Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 Our insurance covers our doctor, but just to give you an idea of what we would have to pay out of pocket if the insurance didn't cover him, they billed the insurance company $414.00 for bilateral leg casts, $240 for cast supplies for both legs, and $70 for an established patient visit, so about $724.00 per visit for the casting. He only needed three, but that would have been almost $2200.00. Obviously, it's not that much now since he just goes for checkups to make sure his feet are doing okay. I think that's still $70.00. Are you sure there's no way your insurance would cover even 50% out of the network? and BCF 03/25/2004 DBB 23/7 Paying out of pocket > I am curious if anyone has had to pay out of pocket for a visit and > casting. I am trying to get an appointment with Dr. Herzenberg and I > know my insurance won't cover ANYTHING out of network. I am willing > to pay whatever I need to but have no idea how much it would be. I > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's feet > asking for their help. My son has been in weekly serial casting for > three months now and he still has a long way to go. Not to mention > the left cast keeps slipping off. I am going with my gut and I > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive I > should see him. I have read wonderful things about him on this board. > > > Tommy Lee BL Clubfoot 4/23/04 > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 I think they said at Iowa it would run around the $600 - 700 range per casting-visit. Get the billing department to work otu payment arrangments with you, if you've gone three months will little progress then it's time to find a " real " doctor. s. Paying out of pocket > > > > I am curious if anyone has had to pay out of pocket for a visit and > > casting. I am trying to get an appointment with Dr. Herzenberg and I > > know my insurance won't cover ANYTHING out of network. I am willing > > to pay whatever I need to but have no idea how much it would be. I > > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's feet > > asking for their help. My son has been in weekly serial casting for > > three months now and he still has a long way to go. Not to mention > > the left cast keeps slipping off. I am going with my gut and I > > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive I > > should see him. I have read wonderful things about him on this board. > > > > > > Tommy Lee BL Clubfoot 4/23/04 > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 OMG! And I thought we had expensive castings. Our first cast was $198 - total. We then switched to Shriners and haven't paid anything since. WOW... and they say this method is cheaper than surgery lol! Maybe by a few bucks hehe... $240 for cast supplies? What'd they use? Gold plated casting material? I can buy the stuff at the local craft store for about $10. Jeez! Kori At 01:08 PM 8/5/2004, you wrote: >Our insurance covers our doctor, but just to give you an idea of what we >would have to pay out of pocket if the insurance didn't cover him, they >billed the insurance company $414.00 for bilateral leg casts, $240 for cast >supplies for both legs, and $70 for an established patient visit, so about >$724.00 per visit for the casting. He only needed three, but that would >have been almost $2200.00. Obviously, it's not that much now since he just >goes for checkups to make sure his feet are doing okay. I think that's >still $70.00. Are you sure there's no way your insurance would cover even >50% out of the network? > > and >BCF 03/25/2004 >DBB 23/7 > > > Paying out of pocket > > > > I am curious if anyone has had to pay out of pocket for a visit and > > casting. I am trying to get an appointment with Dr. Herzenberg and I > > know my insurance won't cover ANYTHING out of network. I am willing > > to pay whatever I need to but have no idea how much it would be. I > > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's feet > > asking for their help. My son has been in weekly serial casting for > > three months now and he still has a long way to go. Not to mention > > the left cast keeps slipping off. I am going with my gut and I > > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive I > > should see him. I have read wonderful things about him on this board. > > > > > > Tommy Lee BL Clubfoot 4/23/04 > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 I was also going to pay out of pocket to Dr. Herzenberg until I found out that he actually is in network for my insurance. His office said that the initial visit was $319.00 and that does not include x-rays. Mom to 12/17/98 and Christian 1/30/04 (unilateral clubfoot) . _____ From: giannasmommy2002 Sent: Thursday, August 05, 2004 3:15 PM To: nosurgery4clubfoot Subject: Paying out of pocket I am curious if anyone has had to pay out of pocket for a visit and casting. I am trying to get an appointment with Dr. Herzenberg and I know my insurance won't cover ANYTHING out of network. I am willing to pay whatever I need to but have no idea how much it would be. I sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's feet asking for their help. My son has been in weekly serial casting for three months now and he still has a long way to go. Not to mention the left cast keeps slipping off. I am going with my gut and I figure if one of the best (Dr. Herzenberg) is just a 4 hour drive I should see him. I have read wonderful things about him on this board. Tommy Lee BL Clubfoot 4/23/04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 , I can't help you with costs as here in Canada, we're pretty lucky with health care. However, I know that some here on the list have challenged their insurance companies and won...hopefully they'll respond to your message and let you know how to go about it. Daiga and Owen, 02/04/03 Unilateral LCF, FAB 14/24 > I am curious if anyone has had to pay out of pocket for a visit and > casting. I am trying to get an appointment with Dr. Herzenberg and I > know my insurance won't cover ANYTHING out of network. I am willing > to pay whatever I need to but have no idea how much it would be. I > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's feet > asking for their help. My son has been in weekly serial casting for > three months now and he still has a long way to go. Not to mention > the left cast keeps slipping off. I am going with my gut and I > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive I > should see him. I have read wonderful things about him on this board. > > > Tommy Lee BL Clubfoot 4/23/04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 Hi , I do not have any experience with paying out of pocket but thought I'd mention that Dr. Herzenberg is on vacation until 8/18 so you will probably not hear back from him until then. Unless of course he has email access! My advice would be to call his secretary Shiela and make an appointment now so that you are not waiting even longer. Her number is . Tommy Lee has been in casts for a long time. Glad to hear you are seeking a second opinion/new doctor! Marilouise 9/9/03, LCF, cast #4/2nd series Owen and 3/20/99 > I am curious if anyone has had to pay out of pocket for a visit and > casting. I am trying to get an appointment with Dr. Herzenberg and I > know my insurance won't cover ANYTHING out of network. I am willing > to pay whatever I need to but have no idea how much it would be. I > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's feet > asking for their help. My son has been in weekly serial casting for > three months now and he still has a long way to go. Not to mention > the left cast keeps slipping off. I am going with my gut and I > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive I > should see him. I have read wonderful things about him on this board. > > > Tommy Lee BL Clubfoot 4/23/04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 Hi again , Had a thought about the insurance. Is your insurance through work? If you have confirmed with a phone call yourself to your insurance that Dr. H is out of network, try going through your company administrator that handles the insurance. I have known of people who have gotten stuff covered because the company " fought " for them. Marilouise 9/9/03, LCF, cast #4/2nd series Owen and 3/20/99 > I am curious if anyone has had to pay out of pocket for a visit and > casting. I am trying to get an appointment with Dr. Herzenberg and I > know my insurance won't cover ANYTHING out of network. I am willing > to pay whatever I need to but have no idea how much it would be. I > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's feet > asking for their help. My son has been in weekly serial casting for > three months now and he still has a long way to go. Not to mention > the left cast keeps slipping off. I am going with my gut and I > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive I > should see him. I have read wonderful things about him on this board. > > > Tommy Lee BL Clubfoot 4/23/04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 Was it your experience as well that you sought a second opinion. I figure I am going to follow my gut as I really think my son should be progressing faster. Don't get me wrong his feet look much better than when he was born but they are stll a far way from full correction. After reading so many bad experiences on this board I feel it is better to be safe than sorry. And to me I think seeing Dr. Herzenberg will put my mind at ease. Why go through all this casting if it is not making much of a difference and set my baby up for sores and blisters because he is not ready for the shoes...and further down the road relapse. Now that I look at the calendar I realizw he has already had 12 casts. Tommy Lee 4/23/04 > > I am curious if anyone has had to pay out of pocket for a visit and > > casting. I am trying to get an appointment with Dr. Herzenberg and I > > know my insurance won't cover ANYTHING out of network. I am willing > > to pay whatever I need to but have no idea how much it would be. I > > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's feet > > asking for their help. My son has been in weekly serial casting for > > three months now and he still has a long way to go. Not to mention > > the left cast keeps slipping off. I am going with my gut and I > > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive I > > should see him. I have read wonderful things about him on this board. > > > > > > Tommy Lee BL Clubfoot 4/23/04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 Hi , Yes, we sought a second opinion with Dr. H on July 9th. will be 11 months on 8/9. She has 10 casts and a tenotomy the first go round. Now she will get cast #5 tomorrow, cast #6 on 8/16 and a second tenotomy on 8/20 under Herzenberg's care. Her first doc simply deviated from the full Ponseti protocol and her foot wasn't fully corrected. I hope Sheila can get you on his schedule ASAP (explain Tommy Lee's history of treatment) and I really hope you can figure out something with your insurance. I am sure with Tommy Lee still being so young that Dr. H will have his foot looking wonderful in no time! Marilouise > > > I am curious if anyone has had to pay out of pocket for a visit > and > > > casting. I am trying to get an appointment with Dr. Herzenberg > and I > > > know my insurance won't cover ANYTHING out of network. I am > willing > > > to pay whatever I need to but have no idea how much it would be. > I > > > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's > feet > > > asking for their help. My son has been in weekly serial casting > for > > > three months now and he still has a long way to go. Not to > mention > > > the left cast keeps slipping off. I am going with my gut and I > > > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive > I > > > should see him. I have read wonderful things about him on this > board. > > > > > > > > > Tommy Lee BL Clubfoot 4/23/04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2004 Report Share Posted August 5, 2004 At 05:49 PM 8/5/2004, you wrote: >Now that I look at the calendar I realizw he has >already had 12 casts. at least 3 too many. The Ponseti Method corrects in 3-7 - with 5 being average. 9 being the max. The last two will abduct the foot quite a bit - so it's essentially corrected before the last one which is typically the tenotomy cast worn for 3w. So if baby starts treatment at 1w old he should be done by the time he's 11w old. You are wise to get a new Dr. Any of the Ponseti Dr's will tell you 12 casts is too many. Wow, poor little man! Poor you! That's a lot of Dr's appointments! Kori Mama of Kenton - 6/98 Merek - 3/00 Darbi - 3/28/03 - Rt. CF - DBB 12hr/d (¨`·.·´¨) `·.¸(¨`·.·´¨) `·.¸.·´ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2004 Report Share Posted August 6, 2004 Also just thought of it, you might be able to talk the doc into getting on your network, some docs will do that. You can call your insurance and see about how to get him on if he is willing. All it is, is usually they get less money from the insurance when they are in the network but alot of docs don't mind. Something to think about. I have had docs do it for me before. Tyler's mommy bi lat cf 1/14/03 second set of second round of casting with Dr. Dobbs -- In nosurgery4clubfoot , " littlebrat2002 " wrote: > Not to scare you but last year alone my insurance paid my son's Dr > 48,000. And his feet were in not much better shape then when we > started. I switched to Shriner's because my hubby got new insurance > and plus I wanted to see Dr. Dobbs. I was willing to do anything > though to get my son's feet fixed for him. I even seen Dr. Dobbs at > St. Louis Children's because Shriner's couldn't get him in for > awhile. Really though you should talk with your insurance and see > if there is some way that they will at least pay a percentage, most > have out of network rates. Our insurance changed to where my last > doctor was not on the list, I called them to see what I could do and > they said since I have out of network coverage they wouldn't do > anything, but if I didn't have it they would have paid the regular > amount. Don't make sense to me but what I am trying to say is it is > worth looking into. > > > Tyler's mommy > 1/14/04 > second set of casts, second round of casting > with Dr. Dobbs > > > > > I am curious if anyone has had to pay out of pocket for a visit > and > > casting. I am trying to get an appointment with Dr. Herzenberg > and I > > know my insurance won't cover ANYTHING out of network. I am > willing > > to pay whatever I need to but have no idea how much it would be. > I > > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's > feet > > asking for their help. My son has been in weekly serial casting > for > > three months now and he still has a long way to go. Not to > mention > > the left cast keeps slipping off. I am going with my gut and I > > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive > I > > should see him. I have read wonderful things about him on this > board. > > > > > > Tommy Lee BL Clubfoot 4/23/04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2004 Report Share Posted August 6, 2004 Hello Just had my little guy to see Dr. H last Fri. He is a wonderful Dr. We travel 2 hrs from PA to see him. Worth every second. Any way we recently had to change to an insurance that doesn't cover out of state Doctors. So I went there knowing I would have to pay out of pocket. When I got there the lady that deals w/the insurance Companies and payments told me that I would have to pay if I didn't have a referal. Well I told her that I couldn't get a referal for out of state Doctors with this insurance. So she brought me into her office and she called 3 different phone #'s trying to get 's visit payed for . AND GUESS WHAT IT WORKED!!!! I was so happy and thankful to her because she took the time to do all of that. What insurance do you have if you don't mind me asking? Also, I know that the visit just had was a follow up visit. He is already in the shoes and bar. And they told me if I was going to pay it would have been $138.00. I'm not sure about the castings..But if you call his secretary and ask her she should be able to tell you how much it would cost. Her name is Shiela. I hope this helps.. If you have any more questions feel free to ask. 5/10/03 dbb 12 hrs --------------------------------------------------------------------- Web mail provided by NuNet, Inc. The Premier National provider. http://www.nni.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2004 Report Share Posted August 6, 2004 Good decision to go for another dr. He sounds partially corrected, so hopefully it won't take too long to get him out of casts and onto maintaining correction! Louisa 6-27-99 Zoe 2-22-04 RCF > > > I am curious if anyone has had to pay out of pocket for a visit > and > > > casting. I am trying to get an appointment with Dr. Herzenberg > and I > > > know my insurance won't cover ANYTHING out of network. I am > willing > > > to pay whatever I need to but have no idea how much it would be. > I > > > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's > feet > > > asking for their help. My son has been in weekly serial casting > for > > > three months now and he still has a long way to go. Not to > mention > > > the left cast keeps slipping off. I am going with my gut and I > > > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive > I > > > should see him. I have read wonderful things about him on this > board. > > > > > > > > > Tommy Lee BL Clubfoot 4/23/04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2004 Report Share Posted August 6, 2004 Dear , I encourage you to ask your insurance to consider covering Dr. H at in-network rates! It is a little trouble to find the right person and submit the information they need, but several of us have been successful in receiving full coverage for out-of-network providers. It's not a matter of fighting your insurer- it's more that you are informing them of a method which is better from their perspective (cost) and yours (quality). In our case, I found the appropriate person in our insurance network (that was the toughest part!), emailed her information regarding Dr. Ponseti, an estimate of what would be involved (no. of visits, no. of casts, tenotomies- bilateral cf here- brace and shoes) and also included some of the studies which show the high rate of success of the Ponseti method. I stated my views of why, long term, I thought the Ponseti method would be both more cost effective and more healthy. We were approved very quickly for full in network coverage. We are covered by United Healthcare. We actually had learned of a dr. within our network who had visited Dr. Ponseti last summer and is now said to practice the Ponseti method (and very well may be). I disclosed this to our insurer and gave several reasons why we felt we still should go out of network (older baby, adopted so we don't know medical history, wanted a doctor with more experience to be able to spot anything unusual...). Even knowing this, they approved us for out of network! Also, we had already started treatment before we were approved, but our insurer made the coverage retroactive for us. It can be done! Please feel free to ask any questions. Caroline, mom to Zeke, 16 mos. bcf Dr. Ponseti > I am curious if anyone has had to pay out of pocket for a visit and > casting. I am trying to get an appointment with Dr. Herzenberg and I > know my insurance won't cover ANYTHING out of network. I am willing > to pay whatever I need to but have no idea how much it would be. I > sent Dr. Ponseti and Dr. Herzenberg emails with pics of my son's feet > asking for their help. My son has been in weekly serial casting for > three months now and he still has a long way to go. Not to mention > the left cast keeps slipping off. I am going with my gut and I > figure if one of the best (Dr. Herzenberg) is just a 4 hour drive I > should see him. I have read wonderful things about him on this board. > > > Tommy Lee BL Clubfoot 4/23/04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2004 Report Share Posted August 6, 2004 Hi , My insurance is MDNY which only covers doctors in NY and I have the plan that you cannot choose out of network. It really doesn't matter if I have to pay though I only want what is best for my son and I think Dr. Herzenberg is the guy. > Hello > > Just had my little guy to see Dr. H last Fri. He is a > wonderful Dr. We travel 2 hrs from PA to see him. Worth > every second. Any way we recently had to change to an > insurance that doesn't cover out of state Doctors. So I > went there knowing I would have to pay out of pocket. When > I got there the lady that deals w/the insurance Companies > and payments told me that I would have to pay if I didn't > have a referal. Well I told her that I couldn't get a > referal for out of state Doctors with this insurance. So > she brought me into her office and she called 3 different > phone #'s trying to get 's visit payed for . AND GUESS > WHAT IT WORKED!!!! I was so happy and thankful to her > because she took the time to do all of that. What > insurance do you have if you don't mind me asking? Also, I > know that the visit just had was a follow up visit. > He is already in the shoes and bar. And they told me if I > was going to pay it would have been $138.00. I'm not sure > about the castings..But if you call his secretary and ask > her she should be able to tell you how much it would cost. > Her name is Shiela. I hope this helps.. If you have any > more questions feel free to ask. > > > 5/10/03 dbb 12 hrs > -------------------------------------------------------------------- - > Web mail provided by NuNet, Inc. The Premier National provider. > http://www.nni.com/ Quote Link to comment Share on other sites More sharing options...
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