How can I find assistance for a procedure not covered by Medicare?

1 answer | Last updated: Sep 14, 2010
A fellow caregiver asked...

Our podiatrist accepts Medicare. He just told us that my heel spur can be treated with extracorporeal shock wave, but no insurance will cover it. What can I do?

Expert Answers

It sounds from your question that the podiatrist is including Medicare in this statement about insurance. If so, you have to find out WHY your podiatrist believes that neither Medicare nor other insurance will cover the treatment. Extracorporeal shock wave is certainly an approved treatment for several medical conditions, including some bone spurs. But it is not approved for all types of bone spurs. And even when it can be approved for a certain condition, Medicare and other insurance may require that other types of therapy be attempted first. So, you need to ask the podiatrist whether the treatment is not approved at all for your specific condition, or whether it might be approved but only if other therapies are tried first.

If Medicare does sometimes approve extracorporeal shock wave treatment for your specific condition, you can ask your podiatrist to make an advance request to Medicare for coverage, BEFORE you undergo any treatment. Medicare may then give the podiatrist a better idea whether, in your case, there is a chance of Medicare coverage if certain steps are taken: further documentation by the podiatrist of your exact condition, for example, or the use of different treatment first.

If Medicare does sometimes cover extracorporeal shock wave treatment for your exact condition but your podiatrist is unwilling to make an advance request, you might consider consulting with another doctor. You can ask your primary care physician for a referral to another podiatrist, or instead to an M.D. who specializes in foot care. (A different doctor may be more willing to work with Medicare on getting you coverage for this treatment. Or, a different doctor may believe that other treatment, which is regularly covered by Medicare, can successfully treat your condition.)