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11/22/2002    Bret M. Ribotsky, DPM

National Foot Care Program, Inc.

RE: National Foot Care Program, Inc.
From: Bret M. Ribotsky, DPM

Today I opened my mail and received a letter
from the National Foot Care Program (NFCP) saying
that they are contracting into my area and
represent 400,000 members, including Fortune 500
Companies. Having received many of these type
letters I tend to look at two items. Do they
charge for an application fee? And how much is
the reimbursement?
I had trouble to control myself from
laughing out loud when I got to the fee
schedule. The reimbursements are the following:
99201-99215 $20
28725 Pantalar arthrodesis $600
28100 Excision of bone tumor calcaneus $350
28045 Excision tumor deep, intramuscularly $140
11040-42 Ulcer Debridement Paid as office
visit thus - $20
11720-21 Nail Debridement Paid as office
visit thus - $20
Once I recovered from the "shock" that some
of my podiatry 'brothers' must be accepting this
fee schedule, sadness came upon me.
WAKE UP! Do not sell yourself like this.
I am sure there is a DPM involved in this company
and I am not sure how you can sleep at night with
these fees. My allopathic friends would never
even receive a fee schedule like this.
I implore APMA to continue to pursue legal
action against this company and others. I for one
would be willing to pay a dues assessment to
fight for our survival.

Bret M. Ribotsky, DPM
Boca Raton, FL

Other messages in this thread:

11/23/2002    Drs. Lloyd S. Smith, Ross E. Taubman, Neal Frankel, R. Kurt Meier, III, Kove Schwartz, DPM, JD

National Foot Care Program, Inc. (Bret M. Ribotsky, DPM)

RE: National Foot Care Program, Inc. (Bret M.
Ribotsky, DPM)
From: Drs. Lloyd S. Smith, Ross E. Taubman,
Neal Frankel, R. Kurt Meier, III, Kove Schwartz,

APMA has worked cooperatively for several
years with the Michigan Podiatric Medical
Association regarding National Foot Care. This
program eminated from Michigan and the auto
companies. It is legal and legitimate. APMA
agrees that the fee schedule is abysmal and
recommends members carefully evaluate all
contracts, fees and conditions before joining any
managed care plan.

Lloyd S. Smith, DPM
Vice-President, American Podiatric Medical
Chair, Health Policy Committee


There are two basic problems that continue
to allow insurers to pay Podiatric physicians at
a lower fee schedule than MD or DO providers.
The first is that health insurance is regulated
by State laws. Currently, only six states have
statutes on the books that make it illegal to pay
DPM’s less than MDs and DO’s. The second issue
is that self-funded plans are governed by the
Federal ERISA laws. Currently, these laws also
makes it permissible for self-funded plans to pay
DPM’s differently than MD’s and DO’s for the same
APMA is working on multiple fronts to
resolve these issues. APMA is assisting numerous
States to change their State laws to force
insurers to pay DPM’s on parity with MDs and
DO’s. Additionally, APMA is currently evaluating
the feasibility of a national law suit against
insurers. A national health law firm will be
hired by APMA to evaluate the merits of such a
suit, based upon State and Federal laws. APMA
continues to push for Federal changes in the
ERISA statutes to eliminate the permissiveness to
pay DPM’s the same as MDs and DO’s.
Unfortunately, the Patient Bill of Rights, which
would eliminate this problem for DPM’s, has
failed to be enacted by Congress for the past
several years.
Until these issues are satisfactorily
resolved, each podiatrist must evaluate each
individual contract to make a reasonable
determination of the merits and value of the

Ross E. Taubman, DPM
Chair, APMA Health Systems Committee
APMA Board of Trustees


When I read Dr. Ribotsky's post I really
thought it was funny. Not because of how lousy
the fee schedule for National Footcare Program
is, but the fact that he suggested that the APMA
fight this plan on our behalf. In other words, we
are too stupid to know that we are losing money
so the APMA should "save" us from ourselves. My
comment is how many DPM’s sign similar contracts
without even knowing the fee schedule? How many
are currently getting $20 for an office visit and
$600 for a pan-talar arthrodesis without even
knowing what they signed? My answer is too many.
The only mistake the National Footcare Program
made is sending out the fee schedule in the first
place. If they didn't probably over 50% of the
podiatrists receiving it would sign it without
even asking. Then they would come on this forum
and complain on how they are being taken
advantage of. I don't think the APMA needs to
spend our money to save us from ourselves. The
joke is on those who sign it.

Neal Frankel, DPM
Chicago, IL.


I too laughed about the National Foot Care
Program. I called the woman in Michigan and, a
la John McEnroe, said "You CAN'T BE SERIOUS!"
When discussing how inappropriate the fees were,
she offered me the option of "Carving Out" (or
some such language) if I didn't participate
with "Multi Plan". I asked her what Multi Plan
was, and she said it was "Big in NJ". Trying to
pin her down, all I could get from her was "A LOT
of Fortune 500 companies use the "National Foot
Care Program". Needless to say, I cannot see
working up a diabetic patient new to my practice
for at risk foot care and happily collecting $20
in 6-8-10 weeks. I asked her if she made more
than $2/hr, which is about what my earnings would
be if I got the $20 and was LUCKY enough to have
2 new patients from their plan! It is time we
become, as a profession, (quoting the
movie "Network"), "I’m mad as hell and not going
to take it anymore!!!

R. Kurt Meier, III D.P.M.
Brick, NJ


I just returned from a ASC survey in
Indianapolis on Tuesday. You might be interested
to know that there are only two payers for foot
care services in that area...BC/BS and the
National Foot Care Program. Some practitioners
who refused to participate in the NFCP program
are out of practice. Others willing to accept the
fee schedule have replaced them.
Yes, there is a podiatrist, Lee Hoffman, who
is their Medical Director. Say what you will
about Dr. Hoffman, he is playing the game and
probably doing quite well at it. Until
podiatrists are willing to "just say no", people
like Dr. Hoffman and the unions he represents
will push practitioners over the edge and never
look back.
I'm so pleased to no longer be in practice.

Kove Schwartz, DPM, JD
Newington, CT