, with 62% of active patients with good to excellent results, compared to 40% of sham patients. However, there was no statistically significant difference between active and placebo groups with respect to function (AOFAS Ankle-Hindfoot Scale (a validated rating scale which incorporates assessment of function (50%), pain (40%), and alignment (10%))). There was also no statistically significant difference between active and placebo treated groups with respect to a measure of general health status (SF12 Health Status Questionnaire (patient's self-assessment of general health status and mental condition)).


Re: Insurance coverage

Dr. Z on 6/24/03 at 20:12 (122852)

Here is what is confusing to Dr. Z . If 62% of the active patients had excellent and good results how can there not be significant difference with respect to function. How could someone not have improved function and still rate their treatment results as excellent or good result. I believe that the Roles Maudsley scoring does take into account the ability to function without pain. I have the definition of Excellent and Good according to the R/M in my office and would be very happy to post it.
Aetna has every right to not pay for any elective treatment that they don't want too. The Weil article which concludes that ESWT is as effective as plantar fascia releases without the complications. Why is this listed as a reference if its not used in their decision making process
Why can't they just tell it like it is. We don't want to cover this ESWT procedure it is too expensive and we can pay less for foot surgery.

Re: Insurance coverage

Ed Davis, DPM on 6/25/03 at 15:02 (122920)

Dr. Z:

Isn't it amazing how insurers that don't want to pay will ignore all of the studies that favor ESWT.

I had the opportunity to meet with United Shockwave yesterday. They are involved in a study that was just submitted last week for potential publication. I got a sneak peak at a draft --- an excellent study with impressive numbers and impressive results supporting ESWT for PF. None of the data or the paper can be discussed until there has been formal acceptance by the journal but I have a feeling that will not take very long considering the quality of the paper.


Re: Insurance coverage

Caarolyn L. on 6/28/03 at 13:32 (123121)

Has anything been heard from Medicare in regard to their covering this treatment (ESWT)?