Insurance Denial Question
58 female otherwise good health & having ablation on 6/2 after 2 yrs of pax AFib. Thankful no enlargement or structural issues and it’s managed somewhat ok with meds but breakthrough episodes a few times a month that last an average of 30-45 mins and stop after PIP or sometimes I get lucky and it stops on its own with cold compress, breathing, walking, sitting, cold water…. actually it’s so random I never know what stops it! Very random episodes too.. I know a few triggers but they don’t happen all time so I guess it depends if it’s a perfects storm of other things like lack of sleep and/or stress coupled with the other triggers.
Anyway I digress … real reason I’m here is that my insurance denied the second part of my procedure I think to address the a-flutter. I sent a message to my EP to discuss on Monday, but wondering is this common? Is it something that warrants another procedure if it can’t be addressed with the first. Has anybody experienced this?
….
‘Your doctor told us that you have an irregular or abnormal heartbeat. Your doctor wants to do a procedure (ablation via pulmonary vein isolation) to treat your heart condition. Your doctor also wants to do extra work on the hearts upper chambers during this procedure (additional linear or focal intracardiac catheter ablation of the left or right atrium). Procedures can be approved when they meet some important rules. It must make your health better and be safe. It also must work well for your condition. There should be medical literature to support the use of this procedure. At this time, there is not enough proof that this procedure works well and improves health when done together with another procedure. It means that there is not enough medical literature available to support it. It may help your doctor to know we reviewed this request using Carelon Medical Benefits Management Guideline titled Transcatheter Ablation for Management of Atrial Fibrillation. This guideline can be viewed at www.carelon.com/mbm-guidelines-cardiovascular.’
This just makes me even more uneasy and not even sure what questions to ask - of course AI gave me a ton, but I’d rather get real intel.
TIA!