Orthotics, inserts, heel cups, etc.Posted by john h on 1/03/05 at 16:34 (166455)
There seems to be a never ending supply of orthotics (custom, over the counter), heel cups, inserts or whatever that you can put in your shoes. I of course try most anything and will not even attempt to list all that I have tried. For me the bottom line is none of them cured me, some made me worse, and perhaps??? one or two may have helped a little. None of them ever equaled the help offered by Birkentstock sandals. For some people they apparently have been helpful but I would suspect that for many you should not place false in any of them thinking they will cure you. Be careful with what you place in your shoes as they can as ofen as not make you worse rather than better if they are not fitted properly or you do not need them in the first place. Beware anyone who wants to immediately fit you with orthotics without doing a thorough evaluation and explain to you exactly why you need them and what they are intened to do. Of all the product sold for our foot problems I suspect there are more foot inserts sold of various kinds than any other product.
Re: Orthotics, inserts, heel cups, etc.Richard, C.Ped on 1/04/05 at 09:22 (166473)
'Beware anyone who wants to immediately fit you with orthotics without doing a thorough evaluation and explain to you exactly why you need them and what they are intened to do.'
......and without a prescription.
Re: Orthotics, inserts, heel cups, etc.Robert J on 1/04/05 at 13:35 (166493)
Over Christmas I was talking to a neighbor at a party. He's a pod and I like him. Anyway, he got a little drunk at the party and began telling me about the economics of the pod business. It turns out that foot orthotics are one of the most profitable items they dispense. The 'custom' orthotics are usually manufactured at large off-site facilities. The manufacturing facility charges the pod about $75 for a standard pair here in Southern California. The pod then charges the patient $300. Plus he charges additional fees for the initial office visit, for making the plaster cast, and for follow-up adjustment visits. The total bill for a single pair of orthotics can easily go over $500.
Orthotics are also virtually liability free. There's no downside to over- prescribing them because they may not help but they don't do the kind of damage that can produce a lawsuit.
So if there's a question why orthotics seem to flood the world of PF sufferers, I think the answer is economics. Right now I have three pair of custom orthotics (one for each pod I saw) sitting in my closet. Total cost: about $1400. Total benefit to me: none. Benefit to the dispensing pods: plenty.
Re: Orthotics, inserts, heel cups, etc.Elyse B on 1/04/05 at 13:55 (166494)
Great post Robert. I feel the same way. One podiatrist told me point blank that she earns her living by dispensing orthotics. It is a win/win situation.
Re: Orthotics, inserts, heel cups, etc.Dr. Z on 1/04/05 at 15:28 (166495)
How about not getting any referrals from satisfied patients.? That is a VERY expensive downside. How long would it take before your practice is gone. I have read about malpractice suits from orthosis. I am not disagreeing with all of your statments. I do believe that orthosis play a role in the treatment of plantar fasciitis and that not every one will need them or will they help you. I backup my statements up with a money back guarantee for all orthosis that I dispense. So what was the pod drinking. Sure wish I was at this christmas party
Re: Orthotics, inserts, heel cups, etc.Elyse B on 1/04/05 at 15:38 (166496)
I forgot to add that my last pair was $600 and $200 for office visit and he has the NERVE to charge $200 for every office visit after that to get adjustments.
Re: Orthotics, inserts, heel cups, etc.Kathy G on 1/04/05 at 19:58 (166504)
With the new tops and padding, my orthotics are up to about $400 and worth every penny of it! I could not function without them and whatever my Pod made on them, he deserves. Figuring out the right type of orthotics for me, doing the adjustments, which were free, took up a great deal of his time. I have recommended him to many people, all of whom have been happy, and whenever asked, I have always told people to go with custom orthotics instead of wasting their money on OTC types.
I guess it's as individual as our foot problems are but for me, they are worth their weight in gold.
Re: Orthotics, inserts, heel cups, etc.Julie on 1/05/05 at 02:56 (166531)
Kathy, I'm glad you said this. I wanted to say something yesterday, but didn't - I've got tired of being one of the sole fans of orthotics and decided to skip this thread. But it's good you came in, and I will too now: it's important that people are given a balanced view. My orthotics were life-savers and foot-savers for me. I have never doubted that they were one of the key factors in my getting over PF, and probably the key factor in it not recurring.
Elyse, you've been unlucky in your providers, but I hope others will not be put off investigating orthoses by your understandably aggrieved comments. I agree with you that $600 is over the top, and that $200 for adjustment visits is extortionate.
Re: Orthotics, inserts, heel cups, etc.Elyse B on 1/05/05 at 07:38 (166534)
you said it Julie, it is extorionate but I never give up hope. I think that this Board is invaluable and should provide everyone with the appropriate questions (why do I need them, are the orthotics correcting biomechanical issues, have podiatrist watch you walk etc.) to ask podiatrists when they want to make you orthotics.
Re: Orthotics, inserts, heel cups, etc.Richard, C.Ped on 1/05/05 at 08:26 (166535)
I guess I am an idiot then. I only take what insurance allows. If someone does not have insurance, or the insurance does not cover, I discount the cost. I also do not charge for adjustments (ours almost never needs adjustments ;-) ).
I am not charging enough.
Re: Orthotics, inserts, heel cups, etc.Kathy G on 1/05/05 at 09:09 (166545)
You're not an idiot; you're a truly caring person. Some people go into medicine for the sole purpose of getting rich and some go into it to make a living and help people in the process. You're one of the latter. You're also not a fool and I'm sure you make enough money to support your family comfortably but you're not price gouging either.
I'm sure you sleep better at night than those jerks that poor Elyse has been to see.
And along with that, you frequently make us laugh! What a guy!:)
Re: Orthotics, inserts, heel cups, etc.Elyse B on 1/05/05 at 09:55 (166548)
even better, my insurance does not cover orthotics!!!!
Re: Orthotics, inserts, heel cups, etc.Dorothy on 1/05/05 at 10:39 (166550)
You're not an idiot! You're a good guy. I love hearing about practices such as yours of discounting costs in certain circumstances. When our first daughter was born, we didn't have insurance. We established a payment plan to pay off the hospital and doctor bill. They were really nice about it and it was just handled so decently and just very routinely. Of course, we never missed any payment and paid it all off early, but it took time. So we had our child on 'layaway' and she was almost three before we knew she couldn't be 'repossessed'!! ':-)
We were 'young', in graduate school, getting on our feet and all that...
Maybe it was a different era, even though it wasn't THAT long ago - but I'm heartened to read that you do something along those lines, Richard.
I think we all wish we had you in our 'neighborhood'!
Re: Orthotics, inserts, heel cups, etc.John H on 1/05/05 at 11:23 (166555)
I had an adjustment made to my orthotics about one month ago and a new cover was put on. Unfortunately they are worse. I can feel a high spot right where my pain is. Yuk.
Re: Orthotics, inserts, heel cups, etc.John H on 1/05/05 at 11:25 (166556)
You must have the Doctor from hell Elyse. You need to make an immediate change as $200 office visits are way out of the park unless he is doing a lot of other procedures.
Re: Orthotics, inserts, heel cups, etc.John H on 1/05/05 at 11:32 (166557)
This past summer I was having some physical therapy on my feet. The therapist had worked with a large group of doctors and did all their casting for orthotics and helped with gait analysis for some years. He offered to cast me for orthotics and spent about an hour looking at my shoes, gait and figuring out what might be the best orthotic for me. He said he would only charge me his cost and I could pay direct from his invoice. I paid $97. I assume these would have easily cost $300 if I had paid the usual cost. I am not knocking Doctors for mark up as I understand the cost of overhead including offices,nurses,insurance,bookkeeping,etc. I am just noting I got a good deal. He made his money on the PT which was discounted way down because of Medicare.
Re: Orthotics, inserts, heel cups, etc.Richard, C.Ped on 1/05/05 at 12:01 (166562)
Kathy: Nope, we are not price gouging at all. There are down sides to being nice. People try to take advantage of it. I could be more comfortable in what I make only if those would pay what they owe me.
Dorothy: We just paid the final bill for my son who was born in 2003. We finally really own him now. haha.
I try to treat people the way I want to be treated. I know of many places that will charge more if you do not have insurance. That just does not seem right to me.
Re: Orthotics, inserts, heel cups, etc.Elyse B on 1/05/05 at 16:07 (166573)
welcome to NYC and the world of not being covered by insurance.
Re: Orthotics, inserts, heel cups, etc.John H on 1/06/05 at 10:19 (166601)
I had a Doctor here in Little Rock who performed a procedure on me many years ago. After that he never again charged me for any visit for over two years whether it was related to the procedure or not. Unfortunately he retired. I still see him around. He is in his 80's now but still plays a lot of golf and travels to England where his son an family now live. I never asked him why he did not charge me. I wish I had. His son had been in the Air Force so maybe that was it?
Re: Orthotics, inserts, heel cups, etc.Kathy G on 1/06/05 at 18:57 (166618)
There may be doctors like Richard in NYC but I'd bet they're few and far between. According to my Pod, most insurance companies don't pay for orthotics. He does take credit cards but no payment plan was offered. ON the other hand, he doesn't push custom orthotics and in my case, that was too bad because they made a world of difference to me.
In the US, those who are uninsured pay for those who are. I can go to my chiropractor, pay my (increased) copay of $30 and I believe he gets maybe $10 from the insurance company. If I was uninsured, a visit with him would be something like $55. Who's getten taken to the cleaners? The person without insurance. It's a mess that no politician wants to take on because it's so out of hand, no one knows what to do.
I sure hope you get some relief, after having made such an investment.
Re: Orthotics, inserts, heel cups, etc.Kathy G on 1/06/05 at 18:59 (166619)
Obviously, I meant who's getting taken to the cleaners. Just got carried away with the 'ens.' If my children could see that, they'd be in hysterics because I was always a stickler for sounding their 'ing's.'
Re: John, was it your Footmaxx orthotics?Kathy G on 1/07/05 at 11:21 (166639)
I hope they can make another adjustment. I had a new cover put on, too, and my Pod made some adjustments which have benefitted me greatly. Hope they can redo yours and make them comfortable. The cover on mine is different from the one on my husband's. Mine is vinyl and his is leather. My Pod said he gave me the same kind of as he gives diabetics because of my super-sensitive feet. He says it doesn't wear as well but it's much less apt to cause problems.
Re: Orthotics, inserts, heel cups, etc.Ed Davis, DPM on 1/08/05 at 21:59 (166752)
$75 cost price??? You are talking about the super economy model. Unfortunately, you have simply run into an individual more interested in making a buck than curing patients. That exists in every profession. There are plenty of ethical podiatric physicians out there fabricating high quality, effective orthotics and they are paying a lot more than that.
Re: Orthotics, inserts, heel cups, etc.Dr. Z on 1/08/05 at 22:33 (166756)
I agree. So what is a fair price for orthosis? They are devices that are custom made. You must see a physician or Richard to have them made. You have years of training in biomechanics of the human foot.
Re: wowEd Davis, DPM on 1/08/05 at 22:36 (166757)
My initial response in reading posts like this is where on earth do patients find practitioners like that? Then I have to remind myself that you may not have wound up here if you did not get stuck with a practitioner who is a shm-ck. You may want to consider reporting that individual to the Board of Podiatric Medicine in your state. When docs report other docs in my state, the board does not listen because they assume we are trying to criticze a competitor. It must be the patient that launches the complaint.
Re: Orthotics, inserts, heel cups, etc.Ed Davis, DPM on 1/08/05 at 22:45 (166759)
Patients must keep in mind that they are paying a fee that includes the doctors expertise in performing an accurate biomechanical exam on the patient, gait analysis, taking measurements and impressions, placing the order, fitting the orthotic, and all aspects of the doctors overhead from insurance, staff and rent. If I factor all of that in, the cost basis to me on an orthotic is about $227 (naturally I, like you use a significantly more expensive lab). Unfortunately, when insurance companies pay for orhtotics they have no way of knowing which lab we are using, how much care went into taking the measurements, exam, etc. so their are some practitioners out there who do it on the cheap and take very short cut imaginable. I just assume that patients who get their orthotics from me will usually be back in a few years to get another pair as they are happy with what they got and will refer family and friends. The shlockmeisters out their who are in it for the quick buck will get little return business.
Re: Orthotics, inserts, heel cups, etc.Ed Davis, DPM on 1/08/05 at 22:48 (166760)
I did the calculation on orthotic cost about 3 years ago so I may be off, around 10-15% low.
Re: Orthotics, inserts, heel cups, etc.John H on 1/11/05 at 10:10 (166891)
Ed when you look at how much retail items are marked up in order for a business to remain viable then I guess $300 or orthotics is not bad. I think furniture is sometimes marked up 300%. Many retail items are easily more than double what the retailer pays for them. When you purchase an auto over $1200 of the cost of the vehicle is directly attributable to the cost of the health insurance of the auto maker.
Re: wowElyse B on 1/11/05 at 15:17 (166907)
don't make me say it Dr. Ed about practitioners like that. This guy is a huge muckety muck in NYC and he has columns in newspapers and is on t.v. all the time. Problem is, he has TONS Of patients. There have been posters on this board who have been 'cured' by this guy.