Health Insurance Companies and New Technologies

This month, EP Lab Digest@ Editor-in-Chief Bradley P. Knight, MD, FACC, FHRS argues that although federal health care reforms now allow patients with preexisting conditions to get health insurance more easily, health insurance companies are still in complete control about what they cover. For example, one way insurance companies can deny coverage for procedures is by deeming them “investigational”, even if the procedure has been determined to be safe and effective by the FDA, is covered by Medicare, and is evidence based. Dr. Knight presents his experience with a specific health insurance company after sending an appeal on behalf of one of his patients to receive the totally subcutaneous implantable defibrillator (S-ICD). After seven phone calls, a peer-to-peer review by phone, and faxed letter, the appeal was denied.

Boston Scientific’s S-ICD™ System is a unique implantable cardiac defibrillator placed subcutaneously beneath the skin. For more information on this S-ICD technology, please see the recent article by Kenneth Yamamura, MD and colleagues, who worked in conjunction to implant the first two S-ICD Systems at Florida Hospital Tampa.