Lead extraction advice

Hi all,

my name is Meg, I'm 34 and on my second pm. I've seen three cardiologist in the last few months and it's been determined I need both leads replaced due to noise and my pacemaker battery is wearing down, basically a whole new system. 

I was trying to go to UC San Diego for the surgery since it is their specialty area, however my insurance has denied my claim for network adequacy since I like in AZ and have an HMO plan.

im going to be interviewing another EP in Phx soon but so far I feel stuck without great options here. I'm nervous for this surgery give my leads are 15 years old and being 34 this is probably not the only time I will have to have this procedure done in my life and I want it done right. I also have three small kiddos to be worried about. 

any one with advice or guidance on lead extraction to dr selection would be greatly appreciated.





by Swangirl - 2020-05-31 16:44:18

So Sorry Meg but your HMO is a real problem.  Is there anyway you can hold off your surgery until open enrollment and get on a better plan?  That means waiting until January 2021 for your surgery.  Lead extraction is a very high risk surgery and should only be done with a highly skilled team.

I had an HMO many years ago (no more) and got a pacemaker when it was not needed and had all kinds of problems trying to get it removed.  I was pacemaker free for ten years but now have one again and will never know if the original damage to my heart had something to do with it.  

HMO's save money but forcing you to take whatever they want to offer or not offer you with whatever providers they have on hand to do it.  Sure you're premiums might be lower but it is a bargain with the devil when you are confronted with a serious threat to your life and have no choices.  

I'm sorry to be a bearer of bad news but am a senior now and many people on this site run into a similar problem with Medicare Advantage Plans which are also HMO's and they are stuck with sometimes inferious treatment or no treatment and can't go elsewhere.  


by AgentX86 - 2020-05-31 23:01:23

What Swan said.  MH85, I know you're not a Senior but just to elaborate a bit on what Swangirl said for those contemplating Medicare, the Suppliment plans allow one to go anywhere that accepts Medicare. Advantage plans don't.  Suppliment plans are more expensive but, IMO, there is little choice for the (eligible) members of this group. Also remember that there is usually only one chance to join a suppliment plan without insurance underwriting.

For those with employer-based medical plans, SwanGirl is right for most years but the IRS has made an exception for THIS YEAR ONLY. Because of Covid-19, one may change plans mid-year, if the employer allows it (i.e. will pay for it).



by Mh85 - 2020-06-01 01:23:46

Thank you both for your advice. As far as the HMO goes my hands are a bit tied. Being 34 and on my husbands insurance we don't have a lot of options. I've tried everything I can think of and am in the process of appealing the denial while researching my in state options for a surgeon.

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