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No charge to patient for ESWT, if no insurance coverage?

Posted by Scott Mc on 8/06/04 at 16:31 (157096)

I have arranged for ESWT from a DPM in Billings, MT. As my insurance company will not cover ESWT, I am prepared to pay DPM fee. United Shock Wave Therapies is owner of the Dornier machine. They say that they will bill insurance company and file appeal if (when) turned down. (And, BC/BS will turn them down.) They further state that if they lose appeal, they will not charge me. I have been advised to get this in writing. I have had long discussions with Pam Vukovich and Kathy Serpico at United. They promise over and over that I will not be charged if they lose appeal. They will NOT put this in writing. The DPM seems to want to avoid this issue and will not intervene. So, can I trust United or do I cancel?

Re: No charge to patient for ESWT, if no insurance coverage?

Dr. Z on 8/06/04 at 17:57 (157101)

My personal opinion is that I would never agree to a fee that is thousands of dollars and not in writing, but if you are comfortable and confident then go for it. Old saying buyer beware. This is my own opinion and you are free to pick and chose anyone opinion on this board. There are cases I am not sure if its your dornier provider or not that have billed the patient after stating the same fact. Go search posters from heelspurs.com.
I am not a lawyer but I have been told that the type of billing that you are talking about where they you won't balance bill the patient may be against local anti- knickback laws and therefore could be problem. What if this is true what are the ramfications with the doctor, company , and patient.
I still repeat< this is your decision and I would get this in writing just my opinion I am sure other will have a difference. Isn't sad when you may have to consult an attorney to see if this is kosher and should you get this in writing.? Speaking as a doctor I am very strongly against pf surgery and for you getting ESWT.

Re: No charge to patient for ESWT, if no insurance coverage?

Scott Mc on 8/09/04 at 13:30 (157269)

In addition to my postings here, I have sent United Shockwave Therapies an E-mail documenting my conversation with them. This may serve as some type of protective documentation. I have attorneys here at work and will ask one of them. I sure would hate to cancel; as I have had 2 years of pain and a trip to Britain coming up and will need to walk. I suppose I could try calling someone in United that is not in the billing office. My procedure is Thursday, I am running out of time for making a decision !!

On another thread, either you or the other Doc mentioned using 2 Strassburg socks for bilateral PF, instead of night splints. What's a good source for the socks? In general, how do they compare to splints as far as efficacy, comfort, and walking to bathroom at night?