Remote monitoring for cardiac devices is now being reimbursed for some private patients at the discretion of health funds, but some insurers are rejecting applications without explanation, according to cardiologists.
The COVID-19 pandemic has highlighted the usefulness of remote cardiac monitoring to avoid unnecessary hospital visits, but there are around 20,000 patients in Australia with defibrillator or pacemaker devices who are not using the technology, according to advocacy group hearts4heart.
The group says that private health funds have agreed to reimburse the costs of remote monitoring devices (around $1450) on an ex gratia (voluntary) basis if an application is made by a cardiologist.
But it estimates around 2,000 high-need cardiac patients face rejection because their devices fall outside criteria of being fitted before 2015 or not being provided in conjunction with surgery.
hearts4heart CEO Tanya Hall said her group had been inundated with appeals from cardiologists and distressed patients who have received rejections from health insurers.
“For months we have been in talks the Department of Health and Private Healthcare Australia, and some funds such as HBF, Australian Unity, GHMBA, DVA, Teachers Health and WestFund are issuing approvals.
“However, several large providers such as NIB, Medibank and AHM are rejecting applications for remote heart monitoring and seem more focused on their bottom line than the heath of their members,” she said.
Cardiologist Dr Bradley Wilsmore from John Hunter Hospital in Newcastle, NSW, said some of his applications for new enrolments in remote cardiac monitoring had been rejected by insurers without any reason being given.
“COVID or no COVID, this is the smartest way to monitor high-risk heart patients. Quite frankly, we shouldn’t be fighting with health funds over access to essential medical technology,” he said.
Representatives for health funds responded by saying they assessed all applications for remote monitoring devices on their merits.
“If a cardiologist tells us their patient has an urgent clinical need for remote monitoring our clinical team will take the advice of the treating specialist seriously,” Medibank medical adviser Dr Linda Swan told the Telegraph.