Medicare Coverage?

I just had an ICD implant on 7/19. I'm 77 yrs. old, several syncope events. Ended up in the ER badly banged up with the last one. Had Echo, Stress test, EP, MUGA etc. and the implant during the EP study on Monday. Doing fine and grateful to have the fear abated now. Syncopes were frightening, for sure!

Does anyone know whether the ICD implant is covered by Medicare? I just realized I never asked, but would have gone ahead regardless since I have been so shook up by events leading up to the implant. Thanks for any input and I appreciate the availability of this site!

9 Comments

Wh Pays What

by SMITTY - 2010-07-22 04:07:05


Hey Decat,

Yes an ICD implant is covered by Medicare. Medicare will pay 80% of the MEDICARE APPROVED charges. I got my first pacemaker at age 70 in 2000 and its replacement in 2009 at age 80. Both times Medicare approved about 95% of the total charges and then paid 80% of that amount. That left me with about 25% of the total to take pay. Fortunately I have supplemental ins. that picks up every thing Medicare doesn't pay, no questions asked.

You say you were so shook up you never asked about who will pay for what. Considering what you had been through I would say that was understandable. But you can bet that doctor and hospital knew who was going to pay what before they started.

Many years before I was covered by Medicare I was in a hospital for a hernia repair and it was uncertain just how much of my care my insurance would cover. The hospital asked me for a hefty deposit before my surgery. Turned out that I got most of that deposit back after about 6 months, but they didn't hesitate to ask for it up front.

I would say don't worry about that and concentrate on getting your health back in order. There will plenty of time later to see who is going to pay what.

Good luck,

Smitty

Interesting???

by windway - 2010-07-22 07:07:26

It must be very worrying for you, dcat77 and reading the comments here it makes us very grateful here in the UK for the system we have.
As we are not required to pay anything at all, I was wondering what the full cost of treatment for heart block with a pacemaker and dual leads would cost, as we have no idea.

Get well soon, never worry about money, you have life!!
Best Wishes.

Medicare Coverage

by Bill T - 2010-07-22 09:07:10

I had a dual lead St Jude PM 2120 (think that was the model) 24 days ago. I was in the hosp 8 days and Medicare was billed $55K and approved the same about. The breakdown for the PM was about $14,500 The Dr's fee hasn't processed yet but I expect Medicare to pay it's part. Fortunately I'm retired military and have Tricare For Lift as secondary. Tricare picks up the Medicare co-pay.
Bill

Medicare Coverage?

by dcat77 - 2010-07-22 12:07:38

Thanks for the feedback. Zombie's site covers wheelchairs etc. No mention of ICD's.
Glad Medicare covers. I can handle the co pays.

Cost

by windway - 2010-07-23 02:07:27

Thanks everyone for the postings, I am really amazed at what it costs.

As Zombie says, nothing is free, but with our system we know we are going to get treated, not assessed what insurance we have or whether we can pay the bill.

All health care workers are public employees, employed by local health boards, which are Government funded, and run by them.

We do have private health care here which is funded by health insurance companies, taken out by an individual or a Company for its employees.It runs alongside the National Health Service, but if anything seriously is wrong you are dealt with just as quickly.Normally your GP (General Practioner or Family doctor as they are known) refers you to a consultant at the hospital. If you have insurance and want to use it, he would refer you to maybe the same consultant (they practice in both systems) He would see you at a private hospital as a private patient, and carry out any surgery there unless it was major and needed an intensive care facility afterwards.It is a better service naturally.

I dont know much about "Obamacare" it seems a good idea for those less fortunate. Maybe it is based on our system which now unfortunately is being abused and overloaded by the influx of asylum seekers, legal and illegal immigrants.

They get the same health treatment so it is an incentive for them to get to this country before declaring that they are seeking asylum. They hide on lorries to cross the English Channel, and congregate in Calais to do so. Our European neighbours are only too happy for this to happen.

Enough said, if anybody wants anymore information a private message is very welcome.

Same As UK Soon

by Bill-2 - 2010-07-23 12:07:46

Windway,

Just wait until next year when our Obamacare kicks in. Then in a few years the mortality rate for senior citizens in the U.S. will be about the same as it is in the UK now.

Everyone who works

by Genie - 2010-07-24 04:07:54

and earns over 110 pounds per week in the UK payes 11% of their income in National Insurance - it's health insurance you don't get a choice about! This money also covers other public services and benefits.
So the NHS is not free, unless you are unemployed, elderly, a child, or unable to work because of disability. But I far prefer this to the US system: we do know that we will get treated, and don't have to worry about how much individual procedures cost. That said, our government and health system does have to worry about this, and some procedures are difficult to get approved if they are new or costly.
Genie

Further

by windway - 2010-07-25 06:07:48

A little to add to Genies' post is that an employer also has to pay nearly an equal amount as well towards the National Insurance.It does place a burden on them and many say this adds to the number of unemployed.

This fund is used as well as funding the health service to fund welfare payments, old age pension payments etc.

Upon its introduction 1st July, 1948, (my wife was born on this day!!) the National Insurance Scheme was hailed as taking care of the people "from womb to tomb."At that time you had to have contributed before you could get benefits.

That very soon changed and no such condition now exists.

Unfortunately is has encouraged many to live quite comfortably on benefits,and we now see two or three generations of families where nobody in them has ever had a job.They are literally taken care of as stated.





exhaustion

by ansbible - 2010-12-20 03:12:02

re: episodes of extreme fatigue?
Been experimenting with things: Doctors have given up or stonewalled my problems - even told me to go to the hospital.

Been eating a lot of small and healthy meals - like soy milk, apple, good nutrition cereal bars, steamed vegetables, turkey, chicken - seems in small meals my stomach pains / pangs lessen, my shakiness declines even goes away, the eratic beat settles down. What exasperates these things is getting chilled, so I dress like an eskimo in San Diego and get funny looks like on sunny days. I seek sunny spots, no longer shady ones, when I play for sev. hours in the local park until my legs get a bit chilled, (under neath two pairs of long pants). I am sure people think I am homeless and desperate as I keep getting pity offers of loose change. I just tell them I am playing music for psychotherapy and it's working, cause I am becoming more psycho every day.

Also joined a indoor health club with a hot therapy pool and a lap pool. It's close by because sometimes I crash on the way home - just cannot predict that will happen, but I take it slow and make it home and quickly eat something light. But the swimming has really had excellent results, I feel much better although immediately exhausted and sleep much better. I think that I must change many details in my life - I have programmed a mid-day rest and will go out a second time, (after playing music in the park), if I feel an improvement in my energy level. But if there is a decline after 4 hours, I take a hot bath, eat something and take a short walk - and keep walking if my energy level improves - it depends. So sometimes you have to challenge your energy level, sometimes that's it for the day. Ambien is the only medication I take which makes me very drowsy and I can being my arduous 9-10 your sleep session. I often take a hot bath in midnight without turning on the lights - carefully correographed?? for safety including bathtub shoes. It works! I am back to sleep - I put on and take off extra shirts, sweat pants, wear sleep sneakers to keep my toes warm and constantly adust a small safety heart to coincide with my crazy body's demands including hot flashes and cool downs. I move from mattress to lazy boy with a heating pad. With this routine down pat, I manage an effective sleep session, mostly on the right side. I cannot sleep on the pace maker side nor ride on a rough bus without double pillows on the seat - that just sets off the arrythmia?? and pains in my chest. There is a lot the doctors haven't told me. My main chest specialist doesn't like talking at all.

I am really tired of being extremely tired, but no medical person seems interested in finding out why. Got a heart specialist to give me a second opinion on Jan 6, but I am trying not to raise my hopes about this. So far I've been given numerous blood tests until my primary doctor concluded I had aids and when I passed yet another test, he shook his head and gave me up to the hospital. He did not choose to pursue a second opinion heart spcialist, thank God my medicare person went to bat for me and told an out of town doctor they had to see me, because some petualant medical staff person refused to see me - "We don't do second opionions" Any way, that's my story and I'm sticking to it.


walter878@juno.com

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Hi, I am 47 and have had a pacemaker for 7 months and I’m doing great with it.