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Out of Pocket for ESTW??

Posted by Leslie B on 2/02/05 at 21:46 (168356)

Well, I thought that everything was all set for my ESWT next Monday. I was told that my HMO had approved everything and all the referrals had been sent. Then today, out of the clear blue, I find out that I will have to pay $1,000 out of pocket. My HMO only covers the payment to the doctor. I am desperately trying to get some answers - if this is ALWAYS the case, or only when the procedure is done outside a clinic/office in the mobile unit. I am working on getting my regular podiatrist to see if there is any way he can schedule me in at a surgery center before March 1 (the day my HMO will no longer pay ANYTHING for the ESWT). If I am correct, since it would be done IN a surgery center, maybe my HMO will pay most of the bill. I just don't have $1,000 to drop right now since I am unemployed. But my foot HURTS and I want this done!!

Leslie

Re: Out of Pocket for ESTW??

Dr. Z on 2/02/05 at 22:20 (168359)

Leslie,
There are two separate fees for ESWT. The payment to the doctor and then there is the payment for the equipment and technical services. There are limitations with HMO products. In order to do this is a surgical center
you must have an insurance policy that pays for ESWT equipment and you must have a surgical center that has a contract with an ESWT provider. Call Maria at Excellence and she can explain to you and answer any of your questions.

Re: Out of Pocket for ESTW??

Leslie B on 2/03/05 at 06:36 (168371)

I just wish I had been informed of this when I met with the doctor. I don't know at this point what my HMO will pay for. I am pretty sure that the surgery center has a contract with ESWT. I know my regular podiatrist goes there once or twice a month when the equipment is brought in. Thanks for your help!

Leslie

Re: Out of Pocket for ESTW??

vince on 2/03/05 at 07:19 (168374)

Go to http://www.unitedshockwave.com and find a podiatrist that uses their Dornier Epos ESWT equipment. You'll be suprised how much less your cost will be.

Re: Out of Pocket for ESWT??

Sarah B on 2/03/05 at 14:02 (168411)

I had the ESWT procedure from United Shockwave and since I do not have insurance my charges were $150 for the doctor and $500 to United. When I inquired about any discounts United told me they have a financial assistance program and they sent me an applicaation. Since I have been on medical leave from my job and am only getting a small short term disability payment, I figure I should qualify. I have not heard back on whether I have been approved or not but I am certain my financial status should qualify me for some relief of the total bill. I hope this helps.
the toll free number to United Shockwave is 877-465-4845 and ask for Patient Financial Services.

Re: Out of Pocket for ESWT??

Dr. Zuckerman on 2/03/05 at 14:46 (168415)

Leslie

Excellence also have a finanical program. Knowing where you live and your time frame March 1,2005 it is best to stick with your present provider who you know.

Re: Out of Pocket for ESWT??

Leslie B on 2/04/05 at 09:51 (168473)

Well, after making a thousand phone calls, it does look like my regular podiatrist will do the ESWT in a surgery center on Feb. 22, so my HMO should cover all or most of it. I still have not been officially told if it will just be my standard co-pay, but I think that's the case. I am thrilled that it looks like this is going to work out, afterall. But what a nightmare to get to this point!!

Leslie

Re: Out of Pocket for ESWT??

Dr. Z on 2/04/05 at 16:02 (168493)

Leslie,
I would make sure that you have everything in writing and your out of pocket expenses are clearing described to you in writing. Everything should always be official and in writing. How many times ( co-pays) will be required by you AFTER the ESWT treatment is done ?