insurance and reading the monitor

I received my PM on an emergency basis and got assigned the cardiologist who was on duty that day in a hospital an hour from where I live.  I've been satisfied with his care so far.  But I recently realized that every quarter when my home monitor uploads my information, and I get a report via the patient portal associated with his office, I am getting charged $50 each time as an insurance co-pay, the same I would have to pay if I visited his office in person.  $200 a year for not even seeing him FTF, in other words.

I can't find where this has been discussed before, so I'd like to ask, does your doctor charge you for interpreting the monitor readings?  Is this standard practice in the U.S.'s lousy insurance system?  

This dr. is in my insurance network, so that's not an extra charge for being out of network.  Suggesting I find a different cardiologist would be a problem; when you live in a small town there aren't that many options.  This particular doctor's office is an hour away when I do have to see him FTF.



by Tracey_E - 2023-09-13 16:09:55

I get a charge once a quarter also, even though mine updates more often than that. I didn't used to. I wrote it off to a sign of the times, if you look at what doctors actually get paid from the insurance company it's pretty low so I don't mind this. They answer my phone calls and email at no charge so I always feel like they are accessible. It takes them time to review the reports. 

This is my fifth device but first one with a remote monitor so I have a different perspective. Compared to the previous ones, I spend a lot less money and time on appointments than when I used to have to go to the office quarterly. Even with a small charge to read the uploads, I still think I'm a lot better off. 


by new to pace.... - 2023-09-13 16:20:26

Every night after midnight a remote transmission is done.  Than the quartely one.  Which I was told so they could get paid for the nightly ones.  To me that did not make any sense.  So they charge medicare and my medigap for the tranmission and for someone to read.  Hopefully the EP  really looks at it as when i call to ask for the log events and summary page.  Notice it is signed electronically.  Whom i have not seen since the pacemaker implanted in Aug. 2019.   

Which i then go an pick up.   For me not a problem as just a couple of blocks away.  

new to pace


by Julros - 2023-09-13 17:01:41

Yes, this is normal. When I still had insurance from my employer, the charge for interrogation is the same, whether in person or remote, plus a separate charge for a cardiologist to review. I don't remember what it was, but $50 sounds close.  At my current clinic, I see my dr. during once a year in-person interrogations, but I did not, at my previous office. 

Now that I'm on Medicare and  Medigap, its covered in full, no out of pocket charge.  I do pay more in premiums now that I did before I retired. 


monitor costs

by georgeazarmitchell - 2023-09-13 17:48:25

I  have a Merlin from the V/a.I am never charged for anything. If you are a veteran I suggest you check the V/A out. I have saved thousands of dollars.They have implanted three ICD devices for me .  The latest is a 3-wire system . My cost was zero dollars . Geo

I agree with Tracey

by PacedNRunning - 2023-09-13 19:23:42

I also get charged for remote monitoring. I have monthly transmissions that are reviewed and bill. They deserve to be paid for their time to read the reports and note them in our chart. It is better than having to go in the office and also to be notified of issues between appointments. I've asked to be changed to quaterly transmissions but my EP prefers monthly updates.


Monitoring Costs

by Marybird - 2023-09-13 19:34:28

The remote monitor schedule for my pacemaker is quarterly, and there is also a yearly in office device check. The cardiology practice group I go to uses a cardiac monitoring company ( Cardionet, I think) to read and interpret the remote data from patients' cardiac devices, and the company sends a completed report for each remote transmission ( they also send alerts to the provider when events occur) to the office - those reports are triaged by the practice's pacemaker technician(s) and sent to each patient's doctor, and entered into each patient's electronic medical records. Each of these reports can be billed for a "technical component" ie, in this case reviewing, interpreting data and preparing the report from the monitor transmission, and a "professional component" billed by the doctor who receives the completed report, reviews it and may make clinical decision for the patient based on the findings in the report.

My insurance ( regular medicare as primary, federal employee Blue Cross Blue Shield secondary) is billed for the "technical component" by the company that receives/interprets the data and prepares the report, and the "professional component" is billed by my cardiologist who looks at the report and signs off on it. The amounts billed aren't much, I think Cardionet bills around $65-70 for each report, but Medicare pays them about $30 or so (or 80% of that and the secondary BC pays the other 20%- about $6.00, which would be my copay without that secondary insurance). The charges for the "professional component" billed by the cardiology office are about the same as those billed for the "technical component" by Cardionet, and the Medicare and BC reimbursements are about the same. If I had to pay those copays myself, guess they'd be a total of around $12 each quarter.

For the in-office device interrogation, the cardiology office charges for both the technical and professional components.

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