to: SCOTT RPosted by MARK L on 8/12/04 at 07:21 (157653)
I don't appreciate being accused of conducting a scam and a fraud. If you continue to post such accusations I'll have my attorney slap you with a slander suit that will put you in the poor house trying to defend. Be assured that I will not limit any expenditure draging your butt through every conceivable legal process possible. By the way my attorney is my son-in-law who's specialty is medical malpractice (makes John Edwards look like a law school dropout) so I have no legal fees. I'll state it once more- Anybody who wants accurate, truthful information about FDA approved High Energy ESWT, provided by one of the most successful comapnies in the business,who are acredited by the Joint Commission on Healthcare, who provide ESWT in about 40 states and have a very attractive business model, e-mail me <(email removed)> If you think that I am conducting a scam or fraud as Scott does simply do not reply to me. However, if you do, you will get accurate information that can be totaly relied on.
Re: Mark L is banned from heelspurs.comscott r on 8/12/04 at 10:39 (157675)
'Mark L' is hereby banned from visiting heelspurs.com which includes posting messages. This is an official demand notice. This applies to the person using the 'Mark L' identity and not just the 'Mark L' alias.
Since we do not know who he is, he can't make any 'slander' claim. Also, i never said he was a scam or a fraud. I said his secretiveness is usually indicative of a scam or fraud. If i knew he was a scam or a fraud i would have been required to ban him immediately. But now he threatens the very web site that gives him his audience, so i think it's time to say goodbye.
Re: to scott rMARK L on 8/12/04 at 10:43 (157679)
Hey fellow moderator, i didn't want MARK L's last post deleted....here is MARK L's's original message:
I don't appreciate being accused of conducting a scam and a fraud. If you continue to post such accusations I'll have my attorney slap you with a slander suit that will put you in the poor house trying to defend. Be assured that I will not limit any expenditure draging your butt through every conceivable legal process possible. By the way my attorney is my son-in-law who's specialty is medical malpractice (makes John Edwards look like a law school dropout) so I have no legal fees. I'll state it once more- Anybody who wants accurate, truthful information about FDA approved High Energy ESWT, provided by one of the most successful comapnies in the business,who are acredited by the Joint Commission on Healthcare, who provide ESWT in about 40 states and have a very attractive business model, e-mail me If you think that I am conducting a scam or fraud as Scott does simply do not reply to me. However, if you do, you will get accurate information that can be totaly relied on.
Re: to scott rModerator on 8/12/04 at 11:20 (157686)
Sorry about that. I thought you would not want this here since it is on the Social board.
Re: to scott rBill, jr on 8/13/04 at 21:34 (157800)
Is Mark L, Mark Rubenstein? Just a thought. After all, Mark Rubenstein owns and controls the company that is referred to in the posting.
Just some interesting speculation.
Re: to scott rEd Davis, DPM on 8/14/04 at 16:33 (157878)
It would be my guess that Mark Rubinstein would simply purchase an advertisement or link on this site if so motivated. It would be unlikely for him to get into a tiff over the issue -- counter-productive.
Re: to scott rDr. Z on 8/14/04 at 17:07 (157882)
The problem is marketing the model that Mark L described, might be a serious problem. Remember the post that stated this. United won't placed this in writing. I am not looking for a response but this activity is the beginning of the end for any type of insurance coverage if we are honest about it. If you were an insurance company would you cover ESWT if you knew that this type of business model was being promoted.
Any ESWT that is serious about getting ESWT coverage with insurances would never take the approach that started this entire thread. I have seen it all in 25 years and this just another one that just won't work.
Re: to scott rEd Davis, DPM on 8/14/04 at 17:51 (157887)
We are still guessing at who Mark is and he just described what is occurring so lets not 'shoot the messenger.' Actually United has placed their policy in writing -- I will fax the letter to you if you wish to look at it. If you prefer not to post your fax number here, send it to me by email at (email removed)
United has a full time attorney on staff, Bruce Cohen, whom you could speak to -- he is friendly and very open to discussion. He has, to the best of my knowledge, reviewed the letter and policy. I don't want to get a string going on the legal issues surrounding the policy as I feel we are both very well qualified to provide ESWT but have limited legal knowledge and will only add to confusion on this aspect.
Re: to scott rDr. Z on 8/14/04 at 18:19 (157888)
I am only pointing out what one of our posters stated that United wouldn't place into writing that they wouldn't charge the patient if their insurance does pay. That is how this entire post started. I am alway oprn to anything and would like to see the letter. I know Bruce Cohen and have met him years ago when United Started out. He is very friendly as you have told me.
My only comment about this is this policy places the ESWT procedure and the insurance company at war
Re: to scott rDr. Z on 8/14/04 at 20:14 (157898)
Thanks Ed. I e-mailed you my fax number.
Re: to scott rPauline on 8/14/04 at 20:37 (157901)
That's just what Scott needs. United's attorney Bruce Cohen visit to his site. Until such time that they are hauled off to jail for an illegal operation of providing ESWT, posters should know about the lower fees that are available through their company.
If Mark is able to provide that information for the consumer and save them money thats good news for them.
Re: to scott rDr. Z on 8/14/04 at 20:53 (157903)
I am not sure where Dr. ED stated this but it might be a good idea.
Re: to scott rEd Davis. DPM on 8/15/04 at 10:58 (157960)
The day a company would be prosecuted for helping people would be a sad day for the US. I tend to doubt it will happen. Yes, it places United and the insurance companies 'at war' as Dr. Z pointed out but until Congress gives us a Patients Bill of Rights, it is good to see some entity take up the battle. Patients taking on their insureres has always been a 'David vs. Goliath' type of situation and, after all, most patients in need are people in pain; they are not up for a fight.
Re: to scott rBill, jr on 8/15/04 at 15:28 (157994)
It really isn't that simple. By offering services below cost, United is working to create a monopoly. Once the other ESWT providers fold, United will be free to charge insurance companies whatever they want. It simply doesn't help consumers to have one national ESWT provider that is run by people who have already demonstated their monopolistic tendencies. You need to think long term.
Re: to scott rBill, jr on 8/15/04 at 15:35 (157996)
I'm not sure that United is a good guy here. I don't see the honor in soaking insurance companies that currently cover ESWT in order to offer ESWT for free in areas that don't have insurance coverage. How about setting a uniform, low price for the service? Do you think that insurance companies should pay United over $2,500 when they are willing to give the service away.
Alternatively, I don't want my insurance rates to increase because my insurance company pays United for ESWT when Aetna patients can get the service for free. It's not right or fair and cannot be sustained.
Re: to scott rDr. Z on 8/15/04 at 16:19 (158001)
I agree with you 100%. It is important to think long term. Now if posters want no insurance coverage which is what the trend is now that is another question.
Insurance companies across the country are looking to avoid ESWT coverage. This just gives them another tool to use against the ESWT industry.
Re: to scott rPauline on 8/16/04 at 09:32 (158065)
As far as I can tell, there is nothing illegal about what United is doing and no proof that any monopoly is being created or will be created in the future.
What is happening is that they are bringing down the artifically high cost of ESWT that doctors were hoping insurance companies would pay for this service.
Let's face it, if the service was only $500 dollars the doctors will get far less from insurance providers than if they can insist the treatment is valued at $2500-$5000 especially by the time the discounts are applied.
I personally think that many providers thought that ESWT would become a huge income producer. This would be especially true if they could inflate the price for treatment and keep it there until general insurance coverage became available. They expected the insurance companies to jump on the bandwagon early, but that didn't happen.
Well now over 2 years has gone by and with little to no insurance coverage do you lower your fees to provide help to some patients and make a few bucks or keep your machine as a dust collector?
United did the former and now the complain isn't about not being able to help patients anymore it's about United dominating the ESWT community and making the small guy follow their bold move to provide less expensive service.
Everything was ok as long as all everyone providing ESWT stuck together. They all thought they could share in the revenue equally, but now those that thought they had an agreement realize the $$$$ rug is being pulled out from under them. They have no choice but to respond by lowering their artifically inflated price for ESWT or let their machines collect dust while their competitor makes money.
Complaining about a monoply that doesn't exist yet may look good on this site, but doesn't hold up until they are hauled into court on charges.
The world isn't fair and all of our insurance premiums go toward paying for others whether it's for medical treatment or hurricane recovery. Our Social Security Taxes do the same.
Re: to scott rEd Davis, DPM on 8/16/04 at 10:11 (158072)
No provider (rarely) gets the asking price for a procedure; it is generally set by the insurance company.
United is not willing to give the service away -- they are willing to fight for payment for a legitimate service.
Hmm. You are concerned about $2500 for ESWT (just an asking price) but not concerned about over $8000 in combined surgery fees, hospital fees, surgeon fees, rehab fees, anesthesia fees for plantar fascial release surgery. What gives?
Bill, Jr. -- Are you a patient or do you work for an entity involved in the health care industry?
Re: to scott rEd Davis, DPM on 8/16/04 at 10:14 (158074)
Pauline and Bill:
Pauline - I would like Bill to explain how United can monopolize ESWT when they have a tiny market share of ESWT being done, no control over low energy market -- it is a specious argument.
Re: to scott rDr. Z on 8/16/04 at 13:14 (158101)
Go search the New Jersey state board of medical examiners rules and regulations for Physicians. The section on referral is what you need to concentrate on.
Re: to scott rEd Davis, DPM on 8/16/04 at 13:29 (158105)
I am unfamiliar with NJ regs but keep in mind that each state is different. Does United operate in NJ?
Re: to scott rBill, jr on 8/16/04 at 14:03 (158116)
I have no problem with your logic if United charged $500 to all payors. Their strategy is not to see reimbursements at $500, ask them. United charges significantly more to insurance companies that pay. My point is that why should my insurance company pay United's high prices when United is giving away the service. Please tell me what you think about this concern.
I really don't care about podiatrists who expect $5000 for the procedure. I don't see the honesty in giving away the service to some and gouging others. Furthermore, this is exactly how monopolies are created. Once the market is clear of competitors, United will be free to raise the price.
Re: to scott rBill, jr on 8/16/04 at 14:10 (158121)
I am very concered about over $8000 for combined surgery fees. ESWT should be covered by all insurance companies and everyone involved should make a fair profit. I believe that the total price for the procedure should be less than $2,500. However, United is willing to treat patients from insurance companies who clearly state that ESWT will not be paid. If you treat a patient knowing that the insurance company will not pay then that is giving away the service.
What is United's success rate at getting paid from Aetna?
Re: to scott rBill, jr on 8/16/04 at 14:52 (158127)
As far as I am concerned, there is no low energy market until low energy ESWT is FDA approved for plantar fasciitis. Until then, the success of low energy remains uncertain based on published articles in peer reviewed journals.
In terms of cases performed in a surgery center or podiatrist's office, United has performed the highest number of cases. United is rapidly expanding and has the ability, through their podiatrist investor model and preditory pricing, to monopolize the market.
United is driving others from the market by offering to treat patients for free. When United performs cases without the expectation of payment, they are performing the cases below cost. United can perform cases below cost because they have paying insurance companies in other parts of the country. This is a classic method for creating a monopoly.
I really think that United's willingness to give service away is not in the interests of getting universal insurance coverage for ESWT.
Maybe you could help us, what does United charge to your patients when they have insurance coverage that pays for ESWT?
Re: to Bill, jrPauline on 8/16/04 at 15:41 (158132)
I believe United is graveling with the circumstances that they as a provider are faced with today. They are in an ESWT market that is providing very little insurance coverage at the moment.
What are their choices? Well, they can continue to provide service only to those people with insurance coverage which will be few and be satisfied with less profit, or they can plan a marketing program which not only includes those that are insured, but also offers treatments at a reduced rate to include people who's companies will not cover it and increase their over all earnings.
Common sense tells them why exclude when you can include and make money.
The basis for your arguement fails because they, United, has no control over which companies will pay and which will not. They just want income.
What is really bothering you, is that fact that you feel cheated and that you feel that United is gouging your insurance company, but in the U.S., United is able to provide their service any way they wish inside the law and if your insurance company happens to be one that is willing to pay then
that is the agreement they have made with their insured and United.
If they agreed to pay, why should United be required to tell them please don't pay us? Your insurance company can stop coverage as quickly as it started it. You can even recommend this to them.
Most people don't think they pay for anything once they have insurance.
Their 'insurance' pays for it. It's sounds better to them and they come to believe the service is somehow free. They don't associate their insurance payments with actually paying for their treatment and in some ways they are correct because if it were not for the collective profit that insurance companies make from investments on those collected funds of their insured they would never be able to pay out the large somes of money to cover the medical bills that some of their insured require or the damages that occur from catastrophic conditions hit their neighborhoods like we see in Florida today. Although policy holders may pay the same premiums not all of them have the same type of claims throughout their lifetime. Their illness are not equal. Thats just life.
Personally what I think United is doing is the only thing they can right now. I think they hope to force the issue of insurance coverage for ESWT front and center, but until this happens they are willing to cut costs for patients.
How much of the market they gather really remains to be seen, but I doubt that we have to fear a single service provider for ESWT. United already provides ESWL and was hauled into court once, my guess is they learned from that experience.
Re: to scott rDr. Z on 8/16/04 at 16:24 (158144)
Most if not all state statues are based on federal laws such as Stark.
Re: to scott rPauline on 8/16/04 at 16:51 (158151)
Are you saying United is violating Stark laws 'now' with the way they are providing ESWT????
Re: to scott rPauline on 8/16/04 at 17:09 (158153)
If United's investors are only Pods I can see why they cannot treat medicare/Medicade patients as stated on their website.
A greater chance of breaking Stark Laws if the Pod that is treating them has an investment in the company providing the treatment.
How do you prevent this with your group when you tell someone who visits heelspurs to contact you or one of your group members for treatment and they turn up with medicare coverage?
'United Shockwave Therapies does not treat Medicare or Medicaid patients at this time. Please note that this includes Medicare/Medicaid patients that wish to be treated as 'self-pay patients. If there is a change in our policy with respect to these cases, we will post it here. We apologize for the inconvenience'.
Re: to scott rDr. Z on 8/16/04 at 17:10 (158154)
No. They won't treat medicare patients. You are bright Pauline and I hope rational. Don't you think that there is something not right when a company has a policy of not treating medicare patients.
Re: to scott rPauline on 8/16/04 at 17:23 (158155)
You're the one who thinks you have the dirt on them. All I know is that they don't treat medicare patients.
Re: to scott rPauline on 8/16/04 at 17:25 (158156)
Does your group treat medicare patients?
Re: to scott rDr. Z on 8/16/04 at 18:00 (158158)
What does dirt have to do with anything. Are you on Medicare. I hope not, cause you wouldn't get treatment
Re: to scott rPauline on 8/16/04 at 18:39 (158168)
If I remember correctly you brought up Stark Laws and United a while back when Mark began to discuss the possibility of less expensive treatment.
It was left on the back burner because neither of you wanted to committ to an explaination nor get involved in legal issue with United.
This is the dirt I was talking about. Obviously by posting the newspaper article about United you and Ed know why they went to court.
As far as I know there is not a repeat of this going on currently with United's ESWT program nor are the same two people involved. From the article you or Ed posted an agreement was reached between all parties.
You know a slap on the hand.
Different program, different people at the helm. Unless one has proof that something illegal is happening not providing medicare patients with treatment by itself doesn't mean anything other than they are not providing this treatment to them.
By your question to me about medicare, which I don't have, I guess you're group is not providing patients with medicare treatment either. Am I correct?
Re: to scott rEd Davis, DPM on 8/16/04 at 18:44 (158170)
I don't know what United's success rate with Aetna is. I beleive, that when a person obtains health insurance that there is a right to expect that company to provide coverage for all maladies without unreasonable exclusions. It is, in my opinion, a breach of faith if not downright dishonest to give insured the impression that they have comprehensive coverage when there are unreasonable exclusions. The companies often reserve the right to change coverage without notice without even benefits managers knowing what is covered when. United is basically holding the insurers 'feet to the fire' by taking the point of view that insurers should be obligated to pay fairly for a legitimate treatment. Eventually we will have a Patient Bill of Rights and that won't be necessary. For now, I see their action as beneficial to the consumer as they are basically telling the insurers that they will not take 'no' for an answer. Bravo!
Re: to scott rEd Davis, DPM on 8/16/04 at 19:02 (158173)
ps. Keep in mind, they are not in business to 'give away' a service. No business can continue to do so and stay in business. They are providing the service with the expectation that they will take on the fight and win.
Re: to scott rEd Davis, DPM on 8/16/04 at 19:09 (158174)
Again, keep in mind that no company can provide a service for free and stay in business. United charges patients their co-payments and deductibles which would be due irrespective of coverage and then takes up the fight with the patients insurer for the balance which is being expected from the insurance company.
As far as there not being a low energy market, that is not the case because it exists as treatment for PF and other tendinopathies as an off label entity. Keep in mind that off label uses often outnumber 'on' label uses. A good example is the drug, Neurontin and the class of drugs it belongs to which is used more for chronic nerve pain than as a seizure med. If you need convincing about the low energy market, take a look at http://www.sonorex.com to see how many low energy machines are placed in the US.
I don't know what United's charges are to the insurers.
Bill, come on, you don't have to be specific but at least tell us what your involvement is in the industry. You know way too much to be a patient.
Re: to Bill, jrEd Davis, DPM on 8/16/04 at 19:19 (158175)
I agree with you completely. The ESWT market is potentially huge and there are those in the industry fretting over market share when market penetration of ESWT as a modality is tiny. There is not a chance that one company can corner the market. United's competitors need to realize that the end effect of United's 'fight' for coverage is to open up the market and all (United, its competitors, patients) will eventually benefit. United's actions are not permanent; it is a temporary move to get the treatment out to those in need establishing a 'critical mass' of cured patients that will drive the market forward. They are really taking a risk of losing in some cases, winning in others but have sufficient confidence that they will win the majority of the time. Every insurer that is 'opened' is a victory for every company that provides ESWT and more cured patients. 'Competitors' are focusing on the short term and not seeing the big picture.
Re: to scott rEd Davis, DPM on 8/16/04 at 19:30 (158176)
You don't seem to know what United's fees are so how can you make the statement that they are 'gouging' some? I don't know anyone who is getting, as a podiatrist $5000 for the procedure. It is possible that you can find someone if you look hard enough but that definitely does not represent the norm. The only Podiatrists who charge in the 'thousands' are those who are both machine owners and practitioners thus recouping machine costs and they can probably be counted on our fingers.
The amount of ESWT being performed relative to the need for such services is infinitessimal. As such, talk about monopolies really isn't realistic. It simply will not happen. United would need a multi-billion dollar grant from the government to 'give away' enough ESWT's to come close to cornering the market. Their intention is not to give away ESWT but to fight the insurer for honest payment. They will have to write some off in the process.
Re: to scott rDr. Z on 8/16/04 at 20:40 (158182)
Where were you when healthronics needed someone to defend that $8,000 surgery price.
Re: to scott rEd Davis, DPM on 8/16/04 at 21:50 (158186)
Not every user of United's service is an investor. So I don't think that is the issue. Medicare is not clear on their coverage issues concerning ESWT. United and its users would need a clear yeah or ney from Medicare on this. United is predicating its procedures often on chalenging insurance company decisions but Medicare is the US government and no one is, practically, going to go to do battle with the government on this.
We, in the Northwest, have Noridian as the carrier which has implied some level ofcoverage but it is vague. we don't get very many Medicare patients with intractable heel pain, mainly working people. I have performed some low energy treatments on Medicare patients but have never gotten paid.
Re: ESWTPauline on 8/16/04 at 22:06 (158189)
Personally, I think everyone that is currently providing ESWT is doing the same thing as United or something very similar. They just won't admit it or talk about it out loud.
No one needs a dust collector when simply offering lower costs will bring in a few extra bucks. I rather doubt there are any purest out there saying 'No I can't make any price adjustments. I must remain true to my convictions on ESWT cost'.
It's much better to elude that United is doing something wrong than admit you may be following their lead to survive and be competitive.
I still don't understand why there had to be so much secrecy surounding
United, it's website and their providers, especially if the main focus of heelspurs is to help people get P.F.pain relief.
Taking a second look, this whole thing with MARK L being banned appears somewhat strange now. Dr. Ed freely posts United's website without any repercussion yet readers were suppose to email Mark for the same information. Doesn't it may you wonder why??? I can't be the only one having difficulty understand the secrecy that surrounds posting about United's inexpensive ESWT offers.
Re: to EdPauline on 8/16/04 at 22:11 (158191)
You're correct. No one is going to take on the U.S. goverment over ESWT and no one wants to get involved in a dispute where Stark could come into play.
Re: to scott rBill, jr on 8/16/04 at 23:02 (158195)
The same people are at the helm at United. Look at their web site and compare the names to the names in the FTC court action.
United does not treat medicare patients. I believe they are concern about federal anti-kickback statutes and their investor model. Their web site states that they will not even treat self pay medicare patients.
Re: to Bill, jrBill, jr on 8/16/04 at 23:13 (158196)
I really have two issues with your response.
First, I don't understand how providing service for free results in income to United. Companies market in order to get paying customers, not to give away services.
Second, and you really never addressed this issue, why should insurance companies continue to pay when United will offer the service for free?
I would appreciate your comments on these issues.
Re: to scott rBill, jr on 8/16/04 at 23:17 (158197)
I don't believe that any podiatrist receives $5,000 for the procedure, but I think that United has some contracts where they collect something close to that number just for the use of the machine!
I don't see how they will win their fight. I hope they do because it will result in universal coverage. However, they are fighting for high energy ESWT. Will you be disappointed if their result only apples to high energy?
Re: to scott rDr. Z on 8/17/04 at 08:01 (158212)
Has you seen this method of trying to obtain insurance coverage work with any other procedure.
Re: to Bill, jrPauline on 8/17/04 at 10:26 (158232)
1. Insurance companies are not being forced to pay. Those that are paying for ESWT have agreed to pay any provider that provides this service within their network. If you don't want them to pay tell them and see what response you get. My guess is that they will tell you it's an agreement that they made with their providers and part of your coverage.
You always have the choice of finding another provider if this particular issue brings soooo much discord into your life. On the other hand, if there was no United and they didn't pay you'd also be angry because you'd think they should be covering this treatment cost. In other words, you want it both ways. 'Don't pay when I don't want you to pay and pay when I want you to pay'. Unfortunately in this day and age the consumer doesn't have that much flexibility or authority with insurance coverage.
I personally think the best place to take your complaint is 'public'.
Write a letter to your insurance company and carbon copy every newspaper in town. Who knows maybe they will stop paying United and you will have achieved your goal.
2. Unless you see the books you or I have no idea how much income is being generated by their unique marketing technique. They ain't going broke yet on the backs of their freebees.
I can understand the issue you argue and it's a legitimate observation, but who are you or I or anyone for that matter to tell a company how they can run their business, who they pass for free, and who they charge.
We don't run the world at lest that is the way it was when I work up this morning:* I understand what you're saying, I just can't fix it for you.
Re: to scott rEd Davis,DPM on 8/17/04 at 23:46 (158297)
They cannot violate Stark due to the safe harbor of having a sufficient minimum of investors. The number used to be 50. I don't know if that has changed or not.
They don't treat Medicare patients, in all likelihood, because they would lose money on each treatment if Medicare reimbursed at their proposed rate. The only way around that is to have patients sign a 'waiver of liability' but that waiver must site specific reasons for non-coverage; something Medicare has yet to make clear. As such, treatment of Medicare patients is in a gray zone in terms of how to go about the legal provision of such services.
Many providers don't take Medicare or Medicaid. One cannot imply that something is wrong just because a provider or providers has made a decision not to treat patients under a specific program. My associate does not treat patients with United Healthcare (due to no contract). That does not make him any better or worse a practitioner nor any more or less ethical.
Re: to scott rEd Davis,DPM on 8/17/04 at 23:52 (158298)
I would like to see the results open both low and high energy. Yes, it is possible that it may only open high energy. If that does occur, it would not last very long because, as you realize the Dornier machine is variable in energy. If I was to use the Dornier for achilles tendinosis, I would use it on low energy only.(one could risk rupture with high energy in significant cases of achilles tendinosis). The energy level issue will pass as more areas of the body are treated with ESWT.
Re: to scott rPauline on 8/18/04 at 09:28 (158317)
I think the point you made about many providers not taking Medicare/Medicaid patients is a valid one. I too have seen the signs posted in doctors' offices. As you say, this doesn't make them any less ethical.
Re: to scott rDr. Z on 8/18/04 at 10:14 (158324)
The reason is because the OIG has listed ESWT as a procedure that isn't
automatically exempt from stark or anti-knick. Any ESWT company not United has this type of policy . So if you have investors you can have problem if you treat medicare patients.
ESWL is safe harbored so hopefully in the future ESWT will be added but at this time it isn't. Take a look at any investment prospective from any ESWT company they will point this out so that you understand this concept.