Dear Fellow Members, Just reading your posts makes my nerves feel better. My question to all is this. I am 55 diagnosed last year with moderate aortic stenosis w/ arrythmias. Last jan I was told that surgery was probably 3-5 years out but after my echo and stress ekg in July I have been moved up to NOW. That was a major shock but the worst of it is how do you pay for the surgery???? I have been quoted an average cost of AVR is approx $$75,000. If you have a good insurance plan you probably say so what??? I may or may not have insurance. My wife just started a job w/ health insurance benefits that kick in for her and I AFTER 30 days. Will this plan EXCLUDE ME BECAUSE OF PRE-EXISTING CONDITION???? If anybody out there is well versed in HMOs PLEASE GET BACK TO ME ASAP. The info they gave the wife at orientation tells you squat about specifics so I visualize myself waiting for the 30 days to pass and then find out I still have no way to pay so I just roll over and die!!! The plan she has is called Empire Blue Cross/ Blue Choice and we are in NYS.THANKS FOR LISTENING. DAVE
Insurance to pay for AVR???
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Nancy
Well-known member
Hi Dave-
Welcome to the site. It's really a terrific place with lots of built in friends who "get it" as far as this surgery goes.
I see you're from Glens Falls. It's a beautiful area. We are from the Glenville area of New York, 45 minutes away from you up there.
My husband had some of his surgery in Schenectady at Ellis Hospital. Where will you be having yours?
I cannot answer your question re: insurance, but I'm sure others will come along who can. Many hospitals have people on staff who can answer all your insurance questions. Perhaps you could check that out also.
My huisband is the patient here and he has had 3 valve surgeries, 2 lung surgeries and a ton of other pretty tough medical things. He's 71 years old and still moving along.
I hope you will use this site as you move towards your surgery date. By the way, what is the date. I'll put you on the calendar so we can keep track of you.
Take care.
Welcome to the site. It's really a terrific place with lots of built in friends who "get it" as far as this surgery goes.
I see you're from Glens Falls. It's a beautiful area. We are from the Glenville area of New York, 45 minutes away from you up there.
My husband had some of his surgery in Schenectady at Ellis Hospital. Where will you be having yours?
I cannot answer your question re: insurance, but I'm sure others will come along who can. Many hospitals have people on staff who can answer all your insurance questions. Perhaps you could check that out also.
My huisband is the patient here and he has had 3 valve surgeries, 2 lung surgeries and a ton of other pretty tough medical things. He's 71 years old and still moving along.
I hope you will use this site as you move towards your surgery date. By the way, what is the date. I'll put you on the calendar so we can keep track of you.
Take care.
Hi Nancy, Nice to hear from a neighbor. In response to where, when, etc It pretty much all rides on my original question. It is a real crap shoot when you don't have insurance and are not independently wealthy. Dr Pat McCarthy at Cleveland wanted to do me about 2 weeks ago but I can't get anything done until we work out the finances. I might have to try to hold out for another year irregardless of my condition. When I was healthy and the family bread winner I always paid all medical bills out of my pocket and many times the medical profession took advantage of this situation and actually charge you more than they do the insurance companies. The companies and the govt negotiate what they will pay whereas cash customers pay whatever they are charged. I personally know Dr Depans father and actually saw his grandfather when I was a youngster. They were both outstanding physicians. Dave
B
Bill Hall
Dave - I want to welcome you to the site and hope others help answer your questions. I had to question how you paid for the echo, since you have no insurance. I assume you are feeling bad and needed to do it. Since you said that you needed to have the surgery NOW, I assume you cannot wait the thirty days. The reason I question that is that I don't think they can deny coverage based on your pre-existing condition. I could not get life insurance, but no one ever questioned my pre-existing condition when I joined BC/BS many years ago. Even if you are not covered by insurance, I think the hospitals are required to provide service for life threatening illness. I know I am way over my head on this issue, so I hope there are others that follow who will confirm or correct my statements. Dave, I wish you good luck getting through this and especially with the actual surgery.
Nancy
Well-known member
Hi Dave-
Dr. DePan who did my husband's surgery is a fantastic surgeon. He did some pretty tricky things for my husband's heart and he also did one of the lung surgeries. No problems post-op at all and a nice person to deal with. Very meticulous and highly skilled.
Joe was not an easy case to work on.
Dr. DePan who did my husband's surgery is a fantastic surgeon. He did some pretty tricky things for my husband's heart and he also did one of the lung surgeries. No problems post-op at all and a nice person to deal with. Very meticulous and highly skilled.
Joe was not an easy case to work on.
R
Ron K
Hi Dave,
Welcome to the site. You'll get a lot of good information here, but I'm afraid that your insurance question will have to be answered by your insurance company since plans vary so much. You're Dr.'s office or the hospital may be able to help you find the answers you need.
If you are not covered, consider going to Deborah Hospital in Browns Mills, NJ (right next to the Fort Dix Army base.) They do heart and lung surgery exclusively and never charge the patient. They accept whatever the insurance company pays, but if there is no insurance, they won't bill you.
I know a lot of people in this area have received excellent care there and opted to Deborah, even though they had insurance that would have covered many other hospitals.
You can try checking them out on the web. I don't know the site address, but they should be easy enough to find on a search engine.
I hope you find that you are covered and that you can go to the hospital of your chooice and have a surgeon you feel very comfortable with. Also, being closer to home will make it easier on you and those who will be supporting you through this stressful time.
Good luck and let us know how you make out with the insurance issue. then ask any other questions you might have about the operation, etc.
Ron K
Welcome to the site. You'll get a lot of good information here, but I'm afraid that your insurance question will have to be answered by your insurance company since plans vary so much. You're Dr.'s office or the hospital may be able to help you find the answers you need.
If you are not covered, consider going to Deborah Hospital in Browns Mills, NJ (right next to the Fort Dix Army base.) They do heart and lung surgery exclusively and never charge the patient. They accept whatever the insurance company pays, but if there is no insurance, they won't bill you.
I know a lot of people in this area have received excellent care there and opted to Deborah, even though they had insurance that would have covered many other hospitals.
You can try checking them out on the web. I don't know the site address, but they should be easy enough to find on a search engine.
I hope you find that you are covered and that you can go to the hospital of your chooice and have a surgeon you feel very comfortable with. Also, being closer to home will make it easier on you and those who will be supporting you through this stressful time.
Good luck and let us know how you make out with the insurance issue. then ask any other questions you might have about the operation, etc.
Ron K
L
Lisa in Katy
If your wife is working for a larger company, insurance companies can no longer deny based on pre-existing condition. I believe that "large" is defined as at least 50 employees on the insurance, but I'm not positive. If it is a smaller company, they can deny, or make you wait a year. I went through that once, but I was young and stupid and didn't realize what a risk I was taking.
To All who have replied THANK YOU for your support!!!I got a positive response from my wifes new employer, but I still have to wait another 28 days for her probationary employment to finish before they allow us to sign up for the insurance. Supposedly then because they are a HMO they have to approve of the hospital I pick and because Cleveland is by far rated #1 that is who I pick. My HMO is here in NYS and I will try to find out this week if they approve of Cleveland, only thing is I hate to push too hard cause the wife just started the job , is 55 yrs old, and can be terminated w/o cause at this point if you get my drift. I just have to try to hold on and pray a lot. Thanks again. Dave
A
ALCapshaw
Hi Dave,
While the Cleveland Clinic is rated at the #1 Heart Hospital, a good friend and cardiology specialist told me that the difference between the best of the best and a good local surgeon who performs valve surgery in a regular basis is miniscule. I selected the best rated hospital in my state which was about 100 miles from my home. Success rates for first time valve surgeries are typically 98 to 99% when performed by competent surgeons nationwide. This might be a good time to check out what is available near home. You can get your test results (Echo, TEE, Catheterization) put on a CD which you can take with you. Check with your Cardiologist / Hospital to obtain your test CD.
BTW, hospital rankings by procedure can be found on www.healthgrades.com
Good Luck,
'AL'
While the Cleveland Clinic is rated at the #1 Heart Hospital, a good friend and cardiology specialist told me that the difference between the best of the best and a good local surgeon who performs valve surgery in a regular basis is miniscule. I selected the best rated hospital in my state which was about 100 miles from my home. Success rates for first time valve surgeries are typically 98 to 99% when performed by competent surgeons nationwide. This might be a good time to check out what is available near home. You can get your test results (Echo, TEE, Catheterization) put on a CD which you can take with you. Check with your Cardiologist / Hospital to obtain your test CD.
BTW, hospital rankings by procedure can be found on www.healthgrades.com
Good Luck,
'AL'
Thank you for the info Al. My choice is not only based on the rating. My cardiologist also recommended Cleveland Heart Center. I went initially to the US News and World Report who rated the top 50 Nationwide in the US. Cleveland consistently came up #1 year after year, then Mayo,Mass General, Johns Hopkins, Brigham&Womens, Duke, in that order. Distance wise, for me it is not too much different between Cleveland and Boston. Dr McCarthy, who is the #1AVR surgeon in the US has already reviewed all my medical records and given me my second opinion so I feel I really would like him to do the procedure. My biggest stumbling block has been the cost/insurance factor. God willing we are almost past that obstacle, now I just have to deal with the "normal" things like fear, family etc. Dave
M
McCln
Dave
Dave
Just keep hanging in there and they will probably approve the hospital. It is so important to be patient and calm during this waiting period. You just keep praying and we will also. HMO insurance has been a problem for a long time now. So glad that you are taking care and keep hanging there. Take care and keep coming in for inforamtion and support.
Caroline
09-13-01
Aortic Valve replacement
St. Jude's valve
Dave
Just keep hanging in there and they will probably approve the hospital. It is so important to be patient and calm during this waiting period. You just keep praying and we will also. HMO insurance has been a problem for a long time now. So glad that you are taking care and keep hanging there. Take care and keep coming in for inforamtion and support.
Caroline
09-13-01
Aortic Valve replacement
St. Jude's valve
Christian
Well-known member
As I understand it, federal law prohibits a group insurer from denying coverage on the basis of a pre-existing condition if you had prior group coverage and it has not lapsed for aperiod of greater than one year.
If you haven't, or it has, they can deny on the basis of a pre-existing condition for the first year (and no longer) the new policy is in effect.
I'm not an expert, but I'm a lawyer, and I read the COBRA / HIPAA rules a while back when researching insurance for my wife. I'm 80% sure I'm right.
I found this link that makes me 95% sure I'm right.
http://www.efa.org/answerplace/factsheets/cobra.html
Now the better news. We have Aetna's HMO, and had absolutely no problem (so far) getting 100% coverage at the Cleveland Clinic (for echos, etc.) despite the fact that we live out of state.
If you haven't, or it has, they can deny on the basis of a pre-existing condition for the first year (and no longer) the new policy is in effect.
I'm not an expert, but I'm a lawyer, and I read the COBRA / HIPAA rules a while back when researching insurance for my wife. I'm 80% sure I'm right.
I found this link that makes me 95% sure I'm right.
http://www.efa.org/answerplace/factsheets/cobra.html
Now the better news. We have Aetna's HMO, and had absolutely no problem (so far) getting 100% coverage at the Cleveland Clinic (for echos, etc.) despite the fact that we live out of state.
Christian, Thanks for the info on your HMO . Ours, if we get it, is Empire Blue CrossBlueChoiceHMO. We have about another 3 weeks before we can sign up and they tell me their is no exclusion or waiting period for a pre-existing condition so everything verbally sounds great. Problem is I keep asking for the employees copy of the plan so I can review it and they keep telling me we get that "after" we sign up. The contact person representing the company tells me he does not have the book either and he will verbally answer my questions. My problem is I hate to tell them too much while the wife is still on her probationary employment. If they hear they are facing a bill of $100,000 right off the bat they may decide its more economical to find another employee!!! Right or wrong that stuff happens. Prior to this we had no coverage and could not get it cause the wife had pre=existing conditions also and after trying with four different companies I just gave up and have been paying out of my pocket for the past 20 years. As long as my health held I just kept working to pay off all the medical bills but now my future is kinda uncertain. The wifes medicine alone costs about $1200/year so once a year we venture across the border and get the same drug made here in the good ole USA for about $250 in Montreal.Can anyone tell me why a US drug Mfg charges and "gouges" its own people and sells the same drug for much less in Mexico and Canada??? I know all the people who have coverage just yawn and say so what?? Listen up there are 40 million Americans who are in the same boat. No insurance and many are going without medical help and drugs because of our shitty system. Dave
