Cost of my Pacemaker Implant

In the past, I've seen posts asking the cost of getting a PM implant. I just got my hospital bill. The total charges were $46,208.50. Medicare paid $8,364.82. The Medicare adjustment was $$36,603.43, which I assume is some sort of "write off". Tricare for Life paid $1,206.34. My portion if $33.91.

The two largest charges out of all of this were $24,677.00 for the PM and $17,602.00 for the OR/Services.

11 Comments

Not a bargain

by donr - 2013-10-04 08:10:11

Should have been ZERO.

If you are covered by TFL. it should cover everything that medicare does not.

I am also covered by TFL & have not had an out of pocket co-pay since TFL started.

Don

$33 bucks is a bargin!

by PacerRep - 2013-10-04 08:10:59

I'm sure anybody on here would take that!

Bill

by RosyEatWorld - 2013-10-04 11:10:06

I just got my PM 2 months ago and got the bill this week. $83, 021.21. That was for 4 days intensive care and I went in as an emergency. My bill is $100. I'm relieved! Thank god for insurance!

Tricare for Life

by Bill T - 2013-10-04 11:10:43

I retired from USN in 1977 after 20 years. TFL has really been a blessing for both of us. My cardiologist says we have the Cadillac of Insurances. One of the great things is our prescription plan with Tricare. In the 60 & 70s Representative Mendall Rivers, from South Carolina, was Charmian of the Armed Services Committee (if i remember correctly) and he went to bat for us and made the govt fill its promise to us that "If we stayed in for a career we could have lifetime medical benefits" We weren't paid much $72, when I enlisted but these 36 years since retirement have been worry free for all our medical needs.

Bill T in NW Ar
Anchors Aweigh, and Fair Winds to all my Shipmates!

Cost of PM

by Jeanie - 2013-10-05 01:10:10

I got my pacemaker last February. It was an emergency that included ambulance to local hospital ER, overnight in ICU, ambulance to airport, airlift to hospital with heart department over 2 hrs. Away, ambulance from airport to hospital, multiple tests, MRI, medications, consults by cardiologist, EP, endocrinologist, neurologist, finally the PM implant 3 days later. Total cost $140,000.00+. Medicare and United Health secondary, no out of pocket expense to me.

Don

by IAN MC - 2013-10-05 01:10:52

Thanks for that explanation. Like Tattoo Man I found it to be a really clear summary. On an international forum like this we are all often guilty of using terminology which is meaningful to us but not necessarily to the rest of the world.

Cheers

Ian

Cost of Pacemaker surgery

by iheartemh - 2013-10-05 05:10:06

I must say that I am surprised to have received so many comments about this post and also the lengthy explanation regarding TFL. I didn't think anyone would care what Tricare for Life was (and would assume it is my secondary insurance). Anyway, I will admit that my husband served as an officer in the U. S. Army for twenty years. He retired back in 1989, and he now works as a government contractor (well, is furloughed until Congress hashes out this mess). He is 66 and I am 65, so we both have Medicare as our primary insurer and TFL as our secondary insurer. We still are a bit uncertain as to how these two function. I was so glad to get a bill for $33.91 that I didn't hesitate to send a check the same day.

And yes, the military promised "free" health care for life, which hasn't been quite the case since the late 1980s. By that time, we already were being forced to go to private physicians as the military no longer had the medical professionals to handle the active duty personnel as well as all the retirees. Since we are 100 miles away from the nearest military installation, I prefer that we do everything locally. Best of all was when we no longer drove all the way to Scott Air Force Base each month to obtain monthly medications at no cost. It was less costly to buy at local pharmacy and pay our "cost share". Of course, now, we mostly get our medications through the Tricare Mail Order Pharmacy.

Even though our health care is no longer exactly "free", we are happy to not have to pay large amounts out of pocket. For now --- I keep on pacing.

Some comments on TFL

by donr - 2013-10-05 11:10:32

You have to be a military retiree in their 65 or over to understand what anyone talking about "Tricare For Life" (TFL) is talking about. Further, you have to be in your late 70's to understand where it comes fro, & its historical significance.

Across the board in US healthcare costs, WW-II was an event that shaped them forever & brought us to where we are today for military & civilians. Even those of us in our LATE 70's are not first person aware of the period pre WW-II, when our Army stood at a staggering 178,000 men (no women then) and pay was dirt cheap.

We swelled to about 8 MILLION during WW-II. Pay still was dirt cheap - bordering on being penurious.

By the time Bill T signed up in 1956, as a new enlistee, he received something like $72 per month. (I checked the historical pay records & they said $78, but I will not quibble over $6 per month in base pay.) Bill must have been about 18 at that time. (BTW: I recommend that you read Bill's Bio sketch. He is a rare creature in the US Navy. He retired as a Chief Warrant Officer 4, a highly respected rank with status as a specialist w/ unusual skills. My hat is off to him.)

After 4 yrs of college & a BS degree in engineering, I signed on as a commissioned officer in 1959 & as a second lieutenant in Uncle Sam's Army, receiving the handsome sum of $222.30 per month for base pay. Throw in some allowances for housing & subsistence & it came to he astounding sum of about $350 per month - for duty hours defined as 24/7/365 days per year and location wherever they chose to send me. Bill had the same hours & "Conditions of employment" as I, but as a very junior enlisted sailor, earned about $150 by then. Promotions were very slow in the peacetime services, so your pay did not increase very rapidly.

Historically we were pretty well off - some Army officers serving during the period 1918 - 1941 spent 17 yrs as a first Lieutenant (their first promotion), at a pay less then half of our 1959 pay.

Part of our compensation was a promise that if you stayed till retirement (beyond 20 yrs), in addition to a retirement pension of at least 50% of your base pay, you would receive "Free" healthcare for life. It was even written into the law where it said "...shall..." when referring to healthcare for military retirees & families. This was in exchange for us getting such a small sum for pay for that period of time - so it really was definitely NOT FREE! It was "Deferred compensation." Before anyone rails on about such poor pay levels, I refer you to Prof Walter Williams of George Mason University for discussions about the rights of people too negotiate for exchanging their labor for acceptable (in their eyes) compensation.

One of the major selling points in recruitment during the days when Bill & I joined up was the promise of "Free" healthcare after retirement. I'm not really sure how much impact that had on Bill when he signed up for his first hitch, but for me, it was just an extra bunch of words. In my comprehension of life in the services in those days, the "free" healthcare became more significant as a RETENTION selling point, trying to entice enlisted personnel to re-enlist periodically. Periods of service differed for Officer & Enlisted personnel - once an officer passed the three yr point, and accepted by the service, he/she served till retirement; Enlisted personnel had to re-up (Ship - Over for the Navy) 3,4 or 6 years til they reached retirement age. As a member aged, it became a more important factor, even critical, in personnel retention.

The history of military retiree healthcare is complex & convoluted during the 40 yrs from 1960- 2000. To simplify, it can be characterized as pay went up - dramatically at times - to generate an "All Volunteer" Force & retirement benefits were never really addressed completely. Sometime in the mid 90's we were placed under Medicare & treatment in Military healthcare facilities essentially ended. As the healthcare morphed into what it is today, there were several lawsuits concerning the subject.

The real problem was that the laws never came to grips w/ the significant differences between the old retirees whose retirement compensation was based on the penurious pay rates of the pre volunteer force days & those who came after. (Try an example I know - a man who retired as a captain for medical reasons in 1944 w/ a retirement benefit of about $100 per month. His benefit was adjusted over the yrs, but never enough to come up to current economic conditions in the US.)

Just for a point of reference, if Bill & I joined up today under the same circumstances as the 1950's, as a new recruit, he'd draw $1401 per month & I'd draw about $2800 per month as a newly commissioned officer.

To alleviate some of the financial healthcare problems retirees were having after the "Free" care evaporated beginning in 1956, the Tricare system was created at different levels, depending on a service member's circumstances & desires. The final level of Tricare is called "Tricare for Life" (TFL) & covers retirees 65 & over who are covered by Medicare. TFL is a coverage that acts as a supplemental policy covering 100% of the retiree's medical costs (Including co-pays) beyond Medicare.

Recall the pre WW-II Army strength of about 178,000. The burgeoning size of the military post WW-II started overloading the active duty medical care system. By 1958, when the first vestiges of those who entered the service in 1938 retired, it was swamped w/ patients not in the active force. Consider that a service member w/ a family adds roughly 3 additional patients to the medical system's load.

In retrospect, these problems were not handled very well by the Govt. The longer it kicked the can down the road trying to ignore the problems or not even comprehending them, the medical costs for the Dept of Defense just got worse till today, when they become onerous.

Consequently, the TFL benefits became something worth fighting for when the Govt started trying to rein in healthcare costs for the services, leading to the situation we have today. Remember that the TFL does NOT kick in till a retiree reaches 65.

Don

Don......

by Tattoo Man - 2013-10-05 12:10:33


................Thank you for a really clear summary of the healthcare situation in the US. Now I don't know whether there are any comparisons to be made here, but I sure know that when my friend Nick (who had served with the US Military in Florida ) dropped dead from an aneurism, aged 41..the Royal Air Force demonstrated just how good they were to his Widow and children..The RAF did everything that they could to help. Nicks funeral courtege from Pall Mall had foreign tourists taking pictures !!

On a slightly lighter note Mrs TM were with his widow, Kate the next day,,sitting at the kitchen table with a mug of tea, she said.......

" I have lost my best friend and drinking partner..."

" Though recently we decided only to drink at weekends and special occasions..."

A five second pause, and..

" There were SO many special occasions..."

It breaks my heart in a very lovely way to tell this story...but maybe its so I can recognise all the fine 'Nicks' of this world.

I'm guessing that you don't know who you are..but , sure as heck,..those who love you do.

TM

Cost of my Pacemaker Implant

by iheartemh - 2013-10-06 01:10:54

Don, you are correct about cost share for pharmacy medications. I get any new prescription filled at Target. Also, I continue to get my Humira Pens there for $17.00 a month rather than use the Tricare Mail Order program (which delivers two months of pens at a very reasonable cost). All my other medications are delivered through the above mail order program. And, yes $5.00 is now the "generic" amount since the costs were raised by earlier this year. Since I also handle my husband's medications and purchase of them, I have the majority of his delivered through the mail order program.

My husband has never had an interest in handling any part of our medical paperwork, even back when he still was on active duty. He left me to deal with all of that tedious work. There probably have been a few times I have paid a small amount that I could have fought, but I find it so frustrating having to act as a "go between" the people at Tricare and the local healthcare facilities that I realize it isn't worth my time. PERIOD!

Until age 65, each of us had secondary insurance through MOAA (MOAA Mediplus). It took care of most of what we were left to pay after Tricare (then our primary) paid our provider. Of course, once we came under Medicare, MOAA dropped our insurance, and Tricare for Life became our secondary. We have not found that ALL costs are covered between Medicare and Tricare. In fact, that may be why we have twice received a check from the Medicare people. We did not understand if this was to reimburse us for small out -of-pocket expenses or what. My husband said to just cash them, and if they want the money back, they will ask for it. We have never found anyone who can truly explain to us just how Medicare works, etc. And yes, we also worry that eventually, the government will do it's best to do away with our "free" lifetime of health care.

TFL Follow-on

by donr - 2013-10-06 02:10:28

Good to hear back from you. For your hospitalization & surgeon's fees you should have had zero co-pay. Even for drugs & Meds administered in the Hosp. If they handed you a Rx for use afterward, you'll have a co-pay, but it seems that it should have been some multiple of 5 or an even number of dollars.

Glad all is going well for you.

Your husband is about ten yrs younger than I, so he would not have seen any of the old retirement system & benefits. I only saw the very first few yrs of it when Social Security started & was quite young when the policy/law started having to face the very harsh reality that the retirees were beginning to tax the ability of the existing Service facilities to handle them.

When TFL came in 1 April 2001 (I think that was the year), I already had a USAA supplement that paid our co-pays - it was worth the additional cost to not have to worry about the hassle of keeping track of that business. I, along w/ a bunch of others did NOT trust the Congress to keep their faith & continue the funding - for whatever the Congress giveth, it can taketh away - and they fought the TFL situation hard enough that we could see the program being abolished & those of us w/ pre-existing conditions being left hanging. At that time, my only pre-existing condition was PTSD, but I was not getting younger!

Came the fateful day I received a phone call from USAA telling me that they were cancelling their entire health insurance program because TFL was killing the profitability of it. Further, they were thoroughly convinced that TFL would survive.

It has survived & is a superb program & had tremendous flexibility. HOWEVER!!!!!

We have had at least two physicians drop all Medicare patients, even established ones. The future is uncertain.

To give everyone reading this, let me give some insight into the difficulty of beginning ObamaCare.

Last year, Congress mandated that the Tricare system & its related pharmacy benefits provider of drugs require that every retiree go to them for all maintenance meds. The program was supposed to start on 1 April of this year. IT is now approaching mid Oct & we have heard nothing yet as to how we are to go about this transition - except get a letter telling us it was coming, but was going to be delayed. The DoD meds dispensing organization was already up & operating, so all they had to do was increase staff & facilities to take care of the added customers.

Unfortunately, the increased load was larger than they could handle effectively, so it's taking a while. I'm not sure, but I have been lead to believe that the DoD meds dispenser was only handling about 15% of the retiree group - going to ALL would be a 7-fold increase in work load. This does NOT give me a warm, fuzzy feeling about what is coming for the ObamaCare system.

Don

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A pacemaker completely solved my problem. In fact, it was implanted just 7 weeks ago and I ran a race today, placed first in my age group.