Thursday, January 8, 2009

Blue Cross Blue Shield Calls Atrial Fibrillation Ablation Investigational And Denies Coverage!!

Kansas City, January 7, 2008

BlueCross BlueShield of Kansas City has sent several of its insurance holders a notification saying that Atrial Fibrillation ablation is no longer a covered benefit in their insurance program. The letter sent out by Bluecross Blueshield quotes – “ It has come to our attention that we may have paid for a procedure called Pulmonary vein isolation for you in the past six months that is considered ‘investigational’ according to our corporate medical policy. Pulmonary vein isolation is used to treat atrial fibrillation. Because the effectiveness of this service has not been established, it is our policy to not cover it for our members.” The notification went on to say that the above mentioned policy was effective May 1, 2008.

The underlying circumstances that prompted this major health insurance company to take this action were unclear. Pulmonary vein isolation otherwise known as the AF ablation is one of the most extraordinary advancement that the field of electrophysiology has made in the last decade. Discovery of pulmonary veins as the major contributors to the initiation of atrial fibrillation has led to this landmark procedure that changed the way physicians treated patients with this disabling heart rhythm condition. This heart rhythm condition affects at least 4-5 % population and its incidence increases significantly with ageing. Pulmonary vein isolation in combination with ablation of the other areas of the atria (upper chambers of the heart) has proven to be very successful in abating AF anywhere from 60 - 90% of patients depending on their underlying conditions. This procedure has been recognized as standard of care in eligible patients by the worlds leading cardiovascular societies including – The American Heart Association, American Cardiology of Cardiology, Heart Rhythm Society and European Society of Cardiology.

Currently the Center for Medicare Services (CMS) currently covers this particular procedure. Since the initial experience of pulmonary vein isolation by Michel Haissaguerre’s group from Bordeaux, France in the New England Journal of Medicine article in 1998, more than 1400 articles have been published in major peer reviewed journals. This is the most well studied subject than any other heart rhythm condition known to the medical field. AF ablation has changed the lives of millions of people around the world who would have otherwise been left on warfarin and heart rate/rhytm control medications for the rest of their lives. The one time upfront costs of this procedure are definitely higher than a single electrical cardioversion (external shock) with drug therapy. The cumulative costs of treating this arrhythmia with conventional lifelong drug therapy including all the patient visits to the emergency rooms, urgent cares, electrical cardioversions, blood tests, echocardiographic tests and hospitalizations were proven to be significantly higher than AF ablation. The devastating effects of stroke and heart failure (from tachycardia mediated cardiomyopathy) are worth taking into account in these patients. There are several published reports that support the superiority of AF ablation over drug therapy from an economic stand point.

Obviously, this latest move by BlueCross BlueShield may save them millions of dollars but denies hundreds of eligible patients their fundamental right to appropriate treatment. Unilateral decisions by insurance companies to deny particular tests and procedures have occurred in the past and AF ablation is a new addition to the list. Situations like this clearly challenge the value and credibility of clinical guidelines put out by the scientific organizations.