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Thread: PFO's

  1. #21
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    Re: PFO's

    Quote Originally Posted by sfldiver  View Original Post
    I live in the U.S., so I don't know much about socialized healthcare, but I am curious, would private insurance in the U.S. cover the cost of this procedure?
    Quote Originally Posted by silentscuba  View Original Post
    If the PFO can be shown as a health threat then it may be paid for by medical insurance. In Mel's case it was paid for but you need to be very careful how you approach the insurance company and you need to be armed with Doctor recommendations for the procedure and get prior Insurance approval before you get it done.
    Aetna, my insurance, has a policy statement documented concerning PFO and closure... they consider closure medically necessary for history of "cryptogenic stroke, transient ischemic attacks, or arterial emboli due to presumed paradoxical embolism through a PFO"...

    My history of C-AGE/Type 2 DCS fell under this guideline and was able to secure approval for the procedure.

  2. #22
    RBW Member Jim is just really nice Jim is just really nice Jim is just really nice Jim is just really nice Jim is just really nice Jim is just really nice Jim is just really nice Jim is just really nice Jim is just really nice Jim is just really nice Jim's Avatar
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    Re: PFO's

    Quote Originally Posted by PhilSiswick  View Original Post
    Been meaning to post about this for a few days, since I read the latest edition of Private Eye (Private Eye for those not in the UK). This seems like a suitable thread to do so, given that someone is being referred to Dr Wilmshurst.

    I don't know Dr Wilmshurst, but after over a decade's reading of Diving forums in the UK, I'm very aware of his key role in sorting out a number of people's PFOs. So, I was saddened to read that he is being sued for libel in the UK as the result of apparently trying to do the right thing about results coming out of a trial of PFO closure devices (if I've read this right).

    PharmaGossip: Dr Peter Wilmshurst - an appeal

    Please give some thought to supporting Dr Wilmshurst if you've benefited from his services in the past. According to P-E, his hospital and the BMA are not supporting him, although the Hospital was paid for the trial.

    Cheers,
    Read and money being sent ...... Dr Wilmshurst was a fantastic to support to me and several others. Hope he does well in the case and glad he has commercial support to fight a commercial entity.

    Cheers.

    Jim.

  3. #23
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    Re: PFO's

    Quote Originally Posted by netmage  View Original Post
    Aetna, my insurance, has a policy statement documented concerning PFO and closure... they consider closure medically necessary for history of "cryptogenic stroke, transient ischemic attacks, or arterial emboli due to presumed paradoxical embolism through a PFO"...

    My history of C-AGE/Type 2 DCS fell under this guideline and was able to secure approval for the procedure.
    I think that says a lot Tim. I have no history of being bent and no problems whatsoever. But I had a TEE at my insistence a few years ago just to rule it out before doing my tech training. A small PFO was found along with a small atrial septal aneurysm. They were both determined to be too small to do anything about. So (as most guys already know) size matters. That could be the reason for the denial, even after a case of skin bends. And I also have Aetna for insurance coverage.

    The cure could be worse than the disease if it is so minor. I think he has every right to appeal or get another opinion. But if the findings show it isn't a problem worth fixing, just take a more conservative ascent profile and adjust your diving accordingly. Take an aspirin a day and keep other cardiac risks in check. I don't see any need to spend thousands of dollars or pounds or rupees if those in the know think it's not necessary.

    OK, I'm ready for the flaming.

    Ken

  4. #24
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    Re: PFO's

    Had a PFO and got it closed before I started diving CCR. Private medical insurance paid all of it. Having migraine and a family history of strokes (not the DIR thing) seems to help.


    Social medical insurance in germany pays for a PFO closure if you already had 2 strokes... even if insurance companies have no clue about medicine, they sure can do statistics... made me think

    What really sucked was the 6 months of anticoagulant medication. Bleed like a pig after having a paper cut can really get on your nerves.

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