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insurance coverage: Life Vest/ external defibrillator

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RushR Find out more about RushR
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  • insurance coverage: Life Vest/ external defibrillator

    A couple months ago I had an episode of ventricular tachychardia. After it was under control I had an ablation schedule and was given a ZOLL Life Vest to wear temporarily until the ablation could correct the problem. I recently discovered that my insurance has rejected the claim on the vest because they categorize the it as "investigative" and say that they see no reason for me not to have an ICD implanted. I'm 37, so we were hoping to be able to correct this issue via ablation and without a permanent device if possible.

    Has anyone ever had to appeal their insurance over something like this? I feel that since it's just a temporary situation I should have a good case, but any experience/tips are appreciated.

  • #2
    I don't know if this will be much help, but you might try talking to the case manager at the hospital where they issued the vest. When I worked in Case Management, we usually helped patients make sure their medications,devices,life vests etc. were covered by their insurance company before they left the hospital. The thought being.... The patient may stop using the medication or device if they find out it's not covered and end up back in the hospital.
    You also might talk to your cardiologist or Electrphysiologist office, they may have dealt with this 100 times and no exactly what to do. Also call the company that issued the vest.... They want to get paid they may know exactly what to put in the appeal. These vests have been out for over a decade..... and I have known patients whose lives were saved while waiting for an ICD because they were wearing a life vest/external defibrillator.....I can't believe they are calling them experimental.
    Good luck.
    Last edited by JillC; 07-13-2016, 11:15 AM.
    After years of symptoms:
    Officially Diagnosed HOCM 2006
    Myectomy 3/11/13 at non-COE
    Extended Myectomy 7/23/14
    At Mayo with Dr. Joseph Dearani

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    • #3
      Thanks, Jill! I've already contacted my Electrophysiologist's office and he's supposed to write a letter for me today. I hadn't thought of contacting the manufacturer, though, that is a good idea. Every time I've dealt with ZOLL on the phone they've been very helpful so I think I'll give them a call as well.

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