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ESWT and Insurance

Posted by Carolyn on 6/28/04 at 22:09 (154126)

I have heel spurs on both feet and have told that ESWT is the best way to go and the fastest healing time. My insurance will not pay, it says it is experimental and therefore not proven to be effective. Who's right, the insurance or my doctor? The insurance will pay for the surgery.

Re: ESWT and Insurance

Ed Davis, DPM on 6/28/04 at 22:28 (154128)

Carolyn:
Spend time reading through this site, its archives. Look at http://www.ismst.com , http://www.sonorex.com and http://www.unitedschockwave.com .
Your doctor is correct.
Ed

Re: ESWT and Insurance

Dr. Z on 6/28/04 at 23:13 (154135)

Hi

If the machine that your doctor is recommended is FDA approved then then by definition the treatment is effective and safe. There are two machines in the USA that are approved Dornier and Ossatron

Re: ESWT and Insurance

MonikaA on 6/29/04 at 13:53 (154158)

Carolyn, definitely do your research. I can tell you that I had eswt with the ossatron a month ago and I feel so much better! Insurance did cover it, but I will still end up having to pay some of it...the expense, to me, is much better than living in (horrible) pain. I am not quite 100percent, but am hopeful I'll keep improving...good luck to you!

Re: ESWT and Insurance

Pauline on 6/29/04 at 22:39 (154198)

Carolyn,
Keep in mind that even though your insurance company will pay for surgery doesn't mean you should have it. Spend some time reading the surgery board and you might just change your mind. Snip and go P.f. surgeries are hard to find and the complications that can and often do result may leave you in worst shape than you are now.

There is also no guarantee the ESWT will help either whether your insurance company pays for it or not. Some people experienced some pain relief others nothing. Unfortunately there is NO sure cure at this time.

Re: ESWT and Insurance

Dr. Z on 6/30/04 at 01:11 (154200)

Pauline,
Sure there is a cure. I have read in many journals, on this board and even by you that the cure rate is about 90% with the consersative treatments when dealing with pf.

There is no universal cure that all pf can be treated with just one treatment modality. PF is something that can be very difficult to treat in some patients

Re: ESWT and Insurance

Pauline on 6/30/04 at 09:30 (154208)

Dr. Z,
Elliott would accuse you of reading tooooo fast or not completely. My post reads ' Unfortunately today there is NO SURE cure. This I think is a true statement. As Elliott would say you need to read more carefully.

Re: ESWT and Insurance

Dr. Z on 6/30/04 at 10:43 (154218)

Yes there is for acute plantar fasciitis.

Re: ESWT and Insurance

Dr. Z on 6/30/04 at 19:07 (154293)

Just want to make sure that you don't confuse new posters that come to this site looking for help. Help is here and there are cures available We need to be positive and look at the portion of pf that is easy to cure and that is the acute. Most acute can be cured with fast, accurate diagnosis by a physician. The longer you wait and just see if it gets better is one of the reasons the chronic cases become difficult.

Re: ESWT and Insurance

Ed Davis, DPM on 7/01/04 at 19:50 (154353)

Dr. Z:
Perhaps it need be mentioned in some permanent portion of the site (note to Scottr, Scott R) that the majority of PF is curable. The visitors to this site are not a typical cross section of those with PF. They either have very tough cases, have not had proper treatment or both.
Ed

Re: ESWT and Insurance

Janice N on 7/02/04 at 00:49 (154370)

I had more than a few minutes of panic. I received a Medicare statement saying they were not paying for my ESWT. It said I was not reasonsible for the pay me because I was not aware it was not a covered item.
Now I knew I migh need another ESWT done and thought now what? Since it is Medicare only the charge was around $1,000. for the one treatment to my right foot only. I know it can be much higher with insurance.
I wrote a letter to the drs office. He called me back himself. I knew that bills sent to Medicare are not always coded right. But I worried anyway. So the dr thinks it was coded a way that needs to be changed and we will see what happens then. But it was very nice he called himself to reassure me. Meanwhile I still have three wks to see if anything improves even more. I guess I will have ESWT for the second time if it is covered.

Re: ESWT and Insurance

Pauline on 7/02/04 at 08:33 (154375)

Dr. Ed,
I think for Scott to make this statement in writing he would need clinical studies to back it up.

Re: ESWT and Insurance

Dr. Z on 7/02/04 at 22:13 (154428)

What will you do if it's not a covered service. It is pretty cut and dry with Medicare. They have a written policy about a procedure such as Medicare. They tell the doctor what code to use, what medical information to use etc etc. What I found with Medicare with regard to ESWT is that they just don't read their own policies that they write and distribute.

Re: ESWT and Insurance

Ed Davis, DPM on 7/02/04 at 22:44 (154431)

Pauline:
Are you serious?
Ed

Re: ESWT and Insurance

Pauline on 7/02/04 at 23:18 (154434)

Ask your attorney?

Re: ESWT and Insurance

Pauline on 7/02/04 at 23:20 (154435)

Ask Scott?

Re: ESWT and Insurance

Janice N on 7/03/04 at 10:55 (154447)

Well Dr. Z if it is not covered then I sure won't be having a second one done. At my internist office things are constantly being coded wrong. So I didn't panic the first couple of days after I got the notice. And if it is not covered there is not one thing I can do. Now my question is how did it get preapproved if not covered? If indeed it was not a covered item then the answer should have been Janice, Medicare doesn't pay for ESWT. The podiatrist said he had 15 patients who had ESWT. Of course it didn't come up if these were persons with insurance or medicare coverage. I was inquiring about this since I read about ESWT here. I was talked to about surgery.
So when he said yes he had good luck with persons who had it done the office staff was to set it up and get it approved. In ten days when she didn't call back and didn't know anything about what I was talking about she read the chart and said it needs to be pre approved by Medicare. In three more days she didn't call back I called and she said yes it was preapproved. Now since all this I didn't know anything about it and I was standing there when the dr said set it up I wouldn't be at all surprised if
a mistake in billing was done. Do to this fact and some other problems coming from there. Also I would be surprised if the company who brought the machine would even come out if they didn't think they would be paid. But now that I think about it the ESWT was billed through the drs office and not the company.
If not covered I don't know as far as paying. I did have it done. Medicare says I am not required to pay it because I was not informed. But is it the right thing to do? That is the question. If I do pay it will be ten dollars a month for life or until it is paid. WHich ever comes first. Sorry this is so long.

Re: ESWT and Insurance

Ed Davis, DPM on 7/03/04 at 11:02 (154449)

Pauline:
Better than 90% of the material on this site does not have the type of studies you are looking for, so if you are serious, then you may be hanging around the wrong place. Most of the material on Scott's Heel Pain Book is valuable material based on a fairly substantial knowledge base but you won't see double blinded peer reviewed studies to back it up as you won't see for better than 90% of surgery practiced today and the majority of medicine.
Ed

Re: ESWT and Insurance

Pauline on 7/03/04 at 12:45 (154459)

Dr. Ed,
You asked a simple question and then try to bait an arguement. If it makes you happy to have Scott put that on his web site so be it, but I think you should first consider putting it on your own, thus taking full responsibility for the statements you toot about here.

Re: ESWT and Insurance

Ed Davis, DPM on 7/03/04 at 13:04 (154460)

Pauline:
I and the other doctors who answer questions here always take responsibility for our answers. There are a number of basic answers we provide repetitively and much of the time we can refer questioners to the Heel Pain Book. The book could use some additional material and we will leave it up to Scott to see if he wants to add to it. Sorry to say that much of the material in that book would not meet your criteria for advice.
You have repetetively entered threads to start controversies and arguments based, often on misinformation which you know will draw a response from one of us. I will go no further with you on this thread.
Ed

Re: ESWT and Insurance

Pauline on 7/03/04 at 13:48 (154462)

Wonderful.

Re: ESWT and Insurance

Dr. Z on 7/03/04 at 17:09 (154470)

Why don't you go on the web and search the carrier policy for your medicare. The rules and regulations are probaby right there.

Re: ESWT and Insurance

Janice N on 7/04/04 at 08:49 (154481)

Good idea. I will do that. Janice

Re: ESWT and Insurance

Tess M on 7/06/04 at 20:01 (154673)

Monika--Iam also battling with BC/BS to get the Ossa Tron costs covered. Is your insurance a Blues and if so, in which area or state are you located? Did the Blues finally pay? I am collecting data to give to the NYS Attorney general's office. Thanks.

Re: ESWT and Insurance

Sher on 7/07/04 at 19:14 (154808)

Count me in as one who believes there is NO sure cure for PF. There are just too many of us still in dire straits with PF after having gone through all the try this, try that, and getting absolutely nowhere except more depressed and more frustrated. I've said it before I don't really believe this is even a podiatrist problem. I feel that it is for a specialist in tendons, sinews, and inflammation. I can't understand why doctors can do such great things in medicine, yet can't come up with a sure fire way to fix the PF problem once and for all. I've been on this board awhile now and see so many people still in so much pain, after having spent so much time and money and they are no further along than they were when the PF first started. I hate to say it but having a pod treat PF is like having a dentist perform cancer surgery in one's mouth. If there were a sure fire cure, I for one would be one of those cured, but I'm not. There is no magic bullet for this horrible stuff.

Re: ESWT and Insurance

Pauline on 7/08/04 at 08:05 (154840)

Sher,
I certainly hear your frustration. Unfortunately there are many medical conditions that no magic bullets can treat.

It's unfortunate when P.F. strikes that it not only brings with it pain, but often times it brings disappointment, frustration, depression, anxiety and even rejection.

It's victims, some in the prime of their life, begin to feel old way before their time.

Having had multiple cases of it myself I too wished for that magic bullet.

My medcial disclaimer:
I am no doctor. The above post is strictly a personal response to Sher and by no means should all or any of the symptoms mentioned in this post that can often be associated with Plantar Fasciitis be used to diagnose any case of P.F. or any other medical condition. Anyone feeling such symptoms whether having P.F. or not should seek the advice of a medical doctor.

Re: ESWT and Insurance

Gina G on 7/09/04 at 09:03 (154913)

I'm