Pacemaker replacement cost

I have an Adapta pm implanted in 2010 and coming up on my first replacement soon. Medtronic told me the battery is encased so it won't be a battery change, but a pm replacement, keeping the same leads. My big concern here is my current cardiologist, who is wonderful, doesn't take my insurance. I tried to switch, but they don't take any of the three insurance providers available where I live. I'm trying to get the medical codes and cost, but does anyone know how much yours cost to replace? I can go back to my previous cardiologist, who is five hours away, but if were talking $20,000 out of pocket vs a five hour drive for insurance coverage, its worth it. I realize every situation is different, but I have no idea of cost. I appreciate any input while we try and get answers from the doctor and insurance company!

 

 


8 Comments

Cost

by Skeet - 2022-12-20 12:47:37

My first pacemaker 2007 was 30,000+. My replacement 2017 was 70,000+. I would check into it. Could save youself some money.

Skeet

Pm replacement cost

by Tinawired - 2022-12-20 13:46:50

Thank you Skeet!

Ask your insurance

by Lavender - 2022-12-20 16:21:48

See who your insurance company DOES pay in your area. It's very expensive to cover this on your own. Once the procedure is done, your regular cardiologist could return to monitoring you. 

travel if you need to

by Tracey_E - 2022-12-20 16:32:47

You are looking at well into 5 figures. Definitely go wherever you have to go to get it covered. 

When we say get a new battery, we always mean get a new generator. They are one piece- the battery and the computer. 

Pm replacement cost

by Tinawired - 2022-12-20 18:38:31

Thanks for the helpful feedback. I will probably be going to the big city as I feel they have better care and better surgeons, plus they take my insurance. I did find out my cardiologist wouldn't be the one to replace it anyway so I will stay under her care for everything else. I'm not feeling confident in the small hosptals close to me. I will do another transmission on January 2 and an office visit with my doctor on January 5.

Interesting the cost differences

by crustyg - 2022-12-22 05:40:58

Over here in the UK the private sector tries hard to avoid publishing prices (and so avoid comparisons), but in general the big health insurers drive much better deals than Joe Nobody who has no negotiating power.  Except that a cycling chum of mine had an ablation for AFlut in the same private hospital as I did - he was self-pay and I had work health cover.  Same price, about £11k.  Of which the EP-doc gets about £1000 - about £400 more than a simple PM and dual lead implantation, and the rest is the rental of the Cardiac Suite and 1 overnight stay (rarely used).  Not a lot of money for the skill involved!  So I would expect a simple PM replacement to be about the same cost.  Hopefully I'm a long way from that and if the NHS is nice and offers a like-for-like replacement then I won't need to self-pay.

A new PM costs between £1k and £1.5k - ICDs are a lot more, I think.  So it's the facility that is taking the lion's share - but setting up and maintaining a cardiac suite is very expensive.

PM replacement cost

by Tinawired - 2022-12-22 09:47:05

You've all been very helpfu!! I did talk to my insurance company and first they said they would cover it. I pushed them anyway and made them check to see if the hospital was in network and its not. I'm so glad I made them check. There's no way I could pay five figures myself and to think it was covered and then find out AFTERWARDS would have been awful, not to mention financially devastating. I'm switching my insurance January 1 to a better company and my previous cardiologist takes that insurance. Happy holidays everyone!

Insurance Companies

by AgentX86 - 2022-12-22 14:51:10

This is something you always have to check before sending the check.  It can be a real issue.

I see that you'll be 65 soon.  Medicare adds a whole new level of mess on top of the normal, or employer based health care.  Government does that.

I just switched from a suppliment plan to an Advantage plan because my retirement no longer suppors anything other than two of the plans they've set up. They've negotiated some good prices because they (IBM) have hundreds of thousands of retirees. I had to think long an hard before giving up my suppliment plan (I'll never get back in) but the difference for my wife and I was somewhere between $5K and $6K per year.  Since they were no longer picking up half that...

ANyway, their plan has an "in plan" and "out of plan" but the co-pay and co-insurance is the same (??!!). Overall the plan is just as good, if not better, than the suppliment but how long will it say that way? In general, if you can affford it, the suppliment ('N' or 'G') is the way to go.

The point is that it gets very complicated.  There are independent agents (paid by Medicare) to work through this but it's still very complicated and there is no clear path.  Plan to spend a lot of time when deciding these things. Also, no matter what (other insurance or not) make sure to sign up for Part-A within 90 days of turning 65. There is no cost for this bit a non-trivial penalty if you don't.

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