A Waukesha, Wisconsin man was prescribed a life-saving medical device after a heart attack, but his insurer denied coverage after deciding the device was “not medically necessary”.
Dan Saccomando, who survived a heart attack at 47, wore the ZOLL LifeVest, a wearable defibrillator, every day. He was told the device would act as a failsafe until he could have an automatic defibrillator implanted in his chest, as the vest is designed to deliver shock treatments when the patient’s heart begins to fail. .
“I’d rather have the chance to live than not,” Saccomando told Fox 6.
Even though the device costs between $2,000 and $3,000 a month, he wore the LifeVest for more than six months between his heart attack in May and his ICD surgery on December 6.
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An image illustration provided by ZOLL shows how the LifeVest, a wearable defibrillator, is worn by patients.
(ZOLL life vest)
Saccomando’s insurance, Anthem Blue Cross and Blue Shield, declined LifeVest coverage.
In a statement to Fox 6, the company said:
“Although Anthem Blue Cross and Blue Shield cover wearable automatic defibrillators in certain situations, current medical research and standards of care do not support the use of these devices after a heart attack, and they are not covered by policy. medical services from Anthem in cases such as this.”
The company reportedly added that it sympathizes with Saccomando and understands his “point of view,” but its policy is consistent with “those of the industry,” including Medicare.
Anthem has released its policy, which explains its reasoning behind the device being “not medically necessary” in Saccomando’s case. Citations from medical studies that support the company’s decision are included in the document.
Medicare also released its wearable defibrillator policy to Fox 6, which is similar to Anthem’s.
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FILE – The corporate headquarters of health insurer Blue Cross Blue Shield Anthem Inc. is seen in Indianapolis, Ind.
(AJ Mast/Getty Images)
Records show that the ZOLL LifeVest was first approved by the FDA in early 2002. Currently, it is the only wearable defibrillator on the market, although other devices are in development. .
Dan Sorajja, a cardiac electrophysiologist at the Mayo Clinic, told Fox 6 he disagrees with the number of insurance denials and wants to see more providers approve LifeVest coverage.
“The device is pretty commonly prescribed,” he said. “This LifeVest is kind of a bridge…to get you to that point where you can get a permanent defibrillator.”
Sorajja is a big proponent of wearing the device after a heart attack. He said there is research showing the device can reduce a patient’s risk of death, especially for those who have recently suffered a heart attack and are at higher risk of sudden cardiac arrest while expecting. that their heart pumping function improves enough for surgery.
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Pacemaker implanted in the chest. Frontal chest X-ray.
(Cavallini James/BSIP/Universal Images Group via Getty Images)
Dalip Singh, a cardiologist at Milwaukee VA Medical Center, also told Fox 6 that he supports using the LifeVest after a heart attack when pumping function is poor. He said most patients improve using the device. If they don’t, that’s when they get a permanent defibrillator.
Over the past three years, Singh said at least two patients have received shock treatment from the device. He said they would probably be dead without it.
Saccomando told Fox 6 he was “discouraged by the rejection,” but was considering filing a final external appeal with Anthem.
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When a health insurer decides on a medical device or declares the procedure unnecessary and denies coverage, consumers should contact their doctor’s office for advice. The office may be able to send the insurance company more documentation or resubmit the claim under a different medical code.
An appeal can also be filed with the insurer. If that doesn’t work, complaints can be filed with the office of the state insurance commissioner.
Fox News Digital reached out to ZOLL for a statement, but did not hear back. A public relations executive told Fox 6 that employees were not giving interviews or commenting.
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