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Insurance said no but.... and another ?

Posted by Lori S. on 6/11/04 at 21:50 (152795)

.... I have talked to a couple doctors who do ESTW. They have a cap on the amount they charge if insurance wont pay. $1000 up front(yes im saving my pennies).

Everytime a cold front goes through I am dying, my feet ache horribly, not that they dont ache all day everyday, but on these days it brings me to tears. Is this common? I went to my doctor doc and asked for shots, surgery anything the last time a front went through. He will not do surgery, he feels its a last ditch effort to attempt surgery because I have been unresponsive in all other treatments he wants ESTW first. And shots are out of the ? because I had a reaction.

Also, my son, age 14 has been complaining about his feet, does PF happen much in younger people? is it a hereditary thing? or just happens to some people? I have bought him good shoes, showed him exercises I do, etc. Gosh, I really hope hes not going to end up like me.. hes only 14. I am taking him to my podiatrist, appt in a couple weeks.

Right now,, I would love to get a shot,,,, they hurt like crazy, but it was wonderful to be painfree for a few months.....
Thanks for your time docs,

Re: Insurance said no but.... and another ?

Pauline on 6/12/04 at 06:21 (152802)

I find your post encouraging for the following reason. The $1000 dollar cap that is being used by doctors in your area to provide patient with ESWT.

This is an indication to me that competition is beginning to drive this market. We have lots of doctors who cannot afford to see their machines become dust collectors. With so little insurance coverage have decided to grab their share of the market with innovative marketing like the cap that is being used by your doctor.

I've always thought that insurance coverage would keep today's artificially high cost of ESWT just where it is, but without insurance coverage competition would eventually begin to drive the cost of treatment down especially those that are done in offices or mobile setting.

I think with insurance coverage ESWT will become a huge money maker for doctors that provide it.

Re: Insurance said no but.... and another ?

Dr. Z on 6/12/04 at 08:33 (152811)


Do we know if that Cap is for the machine, or just the doctor bill.? It has always been my opinion to get insurance out of the picture and let the market take it course. The national ESWT companies must in the end get the insurance companies to play ball. In the mean time the $7 thousand plus fees are out there

Re: Insurance said no but.... and another ?

Pauline on 6/12/04 at 09:03 (152813)

Dr. Z,
I have to disagree with you about the current stand you are taking about insurance involvement. I don't believe this has been your opinion at all because I remember you posting more than one complaint on this site from the time that you began providing ESWT that there should be insurance coverage.

I've always said that without insurance coverage competition would drive down the cost of this treatment, but it was being kept artifically high because if and when insurance coverage comes in they would cover the going rate.

Without it we are seeing the prices drop as more doctors are offering it to their patients. There is not one doctor out there that needs a dust collector in his office if he can cut out his competition by lowering his price.

Patients will shop this treatment.

Re: Insurance said no but.... and another ?

Dr. Z on 6/12/04 at 09:51 (152815)

I probaby stated that without insurance coverage the spread of ESWT would be slow and limited. This is the only reason why insurance should be in place.
Insurance has made the wide spread use of ESWT possible. Not only for the rich and famous.

In my area the price of ESWT is based on what the insurance company thinks they should pay and what you can negotiate.
There are so many issues with fees that you are talking about. It the fee is low maybe it is so that the investor doctor can bill his portion to the insurance company, and the company will still get paid for a tech fee. IT is just too complicated to determine without any specific informaion ie the patient that posted the $1000 cap
What I am seeing is without insurance many companies/doctor won't be offering ESWT.
There are many physicians especially orthopedic surgeons in my experience that just won't offer a procedure if an insurance company won't pay for it. The reason is they just don't want to be bothered. This is my personal experience so we don't need to start a orthopedic why posting. It is just an observation in my area of the country.

So what ever we say on this board won't change the market picture. My advice to patients is to shop around and determine which doctor is right for you and is the price right for you.
There are prices and there are prices. Make sure you ask does this cover after visitis, any additinal treatments if needed. What does it cover? Where is the procedure being performed. Will I have to be under IV sedation and or general anesthetic.
I could have had Lasik eye surgery done for half the price I paid but I went where there was experience and who the doctor was.

Re: Insurance said no but.... and another ?

Pauline on 6/12/04 at 10:18 (152816)

I think the longer it goes without insurance coverage the lower the cost will become less for patients. A machine that isn't in use isn't making anyone a profit.

Right now I think hope for insurance coverage will come through Orthopedic procedures for treating shoulders and elbows. That will be the doorway to coverage for P.F.

Re: Insurance said no but.... and another ?

Dr. Z on 6/12/04 at 13:43 (152824)

We have talked about this before. I hope you are correct.

Re: Insurance said no but.... and another ?

Lori S. on 6/14/04 at 01:41 (152922)

That is for ESTW. And these are prices from two different doctors one in Vegas and one in Idaho. My podiatrist told me he could send me to Vegas, but I asked about going to Idaho, because its 8 hours drive either way,,,, and my parents are there...... LOL.... I would have a free place to stay, let the kids visit, etc. My podiatrist said he didnt have a problem with where I had it, as long as I had it before surgery was even considered. So I started making phone calls, and this seems to be what is happening, at least around here.