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Denial for Stress Test for Cardiac Clearance

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Started by MyLapGotBigger, Apr 14, 2008 4:23 PM
8 replies to this topic
8 replies to this topic

    MyLapGotBigger

    Intermediate Member

  • Posts: 26
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  • Location: NEW JERSEY
  • Surgery: LAP-BAND
Posted April 14, 2008 - 4:23 PM

#1
I am curious if anyone has come across this situation. My insurance carrier approved my lap band surgery that is scheduled for May 12th. In their infinite wisdom, they have declined the stress teast ordered by my cardiologist in order to obtain cardiac clearance because to date I have not had any cardiac symptoms and I do not meet their requirements for a stress test.

BTW, I am scheduled to have my gall bladder removed this Friday (3 weeks before my Lap Band surgery) which does not need cardiac clearance. Go figure.

Has anyone had this type of situation, and if so, what have you done? Were you able to have a different test approved that gave the cardiologist the necessary results to grant clearance. Any help or insight is greatly appreciated.


    gkeyt

    Gwen in WA

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Posted April 14, 2008 - 4:55 PM

#2
Without cardiac symptoms, do you know why your cardiologist wants a stress test?

I am no expert here, but in my anesthesia training we learned that cardiac stress tests are used less frequently than they used to be used. I am guessing that your history doesn't really present the current triggers for doing stress testing, but I don't know your particular situation. It sounds like they are denying coverage because they don't feel it is indicated. In that case, I would imagine that your cardiologist would have to have to tell your insurance company why it is necessary in your case to preauthorize it.

Coverage for preoperative testing has decreased dramatically in recent years because it doesn't affect outcomes as much as it was thought to before. That doesn't mean that you don't need a stress test, but it does mean that they tend to resist some preop testing that your providers order. I'd start with the insurance company to find out exactly why it was denied, then ask your cardiologist about it. They might be able to find out what they want from a cheaper test (although stress testing is less invasive and less expensive than some other tests).


    Brandy~

    Account Suspended

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Posted April 14, 2008 - 5:28 PM

#3
My surgeon said it wasn't necessary for me either.


    jenncore

    Senior Member

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Posted April 14, 2008 - 6:16 PM

#4
I didn't have a stress test because I didn't have any concerns that would have required one. Not everyone has one before surgery. If your primary care physician is okay with it I wouldn't worry. Good luck with your gall bladder surgery.
Jenn


    MyLapGotBigger

    Intermediate Member

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Posted April 14, 2008 - 7:10 PM

#5
It is interesting because the insurance carrier is stating that the reason for denial is due to the fact that I do not present with cardiac symptoms and I have a Framingham risk of 9%. Also, my EKG done in January does not meet ACC definition of an uninterpretable EKG.

I think my next call will be to the surgeon to see if he can recommend another cardiologist who may be less aggressive with cardiac clearance criteria.


    kathystrick

    Sweet freedom!

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Posted April 15, 2008 - 11:38 AM

#6
Sorry you are having all of these complications. I hope you get things cleared up soon. Good luck!!


    MyLapGotBigger

    Intermediate Member

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  • Surgery: LAP-BAND
Posted April 15, 2008 - 6:44 PM

#7
Thank you and I hope you get your approved surgery date soon!! Best of luck.


    jefro13

    Newbie

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Posted April 6, 2011 - 8:13 AM

#8
My situation is a little different. I am 65 yrs old and am looking forward to getting banded in the very near future. I have been a nurse for 40 yrs. I am by no means an expert, but I am aware that many physicians schedule unnecessary tests for the extra bucks. I had an EKG and ECHO cardiogram with no negative indications. I have had no cardiac symptoms nor chest pain. I get a little out of breath at times after exercise, but duhhh, I'm fat. The cardiologist I saw wants me to have a stress test, but I am against it as being an unnecessary and unwarranted use of my medicare. There are plenmty of medical articles stating that this is not a needed test prior to banding, which is a minimally invasive test, done laproscopically, and lasting less than one hour. So he wants me to come in to his office to discuss my reasons for not wanting the stress test, which I think could be much more hazardous to my health than the surgery. ps I will be most upset if he chooses to charge me for this ukpcoming consultation.

I am curious if anyone has come across this situation. My insurance carrier approved my lap band surgery that is scheduled for May 12th. In their infinite wisdom, they have declined the stress teast ordered by my cardiologist in order to obtain cardiac clearance because to date I have not had any cardiac symptoms and I do not meet their requirements for a stress test.

BTW, I am scheduled to have my gall bladder removed this Friday (3 weeks before my Lap Band surgery) which does not need cardiac clearance. Go figure.

Has anyone had this type of situation, and if so, what have you done? Were you able to have a different test approved that gave the cardiologist the necessary results to grant clearance. Any help or insight is greatly appreciated.




    ElizabethNYC

    Bariatric Guru

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  • BMI: 46
Posted April 6, 2011 - 5:08 PM

#9
Sorry that you have to go through this! Hope everything gets figured out soon.


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