PM replacement

I need some advice on an unnusual situation. My PM is going on 9 years and for the past 3 checkups over 18 months - same story, good for 6 mos come back in 3 mos. After last check up I never met with the electrophysiologist - but his assistant scheduled me for replacement. On the day of surgery I was prepped (shave, IV etc) and taken to cath lab for total prep and start of "happy juice". The PM company tech now advises the electro Doc that it has 6 months to go and Medicare will not pay. Procedure is stopped !!! I am waiting to see who is billed for this.

I welcome any comments.


6 Comments

Happy juice

by AgentX86 - 2021-03-12 20:13:01

That is a pickle.  I hope you don't need the happy juice when the bill comes.

I'm not sure what the hospital's responsibility is here.  Generally they check these things out before scheduling the procedure but I've found that hospital administrations are completely incompetent.  I don't know what happens if the hospital screws the pooch here.  I'm not sure we, as patients, can check because we don't know exactly what is involved.  OTOH, we have to sign a form that we're responsible if the insurance doesn't pay.

I had a situation where my neurologist had me wear this ridiculous head thingy bandaged to my scalp for three days, sorta like a Holter monitor for the brain.  I looked like a Cone Head, but that's a different story.  Anyway, when the bill came due ($4,500!!!), my insurance company refused to pay because it was "experimental" (read: of no value).  I didn't check with them before-hand and I "assumed" the doctor had.  Anyway,after some negotiation, the insurance company settled with the company running the scam for $400 and I was off the hook. My insurance company has chased down a few of these scams for me over the past ten years or so. They've told me to not get involved. They'll take care of it.

All that said, I have no idea where you stand.  You're caught between the hospital and the government - not a place I'd like to be.

 

PM replacement

by krpollock21@gmail.com - 2021-03-12 23:49:44

Thanks for the info - I'll keep you up to date.

bad estimate

by dwelch - 2021-03-17 23:10:07

the battery life estimate is simply no good, in general, until the units are in weeks or days, it is a mostly useless number.  Sounds like someone who should have known better made a very bad assumption that the number was real.  This is probably a pandemic related thing, without the pandemic they would have been bringing you in or doing a phone/box check every so many months to watch it.  That home stretch where the device is reporting months, can take years, one of mine went three years at two or three visits a year before it was time.  And today the insurance companies are not paying for early replacement, my understanding that some are not paying for replacement until the pacer goes into the fixed rate safety mode...

When to replace

by TraJac71 - 2021-03-21 01:15:01

I just asked this question a week and a half ago when I was in. I was told when the "low battery" is indicated, there is then a 3 month window in which to replace the battery. Mine is still very new, so I won't know for another 9 years or so :) 

Triggered

by Zapper - 2021-04-03 17:12:01

I hope your hospital-clinic will eat up the prep costs. It is happening more often that the happy cut teams pull the Go trigger before the insurance authorizations! They lost a lot of revenue. I would not worry about the pacing performance, the manufacturer specifies replacement at 80% battery life. I don't know any other device maker that does that. Safe to say, you can go 11 years and not miss a beat. But when you have the new date, make sure there is zero balance on your account and Medicare approval on file before they hook you up for your battery reading.

battery status

by krpollock21@gmail.com - 2021-04-20 13:51:29

thanks for the good info

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So, my advice is to go about your daily routine and forget that you have a pacemaker implanted in your body.