Waiting for device

Although I don't have my device yet I wanted to join because this looks like a very helpful group. Had 3rd heart cath in about 5 years on 9-25-15. All 3 have been clear but I have a left bundle branch block, chf & leaky mitral valve and an EF of 25%. Met with electro cardiologist on 10-9-15 who told me the entire left side of my heart is not working at all. Unable to take beta blockers due to past side effects so they have me on Lasix, potassium & 2.5 mg lisinopril. If a NP I saw in September hadn't ordered a chest X-ray they would still have been treating me for asthma...
Anyway, my problem now is they tell me I have to be on current meds for 3 months with no improvement before insurance will pay for it. My cardio guy tells me it is NOT going to improve & I will have one wire on right side & 2 on left & it will make both sides beat at same time & will pace 100% of time. Has anyone else had to wait 3 months? Feel like ins co would rather I expire... Oh but if I pass out they will do it immediately - that is if I'm not alone when that happens & if I make it to a hospital. We live in a rural area and I'm pretty freaked out by all of this.

5 Comments

intervention

by Tracey_E - 2015-10-11 11:10:50

Can your dr talk to the health insurance company? Usually EF alone is enough to qualify you, but you'd think the dr's diagnosis would be sufficient. I hate insurance companies. Take it easy until you get resolution.

You can also call

by Theknotguy - 2015-10-12 01:10:38

You can also call the health insurance company. Ask to talk to either a case manager or the nurses hot line. Tell them you've gone through testing and don't understand how heart problem will get better. If you go in for an emergency procedure it will cost them more than doing it under a non-emergency situation. Sometimes getting the case managers and nurses on your side overrules the clerks looking at their insurance tables.

Maybe they won't budge, but at least you'll know they heard your side.

Hope you can get some help.

More info

by JudyRocks - 2015-10-12 01:10:43

Thank you TraceyE! I am planning on appealing the insurance company's decision & calling both cardio guys tomorrow. I'm a 57 year old female & our insurance is Anthem through the Carpenter's Union. We just don't understand how they think waiting 3 months with only half your heart pumping is a good plan. Thanks for the support!

I waited 3 months

by Grateful Heart - 2015-10-12 05:10:22

Like ROBO said.

My EF was 24%. Like you I had a clear heart cath but LBBB, CHF, an enlarged heart, SSS and a few other abbreviations. The Docs tried 3 months of meds with only a slight increase in EF so next step was the Bi-Vent ICD. That was almost 7 years ago. My EF went to 50% and has been 55% ever since.

I pace 100% in both ventricles and 98% in atria. These devices truly are amazing.

Try not to freak out, you'll be ok. Think positive.

Grateful Heart

ACC guidelines

by jvaltos - 2015-10-13 01:10:25

Hi, sorry to hear about your troubles.

The American College of Cardiology published guideline on the implantation of pacers, defibrillators, and CRT devices. The EF alone is NOT a clear indication for the immediate implantation of a device.

However, there are other potential ways to get the device earlier than the requisite 90 day wait on optimal medical therapy (OMT) that most insurers require.

They could place you on Beta blockers and see if you develop symptomatic bradycarida. IF so and you require a pace for your medical conniption, it would be reasonable to implant the BV-ICD at that time.

If you have severe disabling symptoms of CHF, you could make a plea to the insurance company.

Good luck and always ask for others opinions and make sure the implanter you are using makes you feel comfortable.

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