A Waukesha, Wisconsin man was prescribed a life-saving medical device after a heart attack, but his insurance provider denied coverage after deciding the device was “not medically necessary.”
Dan Saccomando, a heart attack survivor at age 47, used the ZOLL LifeVest, a portable defibrillator, every day. He was told the device would act as a fail-safe until a cardioverter-defibrillator could be implanted in his chest, since the vest is designed to deliver shock treatments when the patient’s heart begins to fail.
“I’d rather have the chance to live than not,” Saccomando told Fox 6.
Although the device costs between $2,000 and $3,000 a month, he wore the LifeVest for more than six months between his heart attack in May and his ICD surgery on December 6.
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An image illustration provided by ZOLL shows patients using the LifeVest, a portable defibrillator.
(ZOLL Life Jacket)
Saccomando’s insurance, Anthem Blue Cross and Blue Shield, denied coverage for the LifeVest.
In a statement to Fox 6, the company said:
“While portable cardioverter-defibrillators are covered by Anthem Blue Cross and Blue Shield in certain situations, medical research and current standards of care do not support the use of these devices after a heart attack, and they are not covered under Anthem’s medical policy. in cases like this.”
The company reportedly added that it sympathizes with Saccomando and understands his “point of view,” but its policy is consistent with “those across the industry,” including Medicare.
Anthem published its policy, which explains its reasoning behind stating that the device is “not medically necessary” in Saccomando’s case. The document includes quotes from medical studies that support the company’s decision.
Medicare also posted its portable defibrillator policy on Fox 6, which is similar to Anthem’s.
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FILE – The headquarters of health insurer Blue Cross Blue Shield Anthem Inc. in Indianapolis, Indiana.
(AJ Mast/Getty Images)
Records show that the ZOLL LifeVest was first approved by the FDA in early 2002. It is currently the only portable defibrillator on the market, although other devices are in development.
Dan Sorajja, a cardiac electrophysiologist at the Mayo Clinic, told Fox 6 that he disagrees with the number of insurance denials and wants more providers to approve LifeVest coverage.
“The device is prescribed quite frequently,” he said. “This LifeVest is kind of a bridge… to get you to that point where you can get a permanent defibrillator.”
Sorajja is a big supporter of using the device after a heart attack. He said there is research showing the device can reduce a patient’s chances of death, especially for those who have recently had a heart attack and are at higher risk of sudden cardiac arrest while waiting for their heart’s pumping function to improve as soon as possible. enough for surgery.
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Pacemaker implanted in the chest. Frontal chest X-ray.
(Cavallini James/BSIP/Universal Images Group via Getty Images)
Dalip Singh, a cardiologist at the Milwaukee VA Medical Center, also told Fox 6 that he supports the use of LifeVest after a heart attack when pump function is weak. He said that most patients improve with the use of the device. If they don’t, that’s when they’re given a permanent defibrillator.
In the past three years, Singh said at least two patients have received shock treatment from the device. He said that they probably would have died without him.
Saccomando told Fox 6 that he is “disheartened by the denial” but is considering filing one last external appeal with Anthem.
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When a health insurer decides a medical device or procedure is unnecessary and denies coverage, consumers should contact their doctor’s office for advice. The office could send more documentation to the insurance company or reapply with a different medical code.
You can also file an appeal with the insurer. If that doesn’t work, complaints can be filed with the state insurance commissioner’s office.
Fox News Digital reached out to ZOLL for a statement but did not hear back. A public relations manager told Fox 6 that the employees do not give interviews or provide feedback.
