how to get eswt on salePosted by gerry on 10/22/04 at 16:30 (161996)
does any-body know what it should cost to have shock wave done. afriend told me about a doctor in michigan who does the treatment in his office, for $699.(www.footpaindoc.com). any info would be great! is it worth a flight($150.) to travel there...........
Re: how to get eswt on salePauline on 10/22/04 at 20:50 (162004)
Reading your doctors website at one time he was using the Ossatron, but if he is not doing the procedure in his office it has to be another machine.
Things to check:
1. What machine is he using.
2. Total out the door 'final' cost to you.
3. Does he offer free repeat treatments or will you have to pay for additional treatments.
4. How long has he been using the machine and what has his success rate been.
5. What will you do if you need follow up care or have a complication as a result of your treatment. (very important) When you leave his office who's care are you in and would you have to fly back if you are left in pain or suffer a stress fracture. I'm not a doctor but I've had various medical treatments in other states and if you have any complications it's difficult to find follow up treatment unless he can make a referral for you. Certainly ESWt isn't surgery, but you should know your options just in case you need help.
Other posters may have more questions that you should check before signing on the dotted line.
Additionally Dr. Christopher Zingas one of the orthopedic surgeons who rand the FDA studies for Dornier is also in Michigan. I'm sure you've seen Dr. Z's posts about him joining his group. If your coming to Michigan you might want to compare prices with his office after all he gave birth to the usage of ESWT on Plantar Fasciitis here first.
Just things to consider before you spend your money. Hopefully they help you with your decision.
Re: how to get eswt on saleLynn F. on 10/24/04 at 19:26 (162066)
I recently had ESWT done United Shockwave Therapies at my pod's office in NJ. My insurance didn't cover it and my fee was $500 (for one foot).
Re: how to get eswt on saleLori S. on 10/25/04 at 19:43 (162143)
I was charged $500/foot as well with my doc and united shock wave. My insurance hasnt covered it as of yet.
Re: how to get eswt on saleTina H on 10/25/04 at 20:32 (162145)
ditto for me too. Dornier, one foot, 500$ Tina
Re: how to get eswt on saleConnie H on 10/25/04 at 21:21 (162147)
Lori & Tina, Did that $500 for one foot include everything? The treatment, Doctors fees, follow up visit? What about if you need retreatment? I'm contemplating my options at this point, so I'm very interested in learning from your experiences. Thanks!
Re: how to get eswt on saleTina H on 10/26/04 at 07:21 (162161)
The $500 did not cover follow-up visits which were just the usual 15$ copay for me. The 500$ did cover the entire procedure, numbing shots etc. I assume that if I had it done again, I would have to pay another 500$, because the doctor has her costs renting the machine, paying staff etc. To tell you the truth, however I don't think I would have high energy ESWT again, because I personally was really worse off after for several weeks. I am happy about the progress I'm making now but I think much more needs to be studied about how the high energy waves damage the foot etc. That foot, while the heel pain is much better, is still not 'normal' in my opinion. Sometimes I have slight swelling of the ankle area and it just doesn't feel right. My doctor seems to think that these problems are temporary side effects of ESWT and will go away with time. I think she is probabally correct, but for me, I would think long and hard before having a second application at this point. I did not explore all other options, before having this done. I only found out about the night splint for example, after visiting this site for the first time, which was after ESWT. I hope I'm not leaving you with a negative feeling about having ESWT done, as certainly a lot of people claim to have been helped by this and I am one of them. However especially after reading the recent posts here by Dr. Rompe and Mark Evans, I am very leary. Good Luck with whatever you decide. Tina
Re: how to get eswt on saleLynn F. on 10/26/04 at 12:46 (162186)
I am also having concers re. high energy ESWT, especially after reading the posts that raise doubts (I was so hoping someone in the know would post to the contrary!) I had ESWT 3 1/2 weeks ago and my pain, if not worse, is at least more consistent than before having it, therefore, I am less active now than pre-ESWT. In hindsight, I would have it done late spring/summer as the cooler damp weather is definitely a pain trigger for me. I just got the night splint and it does help, especially with those first steps. I also use it whenever I'm sitting for extended periods (on computer, watching tv, etc.) I too was going to ask the previous poster if she would share her dr's tips with us.
Re: how to get eswt on saleConnie H on 10/26/04 at 13:41 (162190)
I have been researching ESWT, and one piece of literature stated that the most healing occurs between the 6th and the 12th week AFTER treatment, so I think you have a bit to go before you can tell for sure. I'd be willing to get a lot worse if I could regain some of my former activities--like walking without pain. (Isn't that what happens with surgery??) I'm not in the know, but I have talked to someone who has had the treatment--in '99--and she now has no pain. I also waded through the abstracts on this site, and they show positive improvements as well. Hang in there, and let your feet heal. I'm still looking around, but I'm ready to go once I finally am sure I've found a knowledgeable pod. at a reasonable price.
Re: how to get eswt on saleLynn F. on 10/28/04 at 11:45 (162332)
Yes, I did all the same research and while I appreciate your response, I was really talking about high energy (vs. low). I had only heard very positive things about high energy ESWT.. until I had it done! Then read posters here questioning whether high energy could cause more damage. I didn't think I should be experiencing more pain than prior to the procedure. Though now well into week 3, using night splint, doing lots of hot soaks and mild non-weight bearing stretches.. I'm actually starting to notice some small improvement. Good luck to you. There's alot of good info on this site. Just take what you need... and leave the rest!
Re: how to get eswt on saleDonald Iain Scott on 10/29/04 at 07:19 (162391)
I hate to rub salt into the wounds (pardon the pun) ESWT in Australia has been around the $350.00USD for the past 3 years. My fee for ESWT is $600.00AUD. The AUD is about .70cents to the US$
The price set by the practitioner is up to the individual practitioners moral or ethical conduct. Don't forget we have studied hard over countless years to improving our knowledge, going out on a limb purchasing equipment in the hundred of thousands of Dollars. We have to show fair profit, pay wages, pay insurances, pay rent. The bottom line is, the patient pays. If you want the treatment, pay their asking price and hope your health fund covers some or all.
Donald Iain Scott
Re: how to get eswt on salePauline on 10/29/04 at 09:53 (162404)
I agree with your statement 'the price set by the practitioner is up to the individual practitioners moral or ethical conduct' and as we are now seeing many have lowered their prices making treatment even without the help of insurance more affordable.
Re: how to get eswt on salejohn on 10/29/04 at 20:29 (162440)
I would guess that the price you paid for your Epos was significantly lower than the price currently charged by Dornier in the US. What was the price that you paid for your Dornier EPOS?
Re: how to get eswt on salePauline on 10/29/04 at 22:24 (162448)
On the same note if you have a major provider serving more than 50 - 100 doctors with one or two machines how much can it cost each individual doctor being served by that provider to actually provide a treatment to a patient? I don't think the math adds up for all the expenses expected and no expendature figures are shared with the patients to check.
A similar example presented itself at an eye doctor's office. This particular doctor will provide a patient with what he calls reversal drops to return your eyes to normal after being diliated if you want them. Most doctors provide the drops for no extra charge, but this doctor charges $5.00 per drop and it takes 4 drops to do the job. So if you want the drops you pay him $20.00. Times that by the number of drops available in one bottle and not only does he cover the cost of the medication but he makes a pretty good profit putting 4 drops into a patients eye. Office visits and complete eye exams are actually cheaper at the doctor who doesn't charge for the reversal drops so the cost of the drops is not being added into the examination or office fee. He is just not willing to charge a patient an extra $20.00 for 4 drops. It's his moral and ethical feeling.
I've said in the past and will continue to say prices for ESWT are being kept artifically high in hopes of insurance coverage paying a higher returned fee for service if and when they come on board. Doctors will reap
back only what they can sell and they already know the insurance companies will all discount the original fee they ask for already so right now it's to their advantage to keep prices higher. United figured out a way to avoid having dust collecting ESWT machines, but still collect some fee for service for the doctors and themselves.
As one poster said United is hoping to collect $3500 or more from the insurance companies for service rendered, but currently the patient is only paying around $500 in some doctors offices. Certainly not as much profit as they would like, but United is still trying to convience insurance companies the treatment is worth a whole lot more for all the reasons Dr. Scott stated in his post.
Obviously contrary to what we've been told insurance companies are not the ones setting the fees nor are they responsible for the high cost of ESWT treatments at this time. If most of them are not willing to pay for the treatment they certainly have no current interest in setting the fees.
Dr. Scott also confirmed this in his post.
Re: how to get eswt on saleDr. Z on 10/29/04 at 23:54 (162467)
The only way to prove your hypothesis is to have no insurance coverage and then see what United or any other ESWT company will charge.
Re: how to get eswt on saleLori S. on 10/30/04 at 01:52 (162475)
I am 4 1/2 weeks post ESTW , Dornier epos machine. the first two weeks were almost heaven... it was the calm before the storm. I have been reading here tho, and it seems this is common in alot of peoples stories of their healing. I was asked (mind you, I have been crawling again at night because more than an hour total on my feet and IM dying), if I would do it again. I would.. simply because I am in pain right now, but I have had some GOOD days and some bad days since the treatment. BUT before the treatment I had horrible days , everyday. I was living on pain meds. I too was at the point, I told my doc to cut my feet up,,,,, of course , being a good podiatrist he refused, saying surgery was the absolute last resort. Anyways, I am going on and on, its nearly midnight here and another sleepless night,,,,,,,
Best wishes ,,,,, and hope for healing,,,,,
Re: how to get eswt on salejohn on 10/30/04 at 08:06 (162483)
The high cost of ESWT is related to the high cost of the equipment and the uncertainty of reimbursement. A high energy machine costs between $350,000 and $500,000. A company purchasing this machine must make back their investment before another technology comes along. Just for example, if they take a five year loan at price rate the monthly payments are around $10,000. This means that the company must receive $10,000 each month just to pay for the equipment.
Considering the on-again, off-again nature of reimbursement, there is considerable risk that the procedure will not be reimbursed long enough to pay-off the equipment. Remember that BCBS in PA covered the procedure, companies bought equipment and now they don't cover the procedure. It is a fact that insurance reimbursement is not certain and coverage can be withdrawn without warning. TO compensate for this risk, the prices must be higher. (Standard business: high risk -> high return)
United does not receive any money when they treat an Aetna patient. They are providing the service for free! Please read this again. If insurance does not cover ESWT, United makes receives no money for the treatment! Think about it, United has costs associated with the technician, transportation, administration and they receive nothing.
It is hard to understand United's policy of not charging a fee for providing this service. They only logical explanation is that they beleive that in the long run they will make a lot of money. Make no mistake, United is setting the price at $0. I hardly consider this price excessive!
Finally, United could not give away service unless they were making a lot of money from paying cases. After all, they are performing more free cases than paying cases. Thus, if you have insurance coverage, look out, United's changes should be high to insurance and your co-pays might well exceed $1000.
Re: how to get eswt on salePauline on 10/30/04 at 10:22 (162497)
I like my idea better. Let the cost for ESWT drop to $50 per foot and let patients pay for their own coverage.
Re: how to get eswt on saleEd Davis, DPM on 10/30/04 at 10:32 (162499)
John: Please see my post above to clarify this issue. United can only not hold the patient responsible for the contractural percentage (less copayment and deductible) that the INSURANCE COULD BE EXPECTED TO PAY.
I am fairly certain that this is the case since insurance law has some state differences but this particular area should not vary that significantly.
Re: how to get eswt on salePauline on 10/30/04 at 10:38 (162501)
United and other providers are using this method not to simply provide ESWT, but to try and force insurance companies to begin coverage. They are hoping that insurance companies that are paying will buck heads with those that they consider are not paying their fair share and then of course there is the legal costs involved in going to court each and every time. They are hoping the insurance companies would rather pay them up front than to pay court costs defending themselves on a regular basis. You've got to admit it's a cleaver idea and kid yourself not they are not the only company doing this.
It's really about FORCE rather of compassion. If they don't do something they have dust collecting ESWT machines on their hands. They already see the bucks they just need a way to get their hands on it. TRY FORCE.
As far as cost recoverage , you haven't divided it up among all the doctors in the group. Now they are painting a story of financial struggling, but that cost will be made up in a weeks time if there was insurance coverage along with a very hefty profit and I assure you ESWT will be used on everything and anything a doctor can possibly adapt it to safely.
It's the new toe nail clipping income of this century. Very easy income. Do you honestly think when they can smell the income they will drop the drive? Never.
Re: how to get eswt on saleDr. Z on 10/30/04 at 11:55 (162506)
You explanation is right on the money. They are in hopes that they can get the doctor who they reward by not charging the tech equipment to non-covered patients. For example.
Patient one- no insurance doctor makes deal for $500 and United eats the cost
Patient two done on the same day has insurance that will cover the tech fee at $7000
Pateint three- same deal
So the doctor now gives refers to United cause they are making money on both the insurance cases and non-covered cases
So the doctor now use United over and over cause he never has to ask
the patient for money to pay for the equipment.
United is happy they receive cases they wouldn't have received
There are laws in the state of New Jersey that prohibit the knick of any service to order to receive a service.
Re: how to get eswt on salejohn on 10/30/04 at 12:09 (162512)
I can see $50 per foot if you pay for the equipment and its operatation. Otherwise, $50 per foot is a false hope given the high cost of the equipment. If you have problems with the high price of ESWT, write to Healthtronics and Dornier and demand that they sell their equipment for the same price in the US as in Europe! A drop in equipment prices would lower ESWT for everyone
Re: how to get eswt on saleDr. Z on 10/30/04 at 12:19 (162515)
This all goes back to the FDA approval process expense. I just had to replace a small part on my Dornier guess what there was no insurance The best method with handling the cost of ESWT would be to have no insurance coveage or a flat rate that the patient could contribute to the expense. This would be very similiar to what is done in denistry.
Re: how to get eswt on salejohn on 10/30/04 at 12:24 (162517)
Do you really think that United can force insurance companies to cover ESWT? I think that insurance companies have lawyers and can easily handle United. From what I can see, the way to force insurance companies to cover ESWT is to publish high quality, properly conducted studies showing positive results. I do not believe that treating large numbers of patients will results in coverage. Insurance companies use the standards of evidence based medicine to make coverage decisions not number of people treated!
No one is painting a story of financial struggling for United. Quite the contrary, it is my understanding that their investors do quite well. In most cases, the podiatrist investors have made back their entire investment within 12 months! My point was that ESWT is risky and that investors should be rewarded for risk since at any moment they may lose their entire investment.
Podiatrists should be reimbursed comparable to surgery since we do not want to provide a financial incentive for surgery over ESWT.
Re: how to get eswt on saleEd Davis, DPM on 10/30/04 at 15:21 (162548)
Obviously it is United's goal to get as many ESWT treatments out there as possible because they KNOW that it will be successful in the vast majority of cases. The more success, the more demand for their service. But it will not just benefit United, the increase in demand will, ultimately create heightened public recognition and overall demand.
It will be very difficult for insurance companies, at a point, to argue against the efficacy of ESWT when United comes to them with thousands od sucess cases.
I went through a similar situation about 9 years ago over the issue of electronic stimulation of non-unions. My state's workers comp. carrier refused to pay for electronic bone stimulators. I had a patient who had seen 3 docs, operated on twice in one year but a fracture would just not heal. His worker's comp carrier refused my proposal to place an electronic bone stim on him. The company lent me one and in 6 weeks, the patient was 70% healed (it was a Jone's fracture-a fracture of the 5th met. base -- outside of the midfoot). I sent before and after radiographs to the director of our worker's comp. program and he changed his mind on allowing the treatment. It is harder for third parties to argue against patients who have been cured and United is out to get as many cures as possible.
Re: how to get eswt on saleDr. Z on 10/30/04 at 17:25 (162566)
I agree showing results is important and helped me get insurance companies to pay for ESWT in my area years ago. The problem is in my area there is alot of coverage so why would a company use the same policy . It is my opinion to control the market. In New Jersey you can't pay for referrals and you can't bill the patient one fee and the insurance company another fee as policy. Giving away free tech services is giving away free . Yes I would love to hear this explanation from United or Bruce Cohen. It would clear things up that our attornies tell us just can't do cause you will end up with a big problem.
I will tell a story told to me by a attorney who was a patient of mine years ago. We use to buy lotto tickets in my office and the the jack pot was millions.
I told the attorney-patient that I was going to open a FREE foot clinic and every one will take a number and my office hours will be from 9-12 every day.
I really though that would be fun and at the same time help patients.
Well he read me the riot act. That would be great doc but you just violated the anti-trust act. You can't give away your services for free
when the other podiatrist are charging a fee . It is just against the law. Strange but very true. With time I have a feeling that that we are going to see this happen . I just hate to see the damage it may cause.
Just can't understand why we can't just keep it simple. A fair fee for a great procedure.
Re: how to get eswt on saleDonald Iain Scott on 10/31/04 at 00:02 (162585)
The price for a Dornier EPOS Ultra is around the $250,000AUD to $350,000AUD for a brand new machine depending on the exchange rate between Australia and Germany. When our dollar took a nose dive last year it could ahve been higher. It all depends on the US Dollar and we all know who controls that!! Not us
The Dolcast machine sells for around $35,000 - $50,000AUD This is Radial Shock Wave Therapy (RSWT)
I believe the Dornier machine in the US is around $250,000USD, but that was a few years ago.
Re: how to get eswt on salejohn on 10/31/04 at 00:12 (162587)
I had heard that the Dornier Epos Ultra sells for USD 350,000. Based on your numbers, the selling price in Australia is significantly lower than the price in the US (AUD250,000 = USD 187,000). It doesn't seem right that Dornier charges double to US customers.
Re: how to get eswt on salePauline on 10/31/04 at 11:27 (162620)
Is the treatment protocol for patients to qualify for ESWT the same in Australia as in the U.S.? I was just wondering if patients could be treated any sooner or do they still have to have had P.F. for six months prior to treatment?
I've often wondered if ESWT was provided sooner if all patients would have positive responses.