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kids
New Member


Date Joined Nov 2008
Total Posts : 7
   Posted 11/15/2008 4:11 PM (GMT -7)   
I am so happy to have found this forum to discuss with other people that have the same problem as I have.


this Thursday I speak with my neurologist to find out my options to repairs it.
Does anyone know if the procedure with the catheter and umbrella is covered by Blue Cross/ Blue Shield or is it considered experimental all the time?

Please answer.
Thank you.

greenhope
Regular Member


Date Joined Oct 2008
Total Posts : 113
   Posted 11/15/2008 5:35 PM (GMT -7)   

Hi, kids, and welcome to the forum!

This is what I know from my personal experience.  Hopefully other members will give you their perspectives as well.

I think the humanitarian device exemption (HDE) has been withdrawn for PFO closure with implants because too many people were getting the procedure done than originally anticipated under the exemption.

Here in the US, I believe almost all insurance companies (although I have heard people having trouble with Cigna) will cover the procedure IF:

1)  You have already had a stroke

2)  You have a PFO and an ASA (Atrial Septal Aneurysm) - the ASA is a "floppy wall" as the cardiologist described it to me.  It is the same wall that the PFO is on, the wall (atrial septum) that separates the right and left sides of the heart.  When you have both the PFO and ASA, you are at much greater risk of having a stroke so most insurance companies will cover the procedure.

3)  You have had at least 2 TIAs

4)  You have been on blood thinning medication (usually Coumadin) and it has not worked for you

I would ask the doctor and his office to check on it for you.  From my own personal experience, I think it is better if the doctor's office checks for you because they are able to give the insurance carrier more information that may be more helpful in getting the procedure approved.

Blue Cross/Blue Shield is a very good insurance company so you should not have a problem, but I think a lot depends on your symptoms and medical history.  If you don't mind my asking, what symptoms are you having? 

A word of advice.  If you do not like what your neurologist recommends, you may want to seek a second opinion.  I went to 2 separate, equally brilliant neurologists.  The first one basically brushed me off and gave me a senseless diagnosis of migraine with aura (I don't suffer from migraines!).  The second one said I needed to have the PFO closed as soon as possible and he thought what I had was a TIA or even a possible small stroke (I need to have a more intensive brain MRI to definitely say whether it was one or the other, but now the cardiologist adviced to wait 6 months before I have any MRIs since I already have the implant in my heart).  I think a lot of the discrepancies in thought come from the fact that PFOs are still not completely understood.  One doctor may have the firm belief that the PFO is what led to a stroke/TIA, whereas a second doctor may not be too convinced of this correlation.  Until they have more data from further research and research studies, I think we are going to continue seeing these discrepancies in diagnosis and treatment.

I hope this was somewhat helpful.  Good luck to you on your quest for answers and treatment.  I hope you will keep us posted!

Greenhope

 


stkitt
Forum Moderator


Date Joined Apr 2007
Total Posts : 32602
   Posted 11/15/2008 11:25 PM (GMT -7)   

Greenhope,

That was outstanding advice and you know your information well.

You are appreciated for helping cover this forum.

Thank you

Kitt


 

Kitt, Co-Moderator: Anxiety/Panic & Depression
& GERD  Forums
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