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Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Posted by Lauren M on 7/31/03 at 12:22 (125790)

Does anyone know the difference between the Ossatron and the Dornier Epos Ultra shock wave therapy? Is one more effective than the other? I got info. from my doctor that the company Ortho Shock Wave Consultants who use the Ossatron are covered by my insurance which is Cigna. Cigna confirmed this as well. The ESWT Shock wave therapy group which uses the Dornier Epos Ultra is not covered. They also get the job done in one treatment, while the Ortho Shock Wave Consultants take three treatments. Which is more effective? Are these two companies just competitors that do the treatment differently?

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Peter R on 7/31/03 at 13:20 (125794)

If you wish me to give you enough information so you can make the proper choice please post your e-mail. I prefer to do this outside of this board. Basicaly you should choose the Dornier.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. Z on 7/31/03 at 17:38 (125817)

Hi

Orthoshockwave consultants uses the Soncur which is a low energy three treatment program. I think you are confused about the use of the ossatron
The ossatron is a high energy single treatment as is the dornier epos.
I have found that the insurance company covers the procedure or they don't . ESWT coding is the same whether we are talking about three treatment sessions with the orthoshockwave Consultants or one ESWT with the dornier epos. I don't understand why Cigna is telling you that the orthoshockwave consultants is covered with the Sonocur. Here is also what I know. I have been involved in a few peer review sessions with Cigna and their policy is they don't cover ESWT no matter what machine is used. Do you have in writing that they cover ESWT. I would get a pre-determination from Cigna stating that your chronic plantar fasciitis is covered with ESWT treatment in writing. The key word is in writing

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Peter R on 8/01/03 at 06:03 (125846)

CIGNA PPO does cover ESWT. I have intimate knowledge of a podiatrist getting paid for a Dornier ESWT treatment by CIGNA.(I saw the check at the doc's office) In some cases there is coverage and non-coverage within the same ins. co. depending on the policy. Again, I'll reccomend that you chose the Dornier Epos Ultra because you will not need IV sedation. Studies indicate that the Dornier is more effective.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Lauren M on 8/01/03 at 08:14 (125852)

Peter-

Thank you for your info. With the Ortho Shock Wave COnsultants which use the sonocur, there is no IV sedation either. My cigna plan said they'd cover the Sonocur three treatment procedure out of network, but not the DOrnier Epos Ultra treatment. I have full coverage out of network, because I filled my deductible over and above the required amount. My email address is (email removed). If you can further educate me, I would appreciate it.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. Z on 8/01/03 at 09:37 (125867)

What part of the country are we talking about. I can't believe an insurance company would pay for one machine and not the other machine. As you know one is FDA approved and the other isn't for pf. I did go back to my file. There is one patient ( had some inside pull) that has been paid for ESWT. I am not sure if it is a PPO I do know that this was the only one and that the rest are all in litigation due to stating that there was lack of medical necessity
There is no mention of any non-plan coverage in the rejection letters. It is all about experimental and investigational and all the rest of the jargon

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

David on 8/01/03 at 10:46 (125881)

Dr. Z. ....I am familiar with a couple of insurance companies that have specified payment down to the type of machine used. This is changing as the insurance companies are becoming more familiar with ESWT. Also...a number of them are moving away from being very rigid and not paying for off-label uses. In a number of states where medicare covers ESWT for both tennis elbow and plantar fasciitis, they don't specify it down to the type of machine. If anesthesia is required, that is a separate charge. The question will be whether providers can deliver the service on the type of machine they have for the amount that the payors are willing to reimburse. Workers' compensation has been very proactive in covering this treatment for a number of different indications so that the patients don't have to undergo surgery. I think you'll see the insurance companies follow this as it is a far cheaper and safer alternative to many other treatments.

I do have a question for Peter R as to the studies where he states the Dornier is more effective than the other ESWT devices that are approved. My opinion is that all the devices work very well as long as the correct protocols are followed for the particular device being used.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. Z on 8/01/03 at 13:11 (125901)

David
I am just received a form from Horizon Blue Shield where they asked which machine was used. This was the first time that was asked. They also asked if the machines was FDA approved for Plantar fasciitis.
Work Compensation has been in most cases very easy to work work. We do alot of chronic insertinal achilles tendonitis . Most insurance companies won't pay for this procedure due to no FDA approval.

I know that this is for Peter R but I do know of the one year FDA study for Dornier and the Ossatron. The dornier was 94% effective compared to the Ossatron. That is the only study that I am aware of comparing these two machines. Maybe Peter R has more information

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. Ben Pearl on 8/01/03 at 20:18 (125947)

The Dornier device is ultrasound guided to visualize the anatomy.
The focus point of the energy is more narrow like a pencil.
The Ossatron focus is more like a sphere.
The energy souurces that produce the shocks are different but both are deemed high energy devices designed for one application although second treatments may be administered after several months if results are less than adequate.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Peter R on 8/02/03 at 09:04 (125970)

Dornier Epos Ultra is the best choice. No IV sedation, only a local block, real time ultrasound imaging, highest range of energy levels, precise tageting of ROI. Doctors, patient and techs do not need hearing protection as with the Ossatron. As far as I'm concerned the choice is clear.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

JudyS on 8/02/03 at 21:04 (126051)

Peter, I'm curious - what are your medical qualifications that make you an expert advisor on the various ESW treatments? Or is your advice based on personal research/experience?

Re: To Judy: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Peter R on 8/03/03 at 08:35 (126076)

Please go to the social board for a statement on this thread.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Lauren M on 8/04/03 at 18:34 (126233)

What is the difference in effectiveness between the usage of the sonocur as compared to the Ossitron and Dornier Epos? I know the Dornier Epos has a 92% success rate, but what about the Ossitron and Sonocur machines? Is the Sonnocur what is being used in Canada? I'm going to go with the Sonnocur treatment, but if it doesn't work, how long after do I have to wait until I can do it again?

I spoke with the ESWT Shock Wave consultants again today. They are based in Westbury,NY and they say that Cigna PPO does cover the Sonocur treatment and that they have had many patients covered under Cigna who've had no problems. My doctor provides them with my history and a letter of medical necessity, Cigna said it takes a month to review my files and then they will decide whether they approve it or not. The Shock Wave Consultants said they wouldn't have even treated me if my insurance didn't cover it, because they would lose money. They said I was in no way responsible for the bill, if my insurance bounces it back. I am going to get this in writng before I have the procedure done of course, but my doctor assures me he hasn't had any complaints from any patients who have Cigna and have had this procedure.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. Z on 8/04/03 at 19:42 (126237)

There is an old saying if it is too good too be true then it isn't true. Don't worry about the insurance bill if it bounces back. On this board it has been pointed out that Cigna PPO is the only type of Cigna that is paid. Get it in writing first. The only ESWT machines in the USA that are FDA approved are the Dornier and the ossatron. The sonocur has no FDA approval for Plantar Fasciitis in the USA. Feel free to ask any questions there are many people on this board with good information. Many times the insurance companies are given a code 0020T and have no idea that the machine that is going to be used isn't approved by the FDA. This is happening more and more. So make sure you ask you insurance company if the Soncur low energy machine can be used. Why do I say this, because if you do have coverage and you use the Soncur and there was never any low energy coverage and you need a 2nd tx then you just lost one of your paid insurance covered ESWT treatments

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Jon R. on 8/05/03 at 16:58 (126299)

Sonocur/Sonorex is the low freqency treatment and the one Canada is using. I had it done on my chronic elbow, and after 3 treatments I am 70% improved. Anthem is not paying, so I am appealing to them now. I need evidence. I have found 2 pro researches and one against, which of course is the one Anthem is using. I need one more treatment, but can't afford the down payment now, of $300. per session. I'm a grand in the hole now, but my elbow is funtional again. I can comb my hair with no pain, I can hold a cup of coffee with no pain, and I can even turn a door knob now with only the slightest pain. This is a GREAT treatment.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

David on 8/05/03 at 23:41 (126356)

Dr. Z....you bring up a very good point in that patients obviously need to make sure that they are going to be covered for the condition that they are going to be treated for. As proponents of ESWT in general, as most of us are on this board, I think it is very important that we begin to look at ESWT in general as a treatment for various tendinopathies and not 'pigeon-hole' patients into different devices for different indications. Certainly many private insurance companies, and medicare, and work comp. are starting to get away from that. For example, even though the Dornier is approved for plantar fasciitis, many insurance companies will cover it for patients being treated for lateral epicondylitis. Ultimately, I think that the insurance companies won't be so restrictive on different anatomical sites because they will see how much less expensive an alternative ESWT is to other forms of treatment for these debilitating problems. Already we have seen prices come down from the thousands per ESWT treatments to the hundreds.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Sunny Jacob on 8/06/03 at 17:02 (126421)

I absolutely agree with David's comment. 'Pigeon holing' with specific manufacturers and approval process based on anatomical sites may have proponents with their own personal agenda.
The insurance companies are slower to accept new modalities. However, once they start seeing the ESWT treatment outcome and cost savings there is no doubt that ESWT will become the gold standard for treating chronic tendonitis and PF.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. Z on 8/06/03 at 17:16 (126427)

I also agree that ESWT for chronic insertional tendonitis will be the gold standard. What I don't see happening in the insurance industry is acceptance of equipment such as the sonocur over FDA approved equipment so early in the ESWT industry. I see the pattern first being the changing at the FDA level, then the acceptance at the insurance level not the reverse.
I also see two ships in the nite coming at each other one called low energy and the other called high energy. If the insurance company pay for both low and or high energy regardless of FDA approval for that procedure I see a very interesting situation coming to the surface. Whether it is positive or not will all depends on how the companies, FDA and the insurance resolve this. My feeling is that the insurance Co have no idea that the Sonocur is using 0020T for insertional pf in the USA and getting paid for it. Does any one have a payment EOB using 0020T in the USA for the Sonocur with the insurance company knowing in writing which equipment is being used. In the state of NJ where the Sonocur is starting to enter on a large scale Horizon Blue Shield nows asked which machine are you using. Why are they asking this question. Anyway get some popcorn and watch what happens.
I sure wish things could be one plus one is two. Not one plus one equals which are you using low or high or low energy.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

David on 8/07/03 at 11:31 (126481)

Good point. My bet is that insurance companies are going to pay within a certain range, regardless of energy level, and providers will have to use equipment that will allow them to deliver the treatment within that range. Efficacy amongst all the devices is relatively equal. It'll come down to cost and patient demand....once patients are more aware of this treatment. If insurers are too 'device-specific' per indication, patients could get upset that they are being directed to have anesthesia for ESWT when an anesthesia-free alternative is available.....or vice versa. Ultimately, I think it'll come back down to price. Dr Z.....NJ may be somewhat different in covering ESWT at this early stage, when medicare there covers it in the same range that they are covering it in other states ($250-$375 per treatment), and private insurers take a multiple of that, that is what providers will have to work with.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. Z on 8/07/03 at 21:25 (126528)

Cost will be a factor, but quality of care, quality of equipment and quality of delivery will play a major factor. Equipment must be able to handle any situation whether it do low energy, medium and or high energy. If price were the only factor in healthcare then insurance companies wouldn't have point of service policies that they sell. What this means is that insurance companies allow patients to pay out of pocket expenses 'so that they can go to any provider they wish to go to. Patients that can't afford the care will be in an HMO. It is a two system payment system. I hope that ESWT doesn't go in that direction but if insurance Co pay the way you predict then this is what may happen.
We already have as Dr. Ed has informed us in his state lack of access to the ossatron/dornier due to low payments. There are cases where insurance coverage that once was in place is now gone.
It is amazing how I have watched doctors, ESWT companies get involved only when insurance started to cover ESWT in the USA. Companies that live by the insurance companies will perish by the . The plain truth is you must be able to deliver quality of care at a fair price
We now have mass training sessions where anyone can take a course and are given the keys to the machine the very next day.
I could have purchased lasik surgery at $500 bucks but I knew quality medicine costs money and has to also be at a fair price.
Equipment companies are going to have to reduce the cost of their machines if the public is going to receive mass eswt services if your above price does take place.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

David on 8/07/03 at 22:40 (126534)

I agree with you 100%!

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. Z on 8/07/03 at 23:39 (126538)

Good nite.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. JB on 9/02/03 at 08:56 (128541)

Peter R,

Who do you work for or who have you invested with to color your view? All the peer review studies that have been published about ESWT, that are negative, have all used low energy devices like the Sonocur (Haake, ESWT In The Treatment of Lateral Epicondylitis, JBJS, Nov 2002), or Dornier (Haake, ESWT For PF, BMJ, July 12, 2003, vol 327 and the notorius Buchbinder study, flaws and all). There are many more studies out there to emphasize this point.

I think all the available technology works for soft tissue indications to some degree. Until a head to head study is done, much of this is speculation. It's the treatment of bone indications like non-union and delayed unions where there is a significant difference between OssaTron and Epos. OssaTron can treat non-unions, Epos can't. Since no device in the US has approval for these indications, I think it's safe to say use what you like for soft tissue.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Sunny Jacob on 9/02/03 at 18:45 (128606)

RE: Ossatron and Dornier Epos - Non-Union of Fracture
Dr. JB is absolutely right regarding non-union of fracture. The only proven equipment for this modality is Ossatron and Dr. Rob Gordon in Canada is one of the most experienced for this procedure.

Re: Does anyone know the difference between the Ossatron and Dornier Epos Ultra Shock Wave Therapy?

Dr. Z on 9/02/03 at 19:52 (128614)

Just curious. Why can't the dornier epos be used for non-unions???