cost of pacer interrogation/office visit

Hi all,
I just need some guidance. Received my first bill for the pacer and all of the visits/testing, etc. I have Aetna Medicare HMO and up to this point never had a problem paying for a treatment, surgery, visit, etc.
The bill shows $364.40 as total billed with insurance paying $159.40. I am to pay $205.00. Since I am supposed to go in and have pacer checked/office visit 4x/year, I will be paying over $800 in cash.
Is this normal? Do I have to be checked so often? So far, with the last checkup, I am feeling pretty good. Can I do with 1-2x/year checkup? What do I do if the MD insists on more checks?
Thanks for any info, from a budget used/all her life, Nita

12 Comments

You gave your own answer...

by donr - 2014-07-18 01:07:45

...you just don't realize it.

You said you were feeling fine. So when the time comes for an appt, just cancel it. If you think it's needed, go.

There are many reasons why the Cardio wants to see you 4X per year. Ask specifically for those reasons.

I just reviewed all your postings/comments.

I'd take the 4 visits the first year - reads like you have some serious problems that are not quickly resolving themselves. Also, you had that rather messy situation during the surgery.

Bottom line - you don't know what is on the Cardio's mind about coming i for a review. You will NOT till you ask. Everyone does not fit into the mold of immediately going tp an annual visit immediately post-op.

donr

Frequency of Pacer visits

by IAN MC - 2014-07-18 11:07:05

You seem to be checked far more frequently in the US than we are here in the UK !

I have an annual check up and am very happy with that !

Once you get your settings right, quarterly checks are unnecessary IMHO !! Providing that you can quickly get a PM check if you develop symptoms then more frequent visits if you don't need them are pointless.

But once money and profit-making are involved, as they are in your system, then good medical sense seems to take second place.

Ian

I'd contact Aetna

by kmom - 2014-07-18 11:07:46

The amount you'd pay depends on the copays that you have to pay for your services ie drs visit etc. also if the dr was in the HMO network usually you only pay the copay that's established for drs visit but that's not always the case I'd check your plan information or contact the member services number on the back of your card. They'll be able to tell you what your copays will be

cost of pacer interrogation/office visit

by stannita - 2014-07-18 12:07:00

Thank you for all advice. I wasn't very clear about this bill. This amount due is for just one office visit/interrogation. I assume more nasty bills are coming. The insurance co. seems to have started with the latest visit; they were denying all: surgeries, visits, etc. Someone in their office decided that I did not have any insurance and I have been arguing with them for almost a year. Now the bills will be coming...
I will call the insurnace people again. Medicare is combined with Aetna in the state of California. So no separate $$ from them.
I will probably have to go to 2 visits/year. Just cannot handle 4 of these bills. Don't have dental insurance, what bills!! Teeth dont get better with age....
Thanks again for info, Nita

MD visits

by stannita - 2014-07-19 01:07:12

THANK YOU ALL FOR COMMENTS. I WILL DEFINITELY ASK MD IF I NEED TO GO MORE THAN 1-2X/YEAR. I WILL CALL AETNA/MEDICARE/REGAL MEDICAL WHO DOES THE BILLING....WILL BE INTERESTING AGAIN.
I DID ASK ABOUT THE HOME MONITOR BUT WAS TOLD "THEY" DON'T DO THIS. AND THIS IS IN "PROGRESSIVE SOUTHERN CALIFORNIA".
THANKS AGAIN, NITA
PS. AS TO OUR HEALTH SYSTEM, THE US HAS ONLY TAKEN A BABY STEP/MY OPINION. WE HAVE TO GET RID OF INSURANCE COMPANIES AND HAVE A NATIONAL ONE PAYOR SYSTEM. MY INSURANCE HAS THREE LAYERS/I ASSUME WITH PROFIT TAKING BEFORE MD AND I INTERACT.

Ask your doctor

by Sunnydaze - 2014-07-19 01:07:45

why you need to be seen 4x per year, and if it is necessary, or could you be seen 2x a year, I'm sure he has a reason, and I doubt it has a lot to do with money, or profit. Since you have health issues you might want to consider going to a Medicare-Medigap policy instead of an HMO policy, if you're able to afford it...the HMO policy may be cheaper on the front end, but carry a higher out of pocket expense.

And, Ian, many of us find the healthcare system in the U.S. FAR superior to England's, or any other country with government controlled healthcare.....the word "controlled" should give you a hint!! Have you ever considered the reason you're only being seen 2x each year is because of money, and profit, or the lack thereof, and maybe your best interest isn't being considered?

It sounds like Nita needs to be followed more closely for awhile. Speak with your doctor, he is thinking about your best interest. Sunny

Frequency of check-ups

by golden_snitch - 2014-07-19 10:07:05

Hi!

Getting checks four times per year is something I only know from ICD patients. And now that many of them have home monitoring, I guess even most the ICD patients are not seen that often any longer.

I read that you have vasovagal syncope. That's a rather "usual" indication for a pacemaker, nothing particularly risky or special that requires closed meshed monitoring. Guidelines (by AHA for instance) say anything between 3 - 12 months for a pacemaker/CRT, but this can be in person or via remote monitoring. So, Ian is perfectly fine with his annual check-up, even according to U.S. guidelines. In Germany, if you have a pacemaker or CRT (without ICD) only, you are advised to have an in-office appointment every 6 - 12 months.

For a "normal" pacer patient, whose bradycardia or heart block has been fixed by the pacer, and who is feeling fine, an annual check-up totally suffices, in my opinion. And nowadays, with so many patients being on remote monitoring, even an annual in person check-up might not be needed.

Oh, the discussion about different countries' health care system! I'd love to reply to that, but - nope, let everyone be happy with what they have ;-) I cannot complain at all about the German system.

Inga



Pacemaker check

by Peaches45on - 2014-07-20 09:07:38

I am from Canada and need 6 month checkups. As I spend my winters in Arizona, USA I made some telephones calls before I left in April to some clinics. I was informed the cost to have the pacemaker checked was $75.00, $160.00 if I needed to see the Doctor. Much cheaper than a flight back to Canada.

Sure hoping this price is right.

pacemaker check cost

by bluebowtye - 2014-07-21 01:07:27

Hi,

I just got my bill for my first remote transmission check. The total was $175, but after my insurance kicked in I only have to pay $11.39. I can live with that!! My doc wants me to do it every 3 months with a physical check in the office once a year. That seems very reasonable to me and I do not have any problems with it. I am the type of person who always wants to know if my pacing has increased and how much battery life I have left.

Good luck to you!

~Sheila

Cost of pacer check

by Sunnydaze - 2014-07-21 05:07:25

I have been on underage Medicare with a Medigap policy, Plan F, to pick up whatever costs beyond what Medicare pays. I have had my Medtronic dual-lead Enpulse pacemaker since April 2005, I am in Safe Mode now, and will have the generator replaced in two weeks. Other than the cost of my insurances, I paid nothing when I had my pacemaker implanted, and nothing since that time for the interrogations, and doctors visits. I have an interrogation twice each year, with a visit with my Cardio after each interrogation.

I am like you, Shiela, I want to know how much I'm being paced, if I'm having any silent A-Fib, PVC's, and how much battery life I have left (not much at the moment). I have never had an issue with my Pacemaker. Obviously my Cardio, and the Medtronic people did a great job programming my Pacemaker when it was implanted...it has never had to be tweeted. Following the doctors instructions about how many interrogation visits, and check-ups we have after implant is important...this isn't the best time to question "why", NO GOOD doctor is going to put profit above his patients health.

Sunny

Cost

by heartu - 2014-07-23 03:07:13

I see my EP twice a year and transmit remotely every 6 weeks during the year, but the EP only bills for a total of 4 checks per year even though I transmit more than that (the EP office made a change to check everyone's pm more often about a year ago, before that I only sent 2 remote transmissions per year). I have Blue Cross/ Blue Shield and it really depends on the insurance, coverage, and if your doctor is in or out of network. I usually end up paying the rate the doctor has agreed to accept from the insurance company because I never meet my $600 deductible for the year. (So I pay about $87 /4 times a year0.

My update on cost

by stannita - 2014-07-29 11:07:15

I called Aetna, they called Regal Medical. After a week, Aetna says that they have to be billed separately for Medicare coverage. But..medical offices have billed for Medicare and it was always denied. Now they are saying Aetna has to be billed, not the designated Medicare billing address/office. Sound complicated??? I still think we need a one payor system with limited insurance companies with profit taking. Hopefully this will all turn out and my copay won't be $215 for each pacer check.
Good luck everyone!!!
Nita

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Member Quotes

I had a pacemaker when I was 11. I never once thought I wasn't a 'normal kid' nor was I ever treated differently because of it. I could do everything all my friends were doing; I just happened to have a battery attached to my heart to help it work.