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On11/30/99 9:05 AM, tgunther@co*.co* wrote: >p.s. I know that this is a specialized test, but I wonder if anyone has had >experience in this qualifying as a referal through an HMO? I'd much >rather pay >a $10 co-payment than $200 out of pocket. Anyone tried this? Tod - I was able to have my test covered under my PPO a few years ago but it took some doing. First I had to explain why I wanted it to a cardiologist -- that I was starting deep decompression diving and there was a high risk of DCS if I had a PFO. I also told him that if the test came back positive, I would limit my diving dramatically, which was true. Once he was convinced that I needed it to avoid potentially serious injury, he set up the test and labelled it "medically necessary" -- which were the key buzz words to getting insurance coverage. My understanding of the medicine involved is fairly rudimentary, but I'll outline it for the benefit of the list: The test I had was an echocardiogram with contrast. It's done by injecting an agitated saline solution (the contrast medium) through an IV line and watching the track of the bubbles on an echo machine. In persons without a PFO, the bubbles enter the right side of the heart and then pass with the unoxygenated blood to the lungs where they are filtered out. In persons with a PFO or other left-right shunt, bubbles can be seen moving across the heart from the right side to the left, where they could then be sent to the brain along with the newly oxygenated blood coming from the lungs. Fortunately for me, no PFO was found. I later learned that a better test would have been a stress echo with contrast. Same test but performed immediately after controlled exercise while your heart rate and blood pressure are still elevated. Since some left-right defects are partially closed and don't shunt blood unless the heart is under stress, the stress echo is able to detect smaller and less obvious PFOs and similar defects. I also understand that in Europe, the common test for these defects is transcranial doppler and not echocardiography. Transcranial doppler looks for the same bubbles, but in the brain instead of the heart. Therefore it detects the presence of a shunt -- regardless of the type -- but does not pinpoint its location, which is really unnecessary for our purposes as divers. It is also apparently more accurate, cheaper and easier to do. Several years ago there was a thread on the list about the cost of the echocardiograms assuming no insurance coverage. It should still be in the archives. My recollection was that the cost varied widely depending on where the test was performed and what part of the country the diver lived in. The range, if I remember correctly, was between $400.00 and $1,200.00, with the least expensive test being performed at the cardiologist's office instead of at a hospital cardiology center where mine was done. As an HMO member, you'll first have to ask your primary care physician to sign off on the test and refer you to a cardiologist, and then ask the cardiologist to perform it. Considering the cost to the HMO of treating a DCS hit (DAN insurance is secondary coverage), it would make good sense for them to cover it as a preventative measure. Best regards -- Bill -- Send mail for the `techdiver' mailing list to `techdiver@aquanaut.com'. Send subscribe/unsubscribe requests to `techdiver-request@aquanaut.com'.
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