Heart attack patient denied coverage for device; the insurer responds

Waukesha, Wis. , It is a prescribed device which was prescribed by a doctor to A you are awake Man can save his life. Still, his insurance provider has denied coverage, calling the device “not medically necessary.”

After suffering a heart attack at just 47, Dan Sacomando wasn’t taking any chances. That’s why he wore the ZOLL LifeVest, a wearable defibrillator, every day.

“I’d rather live than not live,” Sacomando told Contact 6.

Saccomando was told that the device would act as a fail-safe until he had surgery for an implantable cardioverter defibrillator (ICD) in his chest. The LifeVest is designed to deliver trauma treatment to a patient with heart failure.

“If anything happens it’s me,” said Sacomando.

Saccomando wore the LifeVest for more than six months, between his heart attack in May and his ICD surgery on Dec. 6. He says the device was expensive, between two and three thousand dollars a month.

His insurances Anthem Blue Cross and Blue Shield have denied coverage for the LifeVest.

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It told Contact 6 in a statement, “While Anthem Blue Cross and Blue Shield cover wearable cardioverter defibrillators in certain situations, medical research and current standards of care do not support the use of these devices after a heart attack.” are, and are not covered under Anthem’s medical policy in such cases.”

The statement said the insurer empathised with Sacomando and understood their “viewpoint”, but added that its policy was “in line with those across the industry”, including Medicare.

Dan Sforzza, a cardiac electrophysiologist at the Mayo Clinic, wants more health insurance providers to approve coverage of the ZOLL LifeVest.

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Sorazza advocates wearing the device after a heart attack. Only then does he say that the patient is at high risk of sudden cardiac arrest and is waiting for his heart pumping function to improve enough to undergo surgery.

“The device is usually prescribed,” Sorja said. “This LifeVest is that kind of bridge … to get you to the point where you can get a permanent defibrillator.”

Sorazza says he disagrees with many insurance denials. He says there is research showing the device can reduce a patient’s chance of dying.

“I think the scope of the problem in this country is huge,” Sorrazza said. “I feel [the LifeVest] certainly fills a very important niche in our care of patients.”

song sent to contact 6 Policy and a list of resources supporting its decision The device is not medically necessary In the case of Sacomando. It includes citations from several medical studies.

Medicare also sent to Contact 6 uniform policy on wearable defibrillators,

Consumers have a few options when a health insurer decides that a medical device or procedure is unnecessary. Their first step should be to contact their doctor’s office to seek advice. It is possible that their office may send more documentation to the insurer or resubmit under a different medical code.

The member has the right to file an appeal with the insurer. If that doesn’t work, they can Try filing a complaint with the Wisconsin Office of the Insurance Commissioner.,

Dalip Singh is a cardiologist at the Milwaukee VA Medical Center. He’s not Saccomando’s doctor, nor is he weighing in on the insurance debate, but he prescribes the LifeVest and supports its use after a heart attack when pumping function is impaired.

“Most people get better. If they don’t get better, that’s when they’re permanent.” [defibrillator], It acts as a bridge when we don’t know whether it is going to get better or not,” Singh said.

Singh says the device is mostly useful for people who have had permanent defibrillators removed because of an infection. In the past three years, she has given shock treatment with the LifeVest to at least two patients.

“Which means if he had not been wearing the defibrillator, he might have died,” Singh told Contact 6.

Saccomando is disappointed by the denial, but is considering filing a final external appeal with Anthem. He plans on living a long life and spending some of it fighting for what he believes in.

“It’s about everyone who is afraid to stand up and fight,” Sacomando said.

Contact 6 contacted ZOLL, but was told that “ZOLL staff is not able to conduct interviews or provide comment.” a Public Relations Manager referred contact 6 to his website rather than.

FDA approves ZOLL LifeVest For the first time in 2002.

Right now, the ZOLL LifeVest is the only wearable defibrillator on the market, although other devices are in development stages.