Does Medicare pay for pacemaker

I wonder if you can kindly help me.

My mother has had esophageal cancer for 2 years (stage 4) and has been receiving chemotherapy.

The last two chemo sessions landed her in the hospital where she was diagnosed as having Atrial Fibrillation. The very last chemo (the third) landed her in the hospital again and this time her heart has many pauses of 4 to 7 seconds. Her heart was fine up to the last three chemo sessions, and in between chemo sessions, her heart worked well.

The cardiologists at the hospital spoke to my mother’s oncologist and claim that he said that my mother will only live another 6 months since the cancer has spread to her lungs.

So the cardiologists are saying that they can’t put in a pacemaker because she has a life expectancy of only 6 months and Medicare does not pay for a pacemaker unless the patient is expected to live for over a year. Is that true?

I spoke to her oncologist and he says that the cancer has NOT spread to her lungs. He said that he doesn’t want to do anymore chemo due to the fact that the chemo damages her heart so he thinks she won’t live long but he can’t estimate how long she would live.

Would Medicare refuse to pay? I would rather she pass away 6 months to 2 years down the road from cancer rather than tomorrow from her heart.

Thank you for your kind help. Tom


6 Comments

Will Medicare Pay For PM

by SMITTY - 2013-03-30 03:03:54

Hi Tom,

For an answer to your question I think you will have to contact Medicare. So far as I know they do not ask the dr how long a person is expected to live before approving any procedure. Now, I'm not saying yea or nay to what Obamacare will do now but I understand some different rules do apply so that is all the more reason to contact Medicare.

My guess is Medicare will pay for a PM as you, I, nor any dr knows how much longer your Mother will live. My cardiologist told me once (I was 72 at the time) when I was having some rather serious heart problems that I had less than two years to live. So I asked for a prognosis on my life expectancy from my regular dr.. Her reply was "I don't try to answer questions like that because only God knows when we will die." That was 12 years ago.

So I would suggest that you take your Mother to a cardiologist and see what he has to say. There are lots of things involved in getting a PM, one of which is could be your Mother's overall physical condition; While having PM surgery is not bad, it can be bad for a person that has become weakened from some illness other than their heart. Also, it would not surprise me if her irregular heart beat became much more regular after she was off the chemo for a few weeks. I know I sometimes get an irregular heart beat when I have some procedure not involving my heart. Such as the minor back surgery I had last year. I had about as irregular a heart as I ever hope to have for about 2 weeks. The thing is our body is one big unit and sometimes when you do something to one part another part that you would not expect to, will act up.

So why not go ahead and call Medicare about the PM and get the answer from the horses mouth while at the same time hoping your Mother will not need a PM.

I wish your Mother the best,

Smitty

hearts

by Tracey_E - 2013-03-30 04:03:03

I have no idea what Medicare will cover or not, but I'm wondering if it's worth it to put her through the surgery. It's a minor surgery that's fairly low risk on a healthy person, but it's still a surgery with anesthesia, risk of infection, healing time up to several weeks or more. Risk of infection is my first thought because chemo is hard on the immune system so what's a low risk for me might be a lot higher for your mom. I don't know, I'm just guessing, that's a question for the dr.

Pauses up to 10 seconds are not good, but they're not fatal either. The risk is passing out, not that the heart won't start up again. A pm won't do anything for afib, all it can do is speed up a slow heart or even out one that's irregular. When the heart goes fast on its own, all the pm will do is watch.

If it was my mom, I would have a serious conversation with an electrophysiologist- not a cardiologist, an ep is a cardiologist that specializes in electrical problems- set the insurance issue aside for now and discuss risks vs benefits.

Best wishes for both of you.

Will Medicare...

by Zia - 2013-03-30 05:03:17

I think those guys are giving you a bunch of bushwah - Nobody can promise a person will live any amount of future and I think that includes Medicare in their "infinite wisdom"
Tracey and Smitty both gave you good advice and I can only add that it might we well if possible to get those docs together and see who's telling what. You don't say how old your Mom is or if she has anything else wrong besides the cancer and/or heart problems, which might make a difference. But by all means get the real facts and then act accordingly, and I wish both of you the very best.

predictions

by Tracey_E - 2013-03-30 06:03:33

Zia, no one ever knows how long anyone has but that's the direction the US is headed. Part of Obamacare will be a committee that has a formula for how much life the treatment will add, cost, and age of the patient... and based on that they approve it or not. It may be screwy since it's all guesswork but that is the way it will work, but I'm pretty sure it's not in effect yet.

Thanks! Can you help me again?

by TomM1956728 - 2013-03-31 02:03:42

Wow!…Thank you Smitty, TraceyE, Zia, and AngrySparrow!

I deeply appreciate all the great feedback I received from everyone. Your messages were truly enlightening and helpful.

I did contact Medicare today, Sunday – apparently, they are open 7 days a week - and they confirmed what you all were saying, that Medicare will pay for the pacemaker as long as the hospital enters the right diagnosis code.

Apparently, they don’t care if the oncologist says that the patient has 6 months to live since the oncologist could be wrong. As long as the doctor states that the PM is a medical necessity, Medicare will compensate them.

To give you more details: (a) My mother is 88 years old, (b) She has esophageal cancer, (c) She was diagnosed 2 years ago, (d) The initial diagnosis said that the cancer had spread to many lymph nodes outside the esophagus, (e) She has been getting chemo for 2 years.

Over the past 2 years, the cancer outside the esophagus has not spread. However, the cancer in the esophagus became more active a few times but it was controlled through chemo.

The last 3 chemos affected her heart. (Over the last six months, she was getting chemo only once a month due to her age). The chemo on November 2012 gave her Atrial Fibrillation – something she never had before – and the chemo on December 2012 also gave her Afib and she landed in the hospital both times.

She stopped chemo for 2 months (Jan and Feb 2013) due to the fact that the chemo was causing her Afib. She decided to have chemo on March 13th since she felt some pain in the esophagus.

The March 13th chemo for the first time gave her an infection and fever about a week later. She went to the hospital on March 20th, and was there to get the colon infection and fever treated, which we found out was due to very low white blood cells.

While at the hospital, the Afib came back again. But now a new problem started: pauses. She never had pauses before. Initially, the pauses were about 4 seconds and she had no symptoms.

To handle this problem, the hospital staff kept her heart rate high – in 120s or so – which usually means Afib for my mother. However, the hospital said it’s better to have the high heart rate rather than the low heart rate which causes pauses. I didn’t like what I was hearing, but due to my lack of knowledge, deferred to their judgment.

Once the infection and fever were gone and white blood cells were okay, they were extremely eager to get rid of my mother and have her discharged regardless of the pauses. But on the very day and hour of the discharge, she experienced a pause of over 7 seconds and this time she had MAJOR symptoms: Her eyes closed, her head started shaking up and down, her body shook violently, and she lost consciousness for several seconds. It was very, very scary to see.

The hospital staff still wanted her to leave after she recovered but I was afraid to take her since she began to experience several more long pauses.

Since she continued to have major pauses again while we were there, they rushed her to the cardiology department. (Up til then she was technically being treated for the infection and low white blood cells).

In cardiology they did a number of electrical shocks and other things to revive her. It was extremely painful to see her suffer and scream and yell.

This all happened on Friday, March 29th at around 12 p.m. My mother continues to be in the hospital since then.

The electrophysiology team came by at around 3 p.m. on Friday, and said that they can’t put in a pacemaker since her oncologist has said she only has 6 months to live. They said they would give her medications to increase her heart rate, control the rhythms, and restart the heart every time she has long pauses. Once her heart rate was back to “normal” – whatever that means – they would discharge her.

I was at the hospital yesterday, Saturday, and I witnessed her having more pauses than before – at least 6 during the day while I was there – and the pauses were are all long ones that caused her head and body to shake and respond in the way I imagine someone would respond when they are being electrocuted. Each time it looks more painful and each time she “comes back from the dead” it takes her more time to become alert and recognize where she is, what’s going on, etc.

The staff tell me that there is nothing that they can do and that she will continue to experience pauses. They are trying their best to keep her heart beating at an Afib rate – which is safer than pauses - but they admit that in about 2 months or so, the high heart rate will damage her heart muscles. And they said that a pacemaker is a no-no.

The Medicare person I spoke to today said that I can call the State Survey Agency on the phone tomorrow and file a grievance against the hospital since they are not honoring their Hippocratic Oath of performing any service necessary to save a life.

I’m afraid that with all these long pauses – which are becoming more frequent and I think causing major damage – even if they were to put in a pacemaker, it would be too little too late.

I am terrified and going crazy. I would appreciate any feedback.

In particular, if they finally do agree to put in a pacemaker, what are the risks of doing surgery at her advanced age?

In order to dissuade me from considering a pacemaker – before they came in with the excuse that Medicare does not pay for people who have 6 months left – they were telling me that: (a) a pacemaker may not work well for my mother, (b) PM could cause shocks to mom’s body, (c) pm could cause pain, like a horse kicking her in the heart, etc.

Is all this stuff true? After I still insisted on a PM given the way mom was suffering, later that day, Friday, they told me that Medicare does not pay for PMs for people who have less than a year to live.

By the way, I did talk to the oncologist late on Friday, and he denied telling the hospital staff what the hospital staff is claiming: that the cancer has spread to her lungs – it hasn’t – and that she only has 6 months to live. The oncologist did say that the prognosis is not good since they no longer will give her chemo but he doesn’t know how much time she has left.

Would appreciate any thoughts and feedback you can give me.

Thank you once again for all your kind help! Tom







Age

by cropduster - 2013-03-31 03:03:08

While I was getting my PM last month the 2 docs where chatting amongst themselves discussing a case the following day of putting a PM in a 94 year old man. Due to his age they were putting it in his leg.
I hope your Mother gets well soon.

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It may be the first time we've felt a normal heart rhythm in a long time, so of course it seems too fast and too strong.