Insurance company refuses to pay for life-saving device for man after heart attack

Wakeshi, Wisconsin man discharged life-savings after heart attack medical device, but his insurance company denied coverage, deciding the device was "not medically necessary". The edition told in more detail Fox News.

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Dan Saccomando, who survived a heart attack at 47, wore the ZOLL LifeVest, a wearable defibrillator, every day. He was told that the device would act as a fail-safe device until he was able to implant an cardioverter-defibrillator into his chest, as the ZOLL LifeVest is designed to deliver shock therapy when the patient's heart begins to fail.

“I would rather have a chance to live,” Saccomando said.

Although the device costs $2000 to $3000 a month, he wore the LifeVest for more than six months between his heart attack in May and surgery on December 6.

Saccomando's insurance, Anthem Blue Cross and Blue Shield, denied LifeVest coverage.

The company said, "While Anthem Blue Cross and Blue Shield cover wearable cardioverter-defibrillators 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 by Anthem's medical policy in such cases."

The company reportedly added that it sympathizes with Saccomando and understands his "point of view," but the company's policies are the same as those of other companies in the industry, including Medicare.

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Anthem has released its policy explaining why the device is "not medically necessary" in Saccomando's case. The document includes links to medical studies supporting the company's decision. Medicare has also published its policy for wearable defibrillators, which is similar to Anthem's.

Records show that ZOLL LifeVest was first approved by the US Food and Drug Administration (FDA) in early 2002. It is currently the only wearable defibrillator on the market, although other devices are being developed.

Dan Soraya, a cardiologist-electrophysiologist, said he didn't agree with the rate of insurance denials and wants more providers to approve LifeVest's coverage.

“The device is prescribed quite often,” he said. “The LifeVest is kind of a bridge to get you to the point where you can have a permanent defibrillator.”

Soraya is a big proponent of wearing the device after a heart attack. He said there are studies showing the device could lower a patient's chances of dying, 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 ability to improve enough for surgery.

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Duleep Singh, a cardiologist at Milwaukee Medical Center, Virginia, also said he supports using LifeVest after a heart attack when pumping ability is weak. He said that most patients do get better with the device.

Singh said he had at least two patients in the last three years receiving shock therapy with the device. He said that they most likely would have died without him.

Saccomando said he was "disappointed by the rejection" but is considering filing an appeal with Anthem.

When a health insurance company decides on a medical device or says the procedure is not unnecessary and denies coverage, consumers should contact their doctor's office for advice. The office may send additional documentation to the insurance company or resubmit the request under a different medical code.

An appeal can also be filed with the insurer. If that doesn't work, complaints can be filed with the state insurance commissioner's office.

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