Insurance Question

Heya there, fellow pacers. I've got a general question that I'm hoping someone can shed some light on for me. Have any of you been without insurance (in the U.S.) and had to go for a pacer check? If so, was the check free?

I may run into an insurance snafu in a few months...long story. And I know my options (Cobra etc.). I'm not here to discuss all these things. I just know that when my pm implant was done 2 1/2 years ago that the total cost of having the pm implanted (over 100k) also included free checks on the device for its lifetime. I know that when I go in for a check currently, I don't have to pay a copay for the visit or anything; although, I'm sure the insurance still gets something sent to them from the doc's office. And the insurance company that I had originally when I had the pm imlpanted is not the company I have now. So...

I plan on calling my doc's billing office to see what info they can offer, but I thought to put this question out there to all of you in the meantime.

Happy pacing...
ela-girl

5 Comments

hmm

by Tracey_E - 2009-06-14 07:06:01

I've got free maintenance on my van for 100,000 miles but never heard of it on a pm! My checks cost $275, billed by the doctor to the insurance co. I have no idea how St Judes gets paid.

PM checks

by harley63 - 2009-06-15 10:06:01

Initially my PM checks, in office and on phone, did not cost me anything. No copay's, nothing. About a year ago I switched Cardiologist due to insurance contractual issues. Which ended up being an added benefit in my opinion. As I'm much happier with the new management of my cardiac health and PM settings. Back to topic at hand... my new cardio billing office sends me bills & bills the insurance for the 'device maintance'. My portion was $50.00 per check. The remaining portion insurance plans will cover for most medical equipment, depending on the exclusions of the benefit guidelines. Some plans may not cover it or may have a capped amount at which they will stop paying for the maintance/service of the device. (Don't ask how I know all this, ugh!) I fear that the future of US healthcare coverage and payment of services is on the line and rapidly headed towards a MAJOR overhaul with new leaders in office . At which point, I shall become a tad more assertive with my cardiac management since I'm nearing the 3 yr mark of implantation (I understand newly implanted devices or the more fragile would require more intensive monitoring)... negotiating how often my PM is serviced, what price I will pay and to whom I will pay. We will need to become stewards in management of our healthcare dollars much like our own checkbooks.

Perhaps I've had too much coffee today?? I'm hyper!!

So, Ela-girl... to answer your question.. not sure if the device check will be free or cost you.. you might need to do some leg work.. call the potential facilities/offices where the checks could be done and simply ask the fee's. If possible try to obtain that information in a written form (faxed or mailed) and of course when you present (face to face) they will, or should advise you of the cost.

Cheering for you, always...
Harley63

Thanks, guys!

by ela-girl - 2009-06-16 01:06:22

I spoke with my EP's office today and my insurance.

My EP's office DOES bill insurance for my checks, and the cost of the checks are always different based on what was done during the check (any reprogramming etc.). So, they don't know what the cost of a check will be until AFTER the check. The last one I had in October was for $195.00 and March's doesn't show up yet.

That's not helpful at all! LOL

I'm going in for another check before the end of the month, so that will give me a 3 month time buffer. I guess I can expect anywhere from $200-$300 without insurance.

Thought I'd pass along the info in case anyone else is curious...

ela-girl

pm $$

by papaknight - 2009-06-16 10:06:41

Yeh they get you coming and going. If the pm check are increased r changed due to a posssible problem with the device you should not be responsible for teh costs.probably mean a battle with the insurance company but maybe its worth it. Your letter brought up an interesting question, my device failed and had to be replaced. Is my insurance company and my pocket responsible for the new one or is teh failed device manufacturer responsible. i am going to look into this and see what it stirs p. I'll let you know.
Keep on smilinh
papakniht

I've got 90 days for free but after that have to hit the wallet

by COBradyBunch - 2009-07-23 06:07:47

But that does bring up a totally different issue. I was told to see the doc in three months, then yearly. Should I be having the pacer checked more regularly?

You know you're wired when...

You have a 25 year mortgage on your device.

Member Quotes

I had a pacemaker since 2002 and ever since then my life has been a total blessing.