The Center for Podiatric Care and Sports Medicine

Insurance From Head to Toe: Make Sure Your Podiatry Services Are Covered

Posted by on Tuesday, August 6th, 2013

A Milwaukee foot doctor has had his license suspended for 30 days for more than 92 allegations that he overcharged patients. According to reports, Dr. John Lanham told patients his office “accepted all insurance policies” — and later inflated charges and slammed them with the full cost of visits and procedures if the patients were not covered. “How can I stay in business if I have to disclose to patients that I’m not in their network?” he told the Milwaukee Journal-Sentinel, adding that patients would leave if they knew how much he was going to charge out-of-pocket. “I unfortunately have to survive on patients’ ignorance,” he added.

 

Is that unbelievable or what?! Here at our New York podiatric medicine office, our billing department discusses everything with you up front, so there are no surprises.

Insurance Providers In Our Network

To minimize out-of-pocket expenses for you, our doctors accept and participate in most insurance plans, including:

Aetna
Anthem
Beech Street
Blue Cross Blue Shield (BCBS)
Cigna
Elder Plan
Empire Plan
First Health
Group Health Inc. (GHI)
Guardian
Healthnet
Health Insurance Plan (HIP)
Horizon
Medicare
Montefiore CMO
Multiplan
Oxford
Private Health Care Systems (PHCS)
United Healthcare
1199 National Benefit Fund
32 BJ

If your insurance company is not on the list, please call our Manhattan office at (212) 996-1900 or our White Plains office at (914) 328-3400 to discuss prior to your visit. You can learn more about our Medicare coverage in one of our older posts here.

Podiatrist Copays & Deductibles

The amount you pay at the time of your visit (the “copay”) depends upon your individual health insurance plan. Generally, this visit fee may range from as low as $12 to as high as $55. The term “deductible” refers to the amount of coverage you are responsible for paying before your insurance kicks in to cover the rest. That, too, will depend upon the plan you have selected. Some people have a $0 deductible, so insurance will automatically cover any procedures or treatments needed. The trade-off is that these plans cost more for patients to buy. Other plans may have a deductible from $100 to $1,000 and higher. Unfortunately, there is nothing our office can do about the plan you have negotiated with your insurance provider. You may, however, always change your service level with your provider.

Flexible Spending & Health Savings Accounts

Many employers now offer a health savings or flexible spending account program for their workers to invest in, tax-free. A Flexible Spending Account enables you to redirect a portion of your salary to cover any type of medical expense that is not reimbursed under your current (or nonexistent) health care plan. Often times, insurance companies do not cover custom foot orthotics. Many patients use their Flexible Spending Accounts to pay for it. You may also use any money accrued in your medical savings account to cover the cost of your podiatrist copay, deductible and services.

Note: If you were involved in a car accident, your medical expenses may be covered under your auto insurance policy — especially if you are in a “no fault insurance” state like New York.

Changes Are Afoot

In the past, podiatry services were not considered as much of a “medical necessity” as they are today. We have seen other specialists get sidelined in the insurance debate as well — dentists, optometrists and chiropractors alike. Yet, the cost of preventative maintenance from these providers is essential to avoiding larger expenses and hardship down the road. Treating a small blister on the foot of a diabetic is quite a different animal from treating a diabetic foot ulcer, for instance. It’s literally the difference between a $50 fix and a $14,000 surgery.

That’s why courts in places like California are ruling that podiatry and other specialist services MUST be covered by state health insurance programs like Medi-Cal. Even so, there are still innovative and effective procedures (like lasers for toenail fungus, cryotherapy, hyperbaric oxygen wound healing and extracorporeal shockwave therapy) that are not always covered by insurers. We’re likely to see more progress on this front in the future. Until then, do not hesitate to contact us with any questions you may have about NYC podiatry coverage.

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.