Gastric Pace maker

• By Char
• Posted March 5, 2008 at 7:29 am

I've had my pacer for 4 &1/2 years now. It isn't a cure, and it is important to know that so you don't get disappointed. Mine has helped a lot. I went from completly unable to tolerate tube feeds at all and being on TPN to being able to tolerate feeds most of the time. I still have bad spells where I end up in the hospital, which is where I am right now, but they are less frequent then they use to be. I was in the hospital 4-5 days after surgery, but that is mostly because I was the first one done at my hospital and my doctor wanted to keep an eye on me. Haveing the pacer doesn't limit your activity, as long as what you want to do invonlves magnets and things of that nature. I have a problem of my pocket getting bigger and my pacer moving around or flipping, but that is very rare. I hope your insurance approval comes through quickly. Let me know if you have any more questions.
Charity

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• By twin
• Posted March 5, 2008 at 12:54 pm

Hi,

I have had the pacer since June of 07, The greatest thing it has helped me with is the daily nausea. I can still get sick from eating but with the pacer, the nausea feeling goes away much quicker. I am unable to throw up because of a surgery done, so this does help out.
I was in the hospital for 4 day's, The recovery wasn't bad for me.
The pacer doesn't limit your activity but for me laying on my stomach doing some exercises, stretching, etc. it sometimes is uncomfortable.

It took about 5-6 months to get the settings adjusted right to help me, so be patient, and be sure your doctor knows alot about the setting adjustments. It is a bit of an art, and it continues to change as your body changes. It definitly not a cure, but it has helped me.

Hang in there with the insurance approval, that was also an experience, but they finally came around. Let me know if you have any other questions. Take care, Karry

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• By michdey
• Posted March 5, 2008 at 2:08 pm

Hello Everyone--


I got the official insurance denial for the gastric pacemaker surgery yesterday. I have 30 days to submit an appeal so I guess I need to write a letter pleading my case. Does anyone have any suggestions as to what to include? I have been told that is my last treatment option available since I already have the feeding tube in. Does anyone have a name and phone number of anyone at Enterra that can help with the appeal process? My doctor submitted articles to support the medical necessity but evidently the insurance company was not impressed. Any suggestions would be much appreciated. I go into the hospital on Friday to have the J-tube placed and to start the tube feedings. I have been trying real hard not to get discouraged at this point but it has been difficult. I have been having a real hard time this week with nausea and vomiting and stomach pain. My doctor renewed my morphine prescription so that helps with the pain. I will be having another port put in on Friday also so I can start giving myself Zofran through the line again which is much more helpful than the phenergan has been. I'll write again after surgery--hope everyone has a good wekend.

Michelle

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• By twin
• Posted March 6, 2008 at 2:43 pm

Hi Michelle,
I'm so sorry you got the denial, it's so frustrating.. I went through 2 denials because of experimental, not proven as reasons. I worked with Vicki at Medtronix 1-800-292-2903 X50026 if she is still there she can help get you on the right track. I ended up having to use a patient advocacy attorney, but it was worth it. Let me know if you have any other questions. Karry

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• By hajj
• Posted May 18, 2008 at 5:38 pm

having done a lot of appeals with avery good track record,the most important thing is to have ALL of the medicqal documentqation on your paticular case and the reason of needing the pacemaker and any body of law you can get your hands on.If you are MediCare there are layers os appeals and you should get an attorney as you will not get thru it by yourself.MediCal aptients got to welfare and institution codes and health and welfare codes to site for your case.Articles won't do it,sorry.They want everything pretaining to YOUR case.Medical documentation and then the legal findings or body of law citations. It is a daunting task but worth the effort.If you have just regular health iunsurance,get an attorney to represent you that is in health law.Good luck to you.I hope you get approval.write me anytime

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• By hajj
• Posted May 18, 2008 at 5:40 pm

Forgot something that is really important and that is ALL of the time limitations.In some case you can request an extention of time and the reasons you need the extention of t ime, but you still have to beware of those time limitations also.I hope this info helps.

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• By SeussRN1
• Posted May 18, 2008 at 11:37 pm

Thanks for your advice. The MD sent a dictated letter addressing the medical necessatiy ( can't spell tonight) and when I talked to the insurance company last week they had recieved all the documents and had forwarded my file onto the next department. It was apparently a 181 page document that was sent. It seems that it would be wiser for the insurance co. to pay for the pacer rather than the 5,000 they fork out every week.

Thanks again,
Beth

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• By hajj
• Posted May 19, 2008 at 1:37 am

I agree,but thats not the system we have unfortunatly.I am so sorry for you and anyone has to go thru this denial system. Being so ill is bad enough but this will wear you out,don't let them win,think this is the idea.Fight back and get legal help to do it if you have to.You deserve the best life has to offer.

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• By hajj
• Posted May 19, 2008 at 1:41 am

keep your head up high & chin up kid,believe things will work out.I ahve been in the same place lately in trying to get the right medical help needed and have been up & down,sometimes feel like I am on a roller coaster ride.I bounce back.Keep the faith.

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• By ajonesy
• Posted May 19, 2008 at 1:55 am

I am also thinking about the pacer. Do you know about G-Pact? THe website is g-pact.org I guess they help get people approved for this device. I hope this helps. Good Luck. I will be right where you are soon.

Amy

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• By michdey
• Posted May 20, 2008 at 2:39 pm

Beth,

I am glad Char responded to you because that is who I was going to suggest you write to. I am still waiting to hear about my denial/appeal. It has gone through the insurance company and is now in the hands of the company that reviews Medicare denials. Last I heard, they were requesting additional information from the insurance company, so I am hoping they sent a letter asking what the problem is--the insurance company would save so much money if they allowed me to get the pacer and not be in the hospital monthly and paying for the at home nursing care, tube feeds, etc. But they say it is experimental and there is no proof it actually works. My doctors have told me it is either the pacer or a feeding tube for the rest of my life. While I needed to lose weight because I was overweight, I have lost 60 pounds in the past two months and my skin has an unnatural coloring to it. I don't really relish the thought of either but would definitely choose the pacer over the feeding tube. Good luck to you--I hope we both get the news we are looking for.

Michelle

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