Insurance ? and post ESWT ?Posted by Tina H on 8/13/04 at 20:28 (157796)
Thanks to all who have already helped me so much from this site. I would be crazy by now if I thought I was the only one going through this.
First question, The insurance company submitted my appeal for ESWT to an 'independent' consultant, who denied my appeal saying even though I tried all nonconventional treatment ESWT is not an appropriate course of action because it's experimental. How is it that a treatment sanctioned by the FDA is experimental? Anyone know?
Second question, Well it's been 5 weeks since I've had EWST and I have no improvement in pain except those first steps in the morning are not as stiff and painful. I've developed this annoying cracking of something(my ankle?) when I go up and down steps. Anyone else have this, know what it might be? I've never had this before.
Third question, my podiatrist wants to give me a 'short acting' steriod to diminish the pain until the ESWT healing kicks in. I think this sounds like a bad idea because cortisone did not work on me although this is not cortison, it's a different steriod. Are there any steriods that won't interfer with the post ESWT healing process? Thank you so much for your time. Tina
Re: Insurance ? and post ESWT ?Dr. Z on 8/13/04 at 23:19 (157805)
ESWT by FDA approved machine such as the dornier/ossatron is experimental
Any chance your insurance company name is Cigna???
I will avoid any local steriod injections at this stage of post ESWT tretment.
Re: cracking sound.......Lori S. on 8/14/04 at 01:05 (157809)
I havent yet had ESTW......but I am going to in september..... but I have a cracking sound in my right foot..... nearly every step I take.... just thought maybe it was related to my other foot things......
Hope you feel better
Re: Insurance ? and post ESWT ?Ed Davis, DPM on 8/14/04 at 16:23 (157875)
ESWT is definitely not experimental. The 'independent' consultant is paid by the insurance company which makes him/her not so independent.
ESWT takes about 12 weeks to work although many patients note a 'turning point' around week 6 or 7 after ESWT.
Anti-inflammatories are to be avoided for a period of time after ESWT. That time period is not verified by experiment and the amount of time to avoid anti-inflammatories including cortisone varies from a low of 6 weeks to a high of 12 weeks depending on the practitioner.
Also, keep in mind that ESWT is not a 'stand alone' treatment but is to be combined with all the standard treatments such as orthotics, night splints, stretching, PT, etc.
Re: Insurance ? and post ESWT ?Ed Davis, DPM on 8/14/04 at 16:48 (157879)
I don't want to entertain too many rumors but have been told that Cigna often provides approval after the fourth letter of appeal (not just for ESWT but other treatment denials as well). The key is for the patient to get involved. One thing that may be helpful for all on the site is if we can obtain some sample letters of appeal that would act as templates to simplify the process. We recently had a Cigna poster who claimed success with their appeals process but did not follow through with details of how he achieved success. By the way, the Worker's Comp case went in our favor, was appealed by the WA State Worker's Comp. Medical Director. He lost his appeal and we have an order for ESWT coverage on my patient. I was warned by the Attorney General's attorney (who argued against us by contractual obligation representing Workers Comp.) that a win in this case will not necessarily open the door for further approvals. We probably would need several victories to achieve that -- that means a motivated attorney, motivated patient, motivated doctor as, whew, these fights are not easy.
Re: Insurance ? and post ESWT ?Dr. Z on 8/14/04 at 17:01 (157881)
I have seen patients win an appeal with Cigna. I am very surprised that Work Comp gave you such a problem. Congrats on the win
Re: Insurance ? and post ESWT ?Tina H on 8/14/04 at 21:16 (157910)
Thanks to Ed and everyone else who answered my questions. I appreciate your comments, and I am not going to have that steriod injection. I've really stepped up the conservative measures as well, I'm doing everything that I've read on this site and spent money on several new pairs of shoes and am wearing my custom made orthotics all the time. I even bought Birks for the shower, expensive shower shoes!!
For the insurance, it would be great if some people would take the time to post their successful appeal letters. I have 45 days to go to the next step, of course 10 days already passed by the time I got the letter. What type of documentation should I sent with this? Will they accept foreign studies. Any posters out there who are lawyers with ideas? I'm fighting this not for me, as fortunately I am able to self pay, but because my doctor says there are so many people who can't even afford her modest self paying fee of $500 and what about the people who can't work because of pf? It's so sad and I think we all should fight this so those patients who can't pay and don't have the means or eduction to fight will benefit in the future. By the way, my insurance is Health America. I appreciate whatever help and input anyone has. Thank you!! Tina
Re: Insurance ? and post ESWT ?Dr. Z on 8/14/04 at 23:49 (157930)
1. Office notes from your ESWT doctor
2. Letter from your doctor certifying that the FDA procedure is necessary
4. The FDA approval letter for your specific machine
Re: Insurance ? and post ESWT ?Tina H on 8/15/04 at 20:35 (158032)
Thanks Dr. Z