Will Insurance Cover an ICD?
On January 27, 2005, Medicare expanded the indications for coverage of ICD services to include patients with a low ejection fraction (a measure of the heart’s health) and heart patients with or without a prior heart attack. The additional indications are for prevention of an arrhythmia, taking into account that one could occur in the future.
“The expanded indications include many additional people with heart failure,” said Dana Bode, RN, director of Cardiac Services at Froedtert & the Medical College of Wisconsin. “A documented episode of sustained arrhythmia (ventricular tachycardia or ventricular fibrillation) is not necessary to qualify for Medicare coverage of an ICD.”
For insurance coverage, preauthorization is not required for patients who meet the Medicare guidelines, according to Bode. Preauthorization is needed for patients who have coverage through an HMO and for other health insurance. “Private insurance companies tend to follow Medicare guidelines for procedures and will probably follow the same expanded ICD guidelines.” Bode said. “As with any procedure, you should check with your own health insurance provider to determine coverage. To help our patients through this sometimes confusing process, our nurse schedulers will assist in verifying insurance coverage”
Source: Every Day
Date: May - July 2006 Issue