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When medicare dictates what you need, not your Doctor

Updated on October 6, 2011
Me and my mom on her 70th birthday!
Me and my mom on her 70th birthday!

Life vest vs life

My mother is a survivor. She has survived a heart attack, a mitral valve replacement, a massive stroke and a second heart attack . However, can she survive medicare's guidelines? That is the million dollar question.

My Mother’s first heart attack was in 1992 at the age of 51, due to valve damage she had incurred as a child from rheumatic fever. Ten day’s after her heart attack an artificial valve was implanted. For the next thirteen years she worked and traveled as a normal healthy middle age woman should. In 2005, four months into retirement and four day’s before her wedding Anniversary she ca-lapsed suddenly on the bathroom floor. Later at the hospital we learned she had suffered a massive stroke. The doctors surmised that a large piece of plack had formed around her heart valve and was dislodged and caused the stroke. For the next 5 years she received rehabilitation therapy in hopes that she would learn to speak, walk and regain the use of her right arm. Today my mother has no understandable language and cannot use her arm other than to shrug. Her walking skills are limited.

Most recently, September 6, 2011 my mother suffered her second heart attack. The doctors informed us that her heart was failing rapidly and it would not get better without the aide of a pacemaker and defibrillator. However, medicare won’t let them install it until 45 day’s have past since the heart attack. Medicare believes the waiting period is to make sure it is necessary and to give the heart time to heal. We were told there is no grey area when Medicare is involved. Simply put, it doesn’t matter that she has a history already of heart damage, it doesn’t matter that the doctor’s say this is the only available option, or that her heart won’t improve in the next 45 day’s. It doesn’t matter that without it, she could die!

However, medicare preferred and qualified my mother to have a portable defibrillator. It is called “ The Life Vest. “ It’s only function is to prevent sudden death by delivering a jolt of electricity to her heart in the event it stops beating. It is worn as a vest that is equipped with three paddles and 4 EKG leads that are linked to a computer somewhere in Pennsylvania. It comes with a satchel to carry the battery pack and the alarm mechanism, which is to be worn 24 hours a day. The way it operates is relatively simple for the average patient but unfortunately, my mothers not average. Because of the stroke her comprehention skills are limited. With the life vest a patient is instructed that the system will alarm before the life saving jolt is administered. Once it alarms you have sixty seconds to respond, by that I mean, shut it off or stand back. If the patient is awake you HAVE to shut it off, it is imperative that it ONLY shock you if your unconscious! In order to shut it off two buttons need to be pressed simultaneously, one on the front and one on the back. Needless to say, my father for the next 45 day’s cannot be beyond 60 seconds away from her or out of ear shot of the alarm. He is in fear constantly that he will not hear it or be able to reach her in time.

I know the alternatives may be far grimmer if she didn’t have the vest, yet with the internal device, my father will never have to witness her body lurching and stiffening when the machine activates, he won’t be fearful that her beloved dog will be in her lap at the time of the jolt or that he will be in the shower when it alarms and she is awake yet can’t shut it off on her own.

I know, it sounds crazy, but unfortunately the reality is, medicare would rather my parents live in fear for the next 45 day’s, pay for a piece of equipment to be worn by her for 24 hours a day and costs god knows what, than to listen to her Doctors and their recommendations.

Since writing this, On October 4th my father witnessed his wife receive the two separate jolts that saved her life. She is now in intensive care at a facility in Florida. We are awaiting word from medicare wether or not she can have the implant now or will the 45 day clock start ticking again.


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    • wildove5 profile image

      wildove5 4 years ago from Cumberland, R.I.

      Unfortunately since writing this my mother passed away 4 day's shy of the 45th day. Had she been able to have a defibrillator and pace maker, she may have still been with us! Thanks for reading!

    • kj force profile image

      kjforce 4 years ago from Florida

      wildove5..I can sympathize with your plight...many who are unfamiliar with medicare will come to realize the " issues " when it is their turn...and not until..there are many quirks in the healthcare system and for the past 30 years pretty much nothing has changed or been changed...It's really a shame people didn't live a perfect life , free of stress and strife..and that we didn't " OPT" to not get sick or acquire disorders..shame on we pay the price.. ( a bit of sarcasm ) sorry....thnaks for sharing such a personal experience...hope all works out well...