Event monitor not covered by insurance?

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debster913

debster913

Well-known member
Joined
Mar 31, 2005
Messages
1,117
Location
California
Hi, all--

Quick question for you: Has anyone here ever found that their event monitor was not covered by insurance? I'm not talking about the 24-48 hr. Holter, but rather a monitor worn for 7-30 days.

Thanks for any insight/experiences you can share!

Debi
 
Sorry to hear, Cris. I'm going through the same thing myself, and was wondering if anyone else has had the same experience. Other than appealing (insurance wants me to foot the entire $4,000 + bill times two since I've had the event monitor twice now), I don't know what more I can do. I'm pretty pissed about it, especially since I'm covered under a PPO plan. Ins. considers it "experimental."
 
My co-worker had it once and then found out it wasn't covered. Apparently the provider, Cardio-Net knew UHC wouldn't pay so they are not charging her. Dr. wants to monitor again, this time for a month, instead of a week. UHC says, they have no provider. But, they will pay for the Holter for a month... I guess that means she has to go in every two days??? Dr. office said this would cost more that an event monitor. Wow, such progress.

You might want to go back to the monitor provider and the doctor... they should bear some responsibility to know that it's not covered.
 
That's ridiculous! Go in ever couple days to change out the Holter!? Absurd. These insurance companies, I swear, have no flipping clue. A Holter is OK, but a continuous monitor is not. That makes a whole lot of sense. Wow.

I am having my cardiologist and electrophysiologist write letters to my insurance. I'm due to have another (3rd time) round with an event monitor. Cardio-Net was my monitoring company as well, so I'm curious to know if they also knew that my insurance wouldn't pay. I refuse to pay the some $12,000 the monitoring will cost, though (total cost of the monitor times three).
 
FYI, her electrophysiologist - he's in a fairly large practice group- was so mad that he went to practice management people to discuss some renegotiations with UHC. Pretty ticked off to find out that they "Know" better than he does how to diagnose his patient.

Who's your ins. carrier?
 
I have Blue Shield. BTW--When I called my cardio's office and spoke with his nurse practitioner about this issue, she was pretty upset, too! I'm still waiting for the appeal paperwork to show.
 
Debi - I have BCBS/PPO as well and have had the cardio net monitor twice. My insurance did not pay for it either time and Cardio Net knew they were not covered. My insurance company sent me a letter stating it was not covered but I have never received a bill from Cardio Net, so I am assuming that they wrote it all off. The last time I had this monitor was October 2009 and still have not received a bill. Hope you get some answers soon. Is Cardio Net refusing to send the monitor to you if you do not pay the bill?

How in the world do they come up with this being an experimental thing? Kinda strange isn't it? LOL
 
Call the CA insurance commissioner and see if they can help. I called GA insurance commissioner when my husband company did not send us our cobra papers. When I told his company that I had place a call into then, that day the cobra papers were in my e-mail. I am hope that soon we will have active medical cards. Good Luck!!

http://www.insurance.ca.gov/
 
Rebecca said:
Call the CA insurance commissioner and see if they can help. I called GA insurance commissioner when my husband company did not send us our cobra papers. When I told his company that I had place a call into then, that day the cobra papers were in my e-mail. I am hope that soon we will have active medical cards. Good Luck!!

http://www.insurance.ca.gov/
Click to expand...

Thanks, Rebecca (for the link, too!) and everyone. I still haven't received the appeal papers. Maybe calling the insurance company after I put in a call to the insurance commisioner will get them to cooperate!

I also wonder how many people have experienced this with Cardionet. Further, I wonder if any of my cardio's other patients have dealt with this same issue. It would be interesting to find out!
 
I have Blue Shield PPO and the event monitor was covered. This was in 2008. I am noticing differences now, my stress test which was always covered has not been covered fully. I just got a bill of almost $700 in the mail for my echo and stress test!!! I hope you can appeal..let us know how it goes.
 
I have an HMO and when I had my holter monitor for 30 days it cost me $5. It was completely covered. I don't really understand how they could "not" cover it. I mean, really, do they want to be liable if your heart condition goes undiagnosed and untreated? This is terrible. I would be photocopying the letters of denial and sending them to the whitehouse, congress, oprah, CNN, MSN, and any other news source I could think of. (I've done that with other things before and it works pretty well...) I hope you get things straightened out. It's ridiculous when an insurance company puts their bottom line before the health of their patients.
 
Nupur said:
I have Blue Shield PPO and the event monitor was covered. This was in 2008. I am noticing differences now, my stress test which was always covered has not been covered fully. I just got a bill of almost $700 in the mail for my echo and stress test!!! I hope you can appeal..let us know how it goes.
Click to expand...

The thing is there is not one Blue Shield (or any other company, for that matter) PPO plan, so something covered in one plan may not be covered in another and there can be differences in coverage between group plans and/or individual and family plans; there can indeed be variables. If you are part of a large employer group such as a school district or a state or county employee plan, these plans can have richer benefits; it has to do with how the group gets underwritten and how the benefits were negotiated.

Debi, you should have an EOC (Evidence of Coverage) for your plan, either in hard copy or accessible online. If not, ask Blue Shield to send you the EOC for your plan, or email you a PDF; it's usually about 100 pages. It probably will not specifically address the event monitor but it will specifically address coverage of diagnostic testing. While certain treatments, drugs and surgical procedures can be deemed experimental by the insurer, I'm not familiar with a diagnostic test as being experimental (which I think you mentioned in another post as why it was declined). I'm assuming this is diagnostic? You may want to have your doctor put that in writing and that it is not "investigative," which I'm thinking what may have triggered it being declined.

Luana
 
Thanks, Luana!

My plan is through my husband's job--he works for the county. Usually most of my tests have been covered; however, I believe having my cardio write a letter to the insurance is most beneficial at this time. I'm going to fight this to the finish! No way am I going to foot the entire bill--I understand a co-pay, but not the entire thing!
 
I have BCBS/PPO. I had an event monitor for 30 days right after surgery. My event monitor was paid in full. However, by the time I started wearing the event monitor I had satisfied my deductible and my out of pocket expenses.

BAVD John
 
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