Pacemaker monitoring

In Ireland

by BarryMcC - 2023-03-04 08:43:45

I hadn't considered this costing anything... but in hindsight I guess it makes sense.

Had a Medtronic ICD installed late last year, and monitoring is offered free of charge. I think perhaps they don't offer the same if you just have a pacemaker rather than an ICD, but I feel that's down to the risk profile, rather than cost.

🤷‍♂️

monitoring

by new to pace.... - 2023-03-04 09:29:05

Can not speak for about what happens  in Ireland, but for me in the US it is covered under my Medicare.  The Cardiologist's/ EP's office charges Medicare. 

new to pace

In Canada.....

by Beni - 2023-03-04 10:13:10

Here in Canada, it is the same as Ireland.  Monitoring is free of charge, covered by our single payer universal healthcare system . (Note to others: please do not start hammering me with your views of our healthcare  system - especially if you don't live here.  I am well aware it is not perfect but I am not even faintly interested in debating it.)  Oddly, even with this being the case, the Abbott technician told me many people turn it down.  They feel it is an invasion of their privacy. Me, I just think of it as a safety net.

Here, like Ireland, monitoring is available only for those with a defibrillator,  such as ICDs and, as in my case, CRT-Ds.

I am not much help to you, Im afraid.

Monitoring Costs

by Marybird - 2023-03-04 13:57:22

Hi Heatherine,  Like others here have mentioned, the costs of monitoring ( either remote or in office checks) my pacemaker are covered by Medicare and my secondary insurance, so I have no out of pocket expenses for this service.

But to see what the expenses have been for this monitoring, I've gone back and checked the quarterly reports sent by Medicare, and the Explanation of Benefits (EOB) sent by the insurance company to see what was billed to them, and what they actually paid the monitoring providers for the monitoring.

I have a St. Jude dual chamber pacemaker, and the Merlin@Home monitor ( wireless) sends pacemaker reports to the manufacturer's secured website every 91 days, also in between in the event there is an incident showing something outside predetermined setting limits. These reports are accessible to the doctor, pacemaker clinic- whoever is managing your device.

My cardiologist uses a monitoring company (Cardionet) to read and interpret the data from patients' intracardiac device or implanted monitor reports. The company sends a completed report to the doctor. The doctor reviews the report, makes any clinical decisions based on the findings and signs the report.

 In this case, the company bills the patient or insurance for the "technical component" of that report, and the doctor bills for the "professional component" portion. I've seen varied charges for the technical component, for one or two a year or two ago, as much as $170, with Medicare paying around $30 for the service ( the patient on Medicare is NOT responsible for the difference), but for the last few technical bills sent to Medicare, the amount was about $30, and Medicare paid that amount.

My cardiologist's office generally bills about $60 for the professional component for each report, and Medicare reimburses them around $26. Once a year I have an in office device check in the office's device clinic, and Medicare is billed for both the technical and professional component for that- they've billed around $150 for that, but Medicare reimburses them around $60 for both components.

So from this it would look as though a remote monitor report for me ( going by Medicare reimbursement) would run me about $60 a shot, if I were paying those bills instead of Medicare, though if I had to pay the bills these providers submitted to Medicare it could be more expensive, though it's hard to say how much it could be. I'm also betting that these costs may also vary among providers, and in different parts of the US, and world, for that matter.

I'm not familiar with how medical costs are handled in Singapore, but if you have to pay out of pocket for pacemaker monitoring, it'd be worthwhile to see just what they charge for the service, and work at getting some type of a "volume discount" within your affordable price range- especially with three of you having the pacemakers.

It may also be that you, and/or the kids might not need to be monitored as often as every three months, but that's a matter for you and your doctors to discuss. I know they can set up the wireless remote monitors to transmit as frequently as they want them to- every 6 months, every 3 months or more frequently. Or I guess you might have the option, if frequent monitoring isn't needed, of having the devices you use to transmit manually at set times or when instructed to do so by your doctor or clinic. This might cut down on the costs of monitoring.

Beni, I don't think you'll find anyone here that will hammer their views of the healthcare system in Canada ( or the UK, or anywhere else the healthcare is similar) at you. I know there are people and places where this occurs, and frequently, but this isn't one of them. I figure if you're happy with your healthcare, that is what matters.

I found your comment about people declining remote cardiac monitoring because they believe it to be an invasion of their privacy interesting. I've had remote monitoring of my pacemaker for going on 4 years now, and while I must admit I felt kind of wierd about it in the beginning, the monitoring and transmission go on so unobtrusively you're not even aware that anything is happening, so I don't think about it that much. I have had my cardiologist's office call me several times for alerts or reports they believed required some clinical action, but otherwise, life just goes on. But recently I did run across an acquaintance who'd just gotten his 12 year old pacemaker generator replaced ( same leads, I think), and had his old Medtronic MyCarelink monitor repaced with a wireless monitor, from his description he was set up to use the CareLink App on his cell phone. He was very angry about it, said he had told the EP emphatically he did NOT want a wireless remote monitor, did NOT want to have his cell phone set up with this App on his nightstand, and infact was refusing to do so. He said he wanted his old MYCareLInk monitor so he could manually transmit readings when he needed to, but said they had informed him this wasn't available, that only the wireless remote monitors were. He was so adamant, and angry about it he was threatening a lawsuit against the EP who had implanted the device. I can guess that he felt the wireless monitoring was an invasion of his privacy, considering he had no control of when or how often transmissions would be sent. If I recall, he had told me he received the pacemaker after open heart surgery years before that, and it had been determined that as he improved so did his heart rate, so it seems he probably didn't need a permanent pacemaker. He did have some heart issues, though, and it sounded from what he said they were using the pacemaker mainly for its monitoring functions and maybe he paced at a low percentage. If his condition was such that he didn't really need frequent and regular monitoring, perhaps he believed that the occasional manual transmission, under his control was better for him. Just guessing here, but it might show a reason people don't want remote monitoring, whether or not it's free to them.

Frequency of monitoring

by Gotrhythm - 2023-03-04 14:38:23

My monitoring is paid for through my Medicare suppliment policy. Occasionally I get a notice from the insurance company that $268 for a pacemaker checkup was refused because of some clerical/billing mistake. But I never get a bill from the provider for the amount not paid, so I assume the provider and insurance company work it out between them. I don't know what (ex. office visit, expert analysis) may or may not be included in that amount.

I also have a bedside monitor which downloads data from the pacemaker nightly. I have no idea how that service is billed or who pays it.

Something to consider about the contract you are being offered. I notice there are clinical reveiws monthly. In the US, generally pacemaker checks are done at six month intervals unless there is a problem that needs to be more closely watched. When battery life estimates go below one year, the checks are increased to every three months and sometimes more often.

Bewfore you sign a contract, you might want to get the opinion of a cardiologist about what kind and frequency of monitoring you actuallly need, pariticularly since you have or might have lead issues. 

Home monitoring

by AgentX86 - 2023-03-04 17:38:23

I've never seen a bill for remote monitoring.  I pushed the "button" three times last month and had an in-office interrogation and saw no bill.  Now, the EP did sign off on the interrogation results so there will be a charge for that, usually about $150, IIRC (I'll pay $30). I have an in-office interrogation about every four to six months. 

In short, the monitoring cost has to be built into my EPs charge but they can'd  be burying much. Note that I haven't actually seen this EP in about six years, more than a year before I got the PM.

Pacemaker monitoring

by heatherine008 - 2023-03-04 23:56:25

Thank you all so much for replying.  For some reason I couldn't reply individually.  

@BarryMcC -  thank you for replying.  That's interesting.  I'm Irish also, so at some stage will most likely end up back there and it's good to know what I may be getting into. 

@ new to pace - thank you. 

@ Beni - thank you.  We do have health insurance, but unfortunately I am not covered as it was a pre-existing condition.  We're somewhat stuck with this insurance company now as both my boys have pacemakers which was discoverd on this plan.  It's just one of those things we need to prepare for - especially here in Singapore - my leads may not last much longer (already 23+ yrs) - the surgery to remove & replace them will most likely cost in excess of S$50k+ or more depending on whether there are any complications.   My new pacemaker last year cost S$22k which was done under day surgery.  IMHO, anyone who complains about free health insurance really has no idea!  I had my first 2 pacemakers implanted free whilst living & working in the UK - I couldn't be more grateful!  

@MaryBird - thank you very much for your extensive reply.   Good point on asking what exactly the service is for!  I think in an ideal scenario, I would just like to use the service when I feel something may not be working properly rather than running to the clinic every time I have a concern.  My issue here is not so much the cost for the actual home monitoring (which goes to my clinic), but the cost to register (which I believe is with Medtronics) - I have it for both my boys.  It basically takes 5 minutes to set up, but costs S$1k - just seems a bit steep..  
That's a strange one with your acquaintence, a bit mad he didn't know he was being monitored - my feeling is if they are collecting data from me, that data may at some point be helpful to others - I really don't mind, but can understand why people have an issue if they believe it to be an invasion of privacy.  

@Gotrhythm  - that's interesting - what I'm hearing is that in the US/Ireland/Canada - this service is either subsidised or free.  I've been happy without home monitoring thus far, but I do like it for my boys (one of them had malfunctioning leads and everything needed to be replaced) - but for me, I feel I am generally aware of what's going on - so it's not such a big deal.  However, as my leads are 23+ years old, I think a bit of extra monitoring wouldn't go astray!  Just trying to figure out how much I can debate the S$1k registration fees! 

@ AgentX86  - thank you for responding.  I guess what I'm hearing from you aside of the fact it's covered, is that the fees sound much lower than they are here.   As MaryBird pointed out above, I should ask what they cover as I really only want it in place in case I feel that something is working correctly and then send a transmission. 

Thaks all and have a lovely Sunday! 

Monitoring SetUp Costs

by Marybird - 2023-03-06 10:54:50

Hi Heatherine, 

I have to admit the cost of initial setup of pacemaker monitoring with the pacemaker manufacture never entered my mind. I have never seen a price tag, bill, or anything with a price tag for that service. The only bill I saw ( submitted to my insurance company) was from the hospital, and included billing for the surgery, medication and hospital care when the pacemaker was implanted. My pacemaker was paired with the monitor I received, possibly before or around the time of surgery by the St. Jude/Abbott pacemaker technician, and they sent the monitor home with me. So I'm assuming this set up cost was included in the hospital bill, if I recall the hospital billed Medicare somewhere around $60,000 ( not that they ever expect to get the amount they bill), and Medicare reimbursed them around $10,000 for the service. This was considered an outpatient procedure too, I went home after about an 8 hr observation period following the surgery, a couple Xrays, in the hospital. 

The other thing that crossed my mind was your mention that although you have medical insurance, your cardiac diagnosis is a "preexisting condition" so any medical expenses for your cardiac care, including pacemaker monitoring is not covered by your insurance. I know that many health insurances have this policy, though for some of them the exclusion is for a specific length of time ( 1, 2 or 5 years, perhaps) after which they will cover expenses for those "preexisting conditions". I recall seeing this with employer-covered health insurance, though I'm not sure about individual health insurance plans. But it might be worth looking into with your current health insurance. Hopefully any expenses for your boys' cardiac conditions, including monitoring,,would be covered by your insurance as their conditions were diagnosed at the time they were covered by the insurance. 

Best of luck to you all, Mary

Monitoring costs (UK)

by piglet22 - 2023-03-07 10:22:35

In the UK, the home monitor (Medtronics MyCareLink) I have was provided free of charge and arrived through the post.

Although simple to set up many people could find this a daunting process especially going from face to face in-clinic check-ups to totally remote monitoring.

Though expensive, the more sceptical amongst us might think that this is a cost cutting exercise and personally, I have seen the post implantation support go from friendly 6-monthly local checks through to regional annual checks, to none at all.

Various excuses were given like "it's challenging", "the girls find it difficult to transport the equipment".

Disappointing that the hospital didn't provide any guidance on how it worked etc.

What I have found out is that it doesn't any data if things like missed beats start happening.

The first monitor failed in less than one year and involved phoning Medtronics in the Netherlands so there is one monitor gathering dust here because the NHS don't want it back.

Monitoring

by Marybird - 2023-03-07 13:41:21

Piglet, if you're referring to remote monitoring, with a blue tooth wireless pacemaker or other ICD, and an automatic wireless remote monitor, set up basically involves sitting within 6 feet or so of the monitor, pushing a button to start the process, and the monitor takes it from there. There's usually some indication ( may vary depending on the type/manufacturer of the monitor) that the transmission was successfully completed. Or if a problem exists that prevents transmission, there are icons that light up indicating the nature of the problem ( ex. poor cell phone signal, patient too far away from monitor, and short troubleshooting guides included with the paperwork ( or obtainable online at the manufacturer's website- that's where I got mine). can help if problems are encountered.

Even a manually transmitted MyCareLink monitor set up involves placing the "wand" over the pacemaker, then following  instructions as they come up on the monitor screen. 

Though I can understand why it's comforting to have a real live person, a pacemaker tech,nurse, or someone go through those setup steps with a patient, answer any questions, assuage any concerns. When I had my pacemaker implanted,they paired it with my monitor at or around the time I had the surgery. Nobody said anything to me about it, they just plopped the box containing the monitor on the bed tray after the surgery- the floor nurses brought it in but didn't know anything about it. The quick start guide on the box had been torn off, and there were no other instructions. I knew nothing about the pacemaker I had just received other than it was a dual chamber St. Jude, so I asked a nurse to check my chart and find out what information she could about it. She came back with the name, model, and serial number of the pacemaker and leads, and I told her that was enough for me to figure it all out, contact the manufacturer when I, my pacemaker and monitor all got home. I called the manufacturer at the 800 number taped on the monitor, was assured that I was all set to go as the pacemaker and monitor had already been paired. Though she asked me if I would like to go through a manual transmission with the monitor just to see how that worked. I did,, and she verified that transmission was received. 

Your suggestion about remote monitoring being a cost saving measure is spot on. Looking at the various manufacturer's websites, there are numerous mentions, anecdotal "testimonials" and links to studies showing the cost savings in remote monitoring compared to more frequent office visits/monitoring, physician and patient convenience, and detection of actionable problems sooner with remote monitoring compared to just office visits.