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Any insurance headaches with septal ablation?

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  • Any insurance headaches with septal ablation?

    My mother, after consulting with her cardiologist, feels that alcohol septal ablation is the best option for her. Due to the low occurrence of HCM, and hence, the procedure, I'm worried that her insurance company may balk at covering it. Has anyone else dealt with this? She has Humana, private, not Medicare.

  • #2
    Re: Any insurance headaches with septal ablation?

    I had an ASA in November of 2010 and also have private insurance - at the time it was a HIP Medicare HMO - and had no problems. Whether it was due to how my doctor's office filled out the paperwork or whether HIP just decided it was cheaper than a myectomy I have no idea but it was paid for in full and I never received a bill for anything.

    I don't know anything about Humana or how they operate but I would leave the arrangements to your doctor's office and the hospital as they deal with the insurance companies all the time and know exactly what is needed to get your mother the treatment she needs. In the event there is a problem and Humana denies the request there is an appeal system in place - just make sure you have all her test results including the catheterization report to show that the procedure is necessary if they do turn it down.

    I have since switched from the HIP plan to a GHI PPO (same umbrella company, Emblem Health) for many reasons but they seem to be a lot more flexible and easier to deal with.

    The very best to your mother and if her experience is anywhere near what mine was she will never be sorry that she had this "obstacle" taken care of.

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    • #3
      Re: Any insurance headaches with septal ablation?

      I had my ASA back in 2001. Only had the usual and customary problems with the insurance company - Dr. covered, hospital covered, anesthesiologist not covered type stuff.

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      • #4
        Re: Any insurance headaches with septal ablation?

        I had an ASA in 2006. It had to be precertified, but no problems.

        When I had my myectomy in 2007 there were bigger issues with the insurer. They took some convincing to approve my having it at Cleveland--they wanted me to have it at a local hospital that had done maybe 5 myectomies. Cleveland was very helpful in convincing them and working with them. (They accepted the in-network rate.)

        I suspect insurers go easier with ASA's because they're less expensive.
        Diagnosed (w/obstruction) 2003 at 39
        Alcohol Septal Ablation Feb. 2006
        Myectomy April 2007 Cleveland
        Pacemaker dependent (no ICD)
        Thankful and doing fine

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