I was diagnosed with an ASD the day after Mother's Day this year. I have not had anything done yet...and still have not seen a cardiologist. I was diagnosed by a radiologist. Do you know if insurance will cover these expenses, knowing that this is a congenital heart defect?
I believe that your health insurance will cover OHS if the doctors determine that it is medically necessary. Depending upon your health insurance policy, you may or may not have to pay out of pocket. With my health insurance policy, I only had to pay a $15 copay for my son’s surgery. I had not other occurring expenses to pay(ie: hospital stay, etc). Today I requested an itemized bill from the hospital because I am curious to see what the total cost for OHS was. I will post this info for other members to see.
My insurance covered my pre surgery medical visits with various doctors and having multiple tests plus everything related to my surgery and the post care. Your insurance provider should pick up everything seeing as how this was a new condition for you. Any issues please drop me a message. I have helped a couple of people in the past getting their insurance provider to cover their surgery.
In the USA there are so many health insurances that cover different amounts so it depends on your insurance how much is covered. It should be covered. My insurance covered my care, but not all of it.
It definitely depends on your plan as to how much it's covered. It is a medical expense, so, normally, yes, it should be covered. It's not an "optional" thing, in a lot of cases, even though you could choose to not have surgery. No doctor would advise against repair unless it's very small, and in most cases, they would advise to have it done even in that case, which means it's really not an "elective" surgery. It's medically necessary. Now, in today's insurance world, you're still going to probably have to pay something. My surgery back in 2007 ran up a total bill of around $60,000, of which I had to pay about $5000 myself. Not bad, considering, but it is something to be aware of. If at all possible, don't let money concerns determine what you do. GET IT FIXED. It's important, and the longer you wait, the more problems you will have in general. Regardless, you need to see a cardiologist IMMEDIATELY.
I'm pretty sure most insurance companies will pay for all the related treatment. You will just have to pay your co-pay, whatever that may be, like 15 or $20. I know it's a little scary, but you will be okay:)
stenochick said:
I'm pretty sure most insurance companies will pay for all the related treatment. You will just have to pay your co-pay, whatever that may be, like 15 or $20. I know it's a little scary, but you will be okay:)
Wow, that would be exceptional insurance. Here's the trick - COPAYS USUALLY DO NOT APPLY TO ANYTHING THAT ACTUALLY HAPPENS IN A HOSPITAL OR IS BILLED BY A HOSPITAL, EVEN OUTPATIENT TREATMENT, EXCEPT FOR EMERGENCY ROOM VISITS. If you are admitted to a hospital or even serviced by a lab that is owned by a hospital, that is normally going to be covered by your "shared coverage", which means that you pay 20% (or 25%, or 30%, depending on your plan) up to your maximum "out of pocket limit" and the insurance company pays the rest. (Shared coverage doesn't start until you have paid your entire deductible, which could be anything from $1000 to $10000, or possibly more, depending on the plan). Again - if you have insurance that allows you to pay a $15 copay for open heart surgery, you have exceptional insurance. I daresay that no such insurance exists in the United States currently.
I hope this makes sense.
Oh I understand it. I had to pay lots of it and I have "good" insurance that I can not afford to use. Health insurance in the USA or the lack of it makes no sense, but that is another can of worms. I hope you Deana can get your ASD fixed before it causes other problems.
Gosh, $60,000 was the cost back in 2007…it would not be surprising if that amount was doubled.
I live in California and I am fortunate that I have exceptional health insurance. But I do pay about $2000 out of my own pocket a year to include my two boys on my medical and dental plan. As I mentioned earlier, I only had to pay $15 copay for OHS for my son…which was done at the Children’s Hospital in LA.
But please, don’t let money scare you into not seeking further treatment.
Wow, that would be exceptional insurance. Here's the trick - COPAYS USUALLY DO NOT APPLY TO ANYTHING THAT ACTUALLY HAPPENS IN A HOSPITAL OR IS BILLED BY A HOSPITAL, EVEN OUTPATIENT TREATMENT, EXCEPT FOR EMERGENCY ROOM VISITS. If you are admitted to a hospital or even serviced by a lab that is owned by a hospital, that is normally going to be covered by your "shared coverage", which means that you pay 20% (or 25%, or 30%, depending on your plan) up to your maximum "out of pocket limit" and the insurance company pays the rest. (Shared coverage doesn't start until you have paid your entire deductible, which could be anything from $1000 to $10000, or possibly more, depending on the plan). Again - if you have insurance that allows you to pay a $15 copay for open heart surgery, you have exceptional insurance. I daresay that no such insurance exists in the United States currently.
I hope this makes sense.
I had both an ASD and PFO repaired via cardiac catheterization a year ago. We had really good insurance coverage which paid for the repairs on both holes but the tests I had prior to the actual repair. If I remember right we had an 80/20 plan and so I did have a portion that they left as my responsibility. But in comparison to what I know the insurance paid, my portion was small. I don't regret having it done. It has taken a lot of worry off of my mind. Once you see a cardiologist, he can tell you what will need to be done and you can check with your insurance company to find out what percentage they will pay. Good Luck. Keep us posted with updates. It is always nice to hear one another's experiences.