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Cost of Orthotics

Posted by elvis on 7/04/05 at 18:16 (177808)

At some point in the last month someone asked me how much orthotics cost in San Diego. I received an insurance statement today and it indicated $225 for the orthotics. The insurance company did not pay anything. The doctor expectd that and said he will fight with the insurance company. The orthotics are very rigid and are called ' Sporthotics by Langer'. We're still tweeking them to make them more comfortable.

Re: Cost of Orthotics

Elyse B on 7/04/05 at 19:52 (177812)

you got away cheap, I paid $600 insurance covered zippo, zilch, nado nunca. Consider yourself very lucky if doctor tries to help with insurance, he just might get the insurance company to cough up some dough, would not work if you called.

Re: Cost of Orthotics

Dr. Z on 7/04/05 at 20:01 (177814)

Elvis,
Didn't you pay for your foot orthosis to the doctor.

Re: Cost of Orthotics

elvis on 7/04/05 at 21:31 (177819)

I've had orthotics since 1989 and the insurance never paif for them. In fact I don't even remember if I put in a claim. Now that I have chronic pf the doctor said he would write a letter of necessity. We'll see what happens. It's helped alot with the heel pain but now I have some other pains emerging. Could be due to taking 18 months off, the orthotics or a combination of both.

Re: Cost of Orthotics

elvis on 7/04/05 at 21:35 (177820)

No. They wouldn't take my money. I offered to pay. they took the $20 co-pay and told me that they would send in a claim. If the ins co. didn;t end up paying then I would have to pay. I said 'OK'!!

Re: Cost of Orthotics

Elyse B on 7/05/05 at 02:33 (177828)

Yes I paid $600 for the orthotics and $250 for each office visit and $200 for each office visit after that for 'adjustments.' Insurance would not pay a dime of his office visit nor the orthotics.

Re: Cost of Orthotics

vince on 7/05/05 at 07:40 (177835)

Poor coverage for podiatric services are not paid for or paid poorly by many insurance co's because podiatrists have less than a steller reputation with the insurance companies from some bad past history. One instance was the rip-off practiced by some 'mutli practices medical clinics' had podiatrist on the staff. They handed out prescriptions for orthopedic shoes to everyone, you also had to see every medical specialty in the place, and they were turned in at the local shoe store for sneakers that were then sold on the street. This was a big source of $'s for junkies in the inner city areas. I worked in one of these areas, near several of these clinics and not a day went by when sneakers weren't offered for sale. They even came into the stores and business's and offered to get the size and style you wanted. Finally these clinic operaters were shut down but it took many years. A lot of the docs and shoe store owners got put away also.

Re: Cost of Orthotics

Elyse B on 7/05/05 at 08:37 (177841)

Wow Vince, i never knew that, that is some story on rip offs.

Re: Cost of Orthotics

Kathy G on 7/05/05 at 08:43 (177844)

My orthotics were $400, I think. I honestly don't remember. But that counted any adjustments that were made and the retreads that were done were only $50 or so. I would say it was outrageous but it actually was cheap when I consider how much good they've done me.

It's very unusual for medical insurance to cover orthotics or any devices, such as splints, etc. We're lucky they pay for Pod's! Once again, logic doesn't apply. If they pay for a visit to a podiatrist, why won't they pay for the orthotics that doctor recommends?

Re: Cost of Orthotics

Ralph on 7/05/05 at 08:58 (177847)

Elvis,
That's what my Pod gave me and all the tweaking, sanding and filing that was done still didn't make them wearable. I hope you have better luck.

Personally I think for me to wear an orthotic especially on my left foot it must have some type of groove in it for the tendon that runs the length of my foot. This baby sticks out and when anything presses on it there is pain. This is not the only place that my foot is sore. I also have pain on the outside of my foot similar location to where the doctor presses to see if you have P.F. on the inside of the foot, but mine sore spot that makes me jump is on the opposite side of my foot, the outside. Strange isn't it.

Re: Cost of Orthotics

Ralph on 7/05/05 at 09:18 (177849)

Elyse,
I'm surprised by the costs for adjustments, but when I went and looked at my bills I too charged for 'office visits'. Not $200. It was $85 for my repeat visits which were only for adjustments because nothing else was done to my feet. My insurance picked up the cost probably because of the way it was coded.

You seem to have really been taken to the cleaners each and every time you went to that doctors office. Maybe it's because you live in NYC but at those costs we know your doc isn't going hungry.

Re: Cost of Orthotics

Ralph on 7/05/05 at 09:51 (177851)

Elyse,
There was and perhaps still is some health care fraud that exists. Its not just in Podiatry but here is one that surfaced quite a while ago. The unfortunate thing is todays Pods. sometimes still pay the price for those that took advantage of the system because people remember it.

'Billing frauds A $2,600 toenail
Another form of fraud that has become prevalent under discounted fee-for-service managed care is upcoding÷claiming for a service with a higher reimbursement than the service actually performed. Instead of a small toenail fee, one podiatrist claimed a $2,600 foot operation for each nursing home patient. Most upcoding is not this blatant and easy to detect'.

It's important to remember is that Health Care Fraud didn't just happen in the field of Podiatry it became a big business in many different areas of medicine.

'Health care fraud and abuse exist on many levels,' says Edward Hopkins, health care lawyer at Steel Hector & Davis in West Palm Beach, Fla.

'Level one is fundamental theft. There is a great deal more of that than we'd like to believe. It starts with people entering a program such as Medicare with the intent from day one of fleecing the system for as much as possible until they are caught or decide they have enough. Here in south Florida, we have observed several forms of this. A durable medical equipment supplier buys a list of Medicare members and patients and fabricates claims. It can make millions in twelve to fifteen months. We're probably only talking about one-tenth of one percent of practitioners÷but they are draining a lot of money out of the health care system.'

Sooner or later I think they get caught.

Re: Cost of Orthotics

Ed Davis, DPM on 7/05/05 at 16:52 (177880)

vince:
That scandal had occurred in NYC.

The code for orthotics is L3020 and almost any practitioner can bill for orthotics using those codes including physcial therapists, chiropractors etc. Orthopedic surgeons sit on the review boards of many insurance companies and have been the real reason as to why orthotics are not covered. (There is a very long history of animosity between orhtopods and podiatrists that is only recently showing signs of improvement). Incredibly, there is not even a CPT code for orthotics. Having a CPT code adds a level of 'legitimacy' for a service and a CPT code for high energy ESWT is expected in 2006.

By the way, about 70% of health plans in the Seattle area do cover orthotics. Since they cover the orthotics, they set the fee; a fee which is the same if I make a good pair or a bad pair. By making good ones my profit margin goes down but patients and doctors know they are getting a good device and will often choose my services.
Ed

Re: Cost of Orthotics

Ed Davis, DPM on 7/05/05 at 17:39 (177884)

Ralph:

You are probably speaking about a plantar fascial groove which is a groove cut into the orthotic which allows direct pressure to be taken off the plantar fascia which is bulging and swollen while having the orhtotic conform to your foot closer.

Also, the goal of the orthotic is to reduce pronation at the subtalar joint (back of the foot) while reducing oversupination at the midtarsal joint (front of your foot). The lack of good midtarsal control may be causing the pain on the outside of your foot.
Ed

Re: One clue...

Ed Davis, DPM on 7/05/05 at 17:44 (177885)

Ralph:
Your podiatrists who are better at biomechanics tend to use better labs. One trick is to work backwards -- call the lab (one of the top ones) and find out who they use in your area. Many of the professional sports teams as well as I use Northwest Podiatric Laboratory of Blaine, WA. They do an excellent palntar fascial groove and when making forefoot valgus posts (something you may need) they do a very good job at it.
Ed

Re: Cost of Orthotics

Dr. Z on 7/05/05 at 19:21 (177890)

Ed,

I find that patients will pay for a good service and effective service if explained the need. There is no policy that states that any kind of orthosis MUST be covered just as this is true for eye glasses, braces etc.
There are patients paying thousand of dollars for dental implants etc. The reason orthosis aren't covered is that there is TOO MUCH of a need and the cost and expense to the healthcare delivery system can't handle this.

Re: One clue...

Ralph on 7/05/05 at 21:19 (177892)

Thanks for the tip Dr. Ed.

Re: Cost of Orthotics

Ed Davis, DPM on 7/06/05 at 00:49 (177897)

KathyG:
It is a long story but it basically starts in the late 1940's when the 'Blues' formed to provide surgical coverage. Many of the original paragraphs can still be found in the contracts -- there is a strong bias toward surgery. Things are slowly changiing with the majority of plans out West paying for orthotics. Many trends, for better or worse, seem to start on the west coast.
Ed

Re: Cost of Orthotics

Ed Davis, DPM on 7/06/05 at 00:52 (177898)

Ralph:
No offense to New Yorkers but a lot of practitioners in NYC march to a different drummer. It is a great city but one has to accept the good with the bad, I guess. It is very unlikely that the experiences mentioned here would have occurred in the Midwest.
Ed

Re: Cost of Orthotics

Ed Davis, DPM on 7/06/05 at 01:08 (177902)

David:
The same holds true for ESWT and a number of services. The way insurers can deal with this is via tiered coverage or by allowing a fixed benefit toward the service or device -- I see that as the only way for insurers to deal with all the new services on the horizon...
Ed