A Newbie from the UK.

WELCOME from AN OLDIE FROM THE UK

by IAN MC - 2018-05-28 09:38:17

Hello MISSFITS        welcome to the club . It sounds as though everything is going well for you .

I share your gratitude for the UK health service which I had to make further use of two days ago  ( cataract operation ). The treatment I received was fantastic and free.

My story is not dissimilar to yours. Seven years ago I blacked out after a 10 mile run and was taken on a ' blue lights" run to the local hospital where they quickly fitted a pacemaker .  This club has been invaluable in increasing my background knowledge of the whole PM process ; I'm sure you will find the same.

Best of luck and welcome

Ian

Thanks, IAN MCthe PM

by MissFitts - 2018-05-28 10:47:39

Thank  you Ian. Yes, the PM world is still very unfamiliar and my participation  in it is very recent.  I am sure the info here will be invaluable.

I am so pleased that your cateract treatment went well.

MissF

Newbie from the US

by AgentX86 - 2018-05-28 10:58:31

I've known I was on the path to a pacemaker for a couple of years but it came to a head in February.  I've been in pretty much continuous Afib since my GABG and MAZE procedure in Novermber of 2014.  Before that, I was proximal Afib but it had only crept back in, after being in "remission" for seven years.  I've been taking various drugs to keep in NSR since 11/14 but they were causing other side effects, mainly bradycardia.  In February I almost blacked out, so my wife drove me to the ER.  It took a few days but they found long pauses, so I had an AV ablation and pacemaker implanted the following Monday.

To answer your political questoins.  My insurance covered 100% of the cost (I paid $0 out of pocket), though the entire cost wasn't incredible (the AV ablation and pacemaker totaled about $15K, including one night in the hospital).  That doesn't include the ER stuff or the two nights in the hospital the week before.

If I had no insurance, the procedure would still have been done.  They can't refuse patients, life-saving care because of ability to pay.  There is also "Medicaid" for the low-income.  The ones in the middle might have it tough, but basically if you can't pay, you don't (everyone else does).

Cost of treatme

by MissFitts - 2018-05-28 11:20:02

Agent, I wasn't trying to make a political point, just interested in what would happen had we lived in the US. I can see why you  routinely need  insurance   - $15k plus !!!. 

As it happens we have private insurance ourselves. Here you don't need it for emergencies, as the NHS treats you fast and well.  However insurance can be useful if you need something like  hip replacement which is miserable to live with but which won't actually kill you  and  for which there is  a long  waiting list. Because we did not call upon our private insurance for my PM, the insurers have sent us a cheque  for £100, representing £50 for each night I was in hospital.

Good luck and best wishes fior your own pacemaker. 

MissF

Cost in US

by Kassandra - 2018-05-28 13:44:50

Got my PM one week ago. I am 45 and on private health insurance. Everything happened quickly for me so I have spent about $9k out of pocket being diagnosed and tested, including having to pay $4300 before admitting me for the PM implant, in the past 10 days. Our deductible (what we must pay before insurance kicks in) is $5000 per year and then we have to pay 20% of anything after that. Needless to say, we are thankful we have a health savings account and some emergency funds because who knows what the final bills will be! Now we can start saving for the next one in 10 years!

American System ??

by IAN MC - 2018-05-28 15:00:41

I keep thinking that I understand the American system and then realise that I don't.

Thank you, Kassandra, for explaining what " deductible" means . I have often seen the term on here but never understood what it means.

Agent paid nothing himself, Kassandra has to pay a substantial sum . Is this because of inter-state differences or does it simply reflect the different insurance premiums that you are paying ?

Robin seems to quote ENORMOUS costs for procedures, Agent quotes far lower costs.  Why is this ?

I remain confused ????

Ian  ( UK )

Welcome

by Gotrhythm - 2018-05-28 15:46:10

I think one of the best things a newbie can do is read every post even if you don't see how it applies to you. Glad you've alreadly been doing that and are reaping the benefit. 

About cost for a pacemaker in the US, ask 100 people, you could conceivably get 100 different answers. It all depends on whether you have insurance or not. If you don't, it depends on whether you meet this or that guideline in your state. Ifi you do have insurance, it depends on how good your policy is, and how much you are required to pay out of pocket (the "decuctible") before the insurance will pay the rest.

In my case, I'm on Medicare and have a good supplemental policy that pays most of what Medicare doesn't. I don't remember the exact amount, but I payed out of pocket somewhere between $250 and $300. I do remember that the amount insurance was charged for the pacemaker alone was around  $2000.

American System

by AgentX86 - 2018-05-28 20:11:36

"Agent paid nothing himself, Kassandra has to pay a substantial sum . Is this because of inter-state differences or does it simply reflect the different insurance premiums that you are paying?"

Yes, the differences are mostly because of premiums paid (by either the individual or his employer but most often, both).  There are a number of factors in what the patient actually pays for a procedure.  In addition to the premiums, there are co-pays, a deductible and an out-of-pocket maximum.  The co-pay is a fee you pay the care proider each time you see them (I'll explain this later).  As noted in another post, the deductible is an annual number which you're 100% responsible for before insurance starts paying anything (other than their part of the co-pay).  After the deductible, up to the out-of-pocker maximum, the individual is responsible for some percentage of the cost (10% to 20% is common). After the out-of-pocket maximum the insurance company pickes up 100% of the costs.  Now, if you go to the doctor, the co-pay may be $25.  Even before the deductible is met, that's all you pay ($25).  The insurance pays the rest of the bill.

My employer (a very large Japanese company, BTW) treats people well and has very good benefits.  I My portion of the insurance is about $3500/year (for the two of us) and they pay something over $15K/year.  For that, my GP co-pay is $25, $35 for a specialist, and $150 for an ER visit ($0 if admitted).  My deductible is $500 (IIRC) and my out-of-pocket maximum is $1500 (yes, very good insurance but the premiums aren't cheap, either).  This year, I paid my maximum on January 8th (ablation), so everything else for the rest of this year is 100% covered.

"Having a device implanted without insurance is upard of $100,000.00."

That's unusually high and I highly doubt anyone actually pays that amount.  My PM is a CRT-P (two leads) and as I mentioned, above, the total was around $15K.  The insurance company was billed about $35K but their contracted cost was the $15K.  This is perfectly normal.  No one really pays the full amount. 

Cost

by Runner 71 - 2018-05-28 23:42:21

I am Canadian, was on holiday in Florida, had out of province travel insurance. Had sudden heart block. PM inserted in Tampa Fla. presented with a bill of $135,000.  After several negotiations I paid $35,000.  If I had $25,000 cash when first received bill, they would have taken it. My Cdn Insurance paid me all but my thousand dollar deductible.  I did receive excellent care for the two days in hospital and have state of the art pm.  Back full tilt to running, working out.....

Agent

by IAN MC - 2018-05-29 12:07:40

Thanks for your comprehensive reply to my query,

The moral of the story seems to be " Work for a large Japanese company " if you can .

Cheers

Ian

PS  I hope that you get free sushi as well ?

Agent, here

by AgentX86 - 2018-05-29 20:18:05

"The moral of the story seems to be " Work for a large Japanese company " if you can ."

Well, I retired (or was retired from, depending on your POV) a large US corporation, which had outstanding insurance, too.  I think  the moral of the story is that there is more to a job than a paycheck.  Some employers treat their employees better than others.  It's not like they're giving anything away.  They've found that loyalty is a two-way street.

American Health Cost Nightmare

by Dexter - 2018-05-30 13:19:23

My pacemaker surgery, including hospitalization, cost about $85,000 here in Los Angeles six years ago. I paid $100 because it was covered by my work insurance, so I was very lucky. Others not covered by employment insurance, or by a less generous plan, get a fat bill. That's why many Americans end up filing for personal bankruptcy after a major medical episode. I know Brits sometimes complain about their national health insurance, but they should be on their knees thanking the gods that they have it!