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Neenee I was diagnosed with IHSS/HOCM in 1999 Find out more about Neenee
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  • what do you think?

    I just got my statement from the first lead replacement. I have UPMC insurance. They were billed $59,242.75
    I did NOT get a new pacemaker/ICD - only the lead was replaced. Description of service says PACEMAKER. Billed amount: $39,571.00
    I might not be the brightest bulb in the chandelier but this sounds like 'fraud' to me. There is no way a lead could possibly cost that much.....right?? Should I report this? No wonder our medical insurance costs so much.
    Also, my own EP who 'consulted' in the hospital billed the insurance $95 as did his associate who popped in for 2 minutes to see how I was doing. A doctor from India...who I never met before and who is NOT associated with my EP was in when I was admitted and asked me questions for no more than 10 minutes and her bill was for 60 minutes at $200 for consultation. What the heck??

    UPMC will be getting another bill from the hospital for the exact same surgery done the following week....with an added day. I wonder if they will ask for my ins. card back, LOL.
    ~Neenee~
    Diagnosed in 2000 at age 47 with IHSS/HOCM. Father died at age 42 in 1975, official diagnosis cardial infarction
    Feb. 20, 2007 - Septal Myectomy & Mitral Valve repair Feb. 24th 2007- dual pacemaker/ICD implant.
    Jan. 21, 2009 - surgery to replace fractured lead ( Guidant)
    Jan. 27, 2009 - inappropriate shock from defib. back into hosp. for another lead replacement ( St. Jude).

  • #2
    Re: what do you think?

    I think that the bill for my whole implantation was somewhere in the neighborhood of $150K, so this amount for the lead sounds possible.
    Daughter of Father with HCM
    Diagnosed with HCM 1999.
    Full term pregnancy - Son born 11/01
    ICD implanted 2/03; generator replaced 2/2005 and 2/2012
    Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

    Comment


    • #3
      Re: what do you think?

      Wow, Neenee. I'm not sure, but I think I would at least CALL, and if you get the run-around, I think I would schedule a review with the billing department and ask about the accuracy of the amounts and accuracy of the service descriptions. Medical bills never cease to wow me. And I agree, we all end up paying for 'mistakes.' I'll be very interested to hear what you find out!
      Theresa
      Philippians 4:4-9; Wife, & 39 yo Mom to 9 year old son and 6 year old son/daughter twins; Diagnosed with HoCM 1999; Cleveland Clinic Myectomy and ICD, January 2006.

      Comment


      • #4
        Re: what do you think?

        Cynthia,
        if that was the cost of your ICD implantation, what in the world was the cost of your myectomy? I'm going to have to go back and dig out our old bills. Maybe my memory is more shot than I thought....

        Theresa
        Last edited by THW; 02-15-2009, 01:15 PM.
        Philippians 4:4-9; Wife, & 39 yo Mom to 9 year old son and 6 year old son/daughter twins; Diagnosed with HoCM 1999; Cleveland Clinic Myectomy and ICD, January 2006.

        Comment


        • #5
          Re: what do you think?

          My insurance was billed $45,000 for the defibrillator INCLUDING the leads !! The insurance allowed was $25,000. My entire hospital bill was $60,000 (give or take a few bucks) for the 24 hr stay for the "installation".

          Do I live in an area where the insurance allowed rate is cheap, or is it just my carrier? Heck, my myectomy, which was not done locally, was cheaper than Cynthia's implant...........go figure...........

          Neenee, I would definitely be contacting the hospital for a review of your charges.

          Linda
          Onward and Upward !

          Diagnosed 4/07 HCM with fixed & dynamic obstruction
          Myectomy with resected cordonae tendonae 4/08 CCF
          ICD 10/08

          Comment


          • #6
            Re: what do you think?

            My defib with 2 leads and 24 hr stay at CC was $89,000.
            Its hard to say what is going on. $200 for a consult is ridiculous. But what can you do ?
            peace
            mariab

            Comment


            • #7
              Re: what do you think?

              Well my ICD was put in years ago loike 6 yrs but it was 59,000 and I didn't stay, I went home 2 hrs after it was put in

              Shirley
              Diagnosed 2003
              Myectomy 2-23-2004
              Husband: Ken
              Son: John diagnosed 2004
              Daughter: Janet (free of HCM)

              Grandchildren: Drew 15,Aaron 13,Karen 9,Connor 9

              Comment


              • #8
                Re: what do you think?

                I would call and see what is up...that seems expensive for just a lead replacement.

                I had my defibrillator inserted at Mayo in September. I believe I just have one lead and it was $33,000 (give or take) for the defibrillator, $5700 for the insertion and then about $3000 for the overnight hospital stay and $1500 for anesthesia. So, just a little over $40,000 for everything.

                We are still having an issue with my insurance and this...they paid the entire $33,000 for the defibrillator almost all of $3,000 hospital stay/drs and almost all of the anesthesia, but denied the $5700 insertion as experimental/investigational. We are STILL working on getting that taken care of, getting the run around from insurance, etc. It came down to what I believe was a coding error on Mayo's part (though I can't get a 100% answer on it)- they requested it be changed and insurance stated they needed my records to do so, even though my records were already there. Mayo faxed records, insurance claims they didn't get it, Mayo faxed again and only NOW is it being reviewed, months later.

                My point is (and I do have one after my babbling)if you think there is an error, I would definitely call and keep on them until you find out what is going on. My entire surgery cost about as much as your lead replacement, so in my opinion it does seem like a lot.

                -Kaye

                Comment


                • #9
                  Re: what do you think?

                  Thank you for all your replies. I'm going to call the hospital tomorrow and question that $39,000. Even though I won't have to pay that, I don't think it's right that the Health Insurance is being charged for something that 'may' not have been implanted. I was never told that the device itself was being replaced.....just the lead. The wording on the statement just says 'Pacemaker'.

                  everyone's bills sound so outrageous. Without Health Insurance we'd all be up to our eyeballs in debt.

                  Kaye - I sure hope your issue with your insurance co. will be resolved to your satisfaction.

                  Shirley - wow - no hospital stay?? I was told I needed to be monitored and that's why they had me stay overnight...both times.
                  ~Neenee~
                  Diagnosed in 2000 at age 47 with IHSS/HOCM. Father died at age 42 in 1975, official diagnosis cardial infarction
                  Feb. 20, 2007 - Septal Myectomy & Mitral Valve repair Feb. 24th 2007- dual pacemaker/ICD implant.
                  Jan. 21, 2009 - surgery to replace fractured lead ( Guidant)
                  Jan. 27, 2009 - inappropriate shock from defib. back into hosp. for another lead replacement ( St. Jude).

                  Comment


                  • #10
                    Re: what do you think?

                    Theresa - As I recall, the ICD did cost more than the myectomy which was only about $60K.
                    Daughter of Father with HCM
                    Diagnosed with HCM 1999.
                    Full term pregnancy - Son born 11/01
                    ICD implanted 2/03; generator replaced 2/2005 and 2/2012
                    Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

                    Comment


                    • #11
                      Re: what do you think?

                      Oh my. My ICD was 60K plus MD charges. My myectomy was 102K all inclusive. My next all inclusive will be at a resort in the South Pacific !
                      Onward and Upward !

                      Diagnosed 4/07 HCM with fixed & dynamic obstruction
                      Myectomy with resected cordonae tendonae 4/08 CCF
                      ICD 10/08

                      Comment


                      • #12
                        Re: what do you think?

                        One thing to keep in mind, what the hospital bills is usually not what the insurance companies pay. They all have a negotiated rate with the hospitals / Doctors in their plan and that rate is usually substantially less than the billed amount.

                        Bob

                        Comment


                        • #13
                          Re: what do you think?

                          Hi Everybody

                          I just had my ICD put in on Jan 12. Total bill to insurance was $105K. I have two leads and both leads were around $22K. This was done at U of M in Ann Arbor. Medtronic ICD was around $46K. I looked on the insurance website today, Blue Care Network, they paid a little over $33k of the $105K with me owing nothing more because it was done "in network".

                          Bruce

                          Comment


                          • #14
                            Re: what do you think?

                            My guess is that lead replacement is more involved than a new implantation or replacement ICD since it is hard work to fish a new one in and TRY to get the old one out. I know as they were putting me under they were preparing for the venous study, which probably is only need when leads are involved. In any case, the main cost is the doctor, anesthesiologist, EP Lab, etc. so I wouldn't expect a lot of difference.

                            What I wonder is do the medical device companies pay for it when it is their fault in these bad leads? I assume no and that is what the lawsuits (that were recently thrown out) are about. It sure isn't right that the insurance company (and it's rate payers) get stuck for the bill. You would hope that these companies would do the right thing and cover the surgery like they are covering my deductibles up to $800. I would be mighty pissed if I had taken the high deductible health plan and got nailed for five or six thousand.

                            We really do need to reform the way health care is billed, it just seems totally out of control with this high price for regular people and low negotiated price for insurance comapnes. I am worried that if I ever lose my job or even retire that I will be uninsurable. What a mess!
                            First major HCM symptoms at age 50
                            ICD 6/06

                            Comment


                            • #15
                              Re: what do you think?

                              Neenee,
                              What ever came of this, if you don't mind sharing?
                              Theresa
                              Philippians 4:4-9; Wife, & 39 yo Mom to 9 year old son and 6 year old son/daughter twins; Diagnosed with HoCM 1999; Cleveland Clinic Myectomy and ICD, January 2006.

                              Comment

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