PFO closure/insurance coverage

[Pullnglide]

Last May I suffered a DCS II hit 2 hours after surfacing from 3 hours in Bozell. There were a few things that I considered to have caused it to include thermal stress and the sawtooth profile. My dive buddy mentioned PFO so I had a TTE done the following day, it was negative. I have since done similar dives and several exceeding 200' and approaching 300' with multiple hours deco and haven't had a problem (luck of the draw I guess). A few months ago a friend recommended a TEE. That was performed yesterday w/ bubble test and it was positive for the PFO. I don't know how my insurance is going to respond to having it closed since I wouldn't imagine diving would deem it medically necessary. Seems like they would just advise against diving and deny covering the procedure. The insurance is BCBS and is very good but I'm just not sure they will cover it, I will find out more next week. To those who have had it closed, did your primary insurance cover the procedure and what was the process i.e. Recovery time and time out of the water? Thanks for any information!

[rddvet]

Out of curiosity did you request a tee and have issues getting someone to perform it? Sometimes you ask for something and doctors don't always want to oblige as they some times take it as an insult. I've had two minor hits. I've changed some things in my diving and haven't had one since. My tte bubble study was normal, but if I have another issue I plan to get the tee.

[Pullnglide]

I didn't know much about it at the time and didn't know there were multiple tests. I just asked them to test for a PFO and the Dr. chose the TTE. I went to my primary Dr. who is familiar with hyperbaric and diving medicine and he ordered the TEE for me a few weeks ago. I have to make the decision whether to have it closed or not but I'm leaning towards having it done since it will always be in the back of my mind, is this the dive where it will happen again?

[IowaCaveDiver]

I would suggest contacting Doug Ebersole... Extremely active cave diver and instructor and also is a heart surgeon that specializes in closing PFOs. I'm sure he could be a great resource to you

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[kensuf]

Insurance may cover because you have a history of decompression illness. PM sent.

[bamafan]

Derek I hope it works out the best for you. You definitely scared me that day. It is something I will never forget

[Pullnglide]

Thank you everyone for all of the info and the very informative pm Ken! It definitely was a bad day for sure and thank you Eric for helping me to get on o2 quickly and making the 911 call when the $h*t hit the fan! It may have ended badly had I been alone.

[DiveMonkey]

I would 2nd IowaCaveDiver's recommendation for Doug Ebersole in Lakeland FL. I'd had 8+ episodes of skin bends, the most recent being in January 2016. I had the procedure done at the beginning of April this year. Was diving by the end of June without any issues, other than more post-dive energy. Also haven't had a migraine since the procedure and normally would have had at least a dozen by now.

Dr Ebersole was fantastic! It was worth flying out from California for the tests and procedure. My Health Net PPO insurance covered most of it, too.

[MichelleC]

After a few incidents of skin bends (3 out of 7 dives...) I contacted Doug Ebersole. A TTE confirmed the PFO, and I had it closed the very next week. I was expecting insurance to cover 80% but actually was happily surprised when they covered it at 100% (the diagnostics and surgery to fix.)

A septal defect increases your risk of other medical issues as well (stroke for one...) which your insurance company may find it worthwhile to help you avoid.

[bigdave]

After a few incidents of skin bends (3 out of 7 dives...) I contacted Doug Ebersole. A TTE confirmed the PFO, and I had it closed the very next week. I was expecting insurance to cover 80% but actually was happily surprised when they covered it at 100% (the diagnostics and surgery to fix.)

A septal defect increases your risk of other medical issues as well (stroke for one...) which your insurance company may find it worthwhile to help you avoid.

It does reduce risk of stroke, but there are risks inherent in the procedure itself and the long term effects of the closure are unknown. From heartplace.com:

http://www.heartplace.com/services/i...amen-ovalepfo/

This procedure is effective, but it has associated risks that include stroke, TIA, infection of the device, the need for surgical removal of the device, bleeding requiring a transfusion, vascular damage, cardiac puncture requiring emergency surgery, severe cardiac rhythm problems, contrast allergy, kidney failure (temporary or permanent), esophageal damage caused by TEE, reaction to medication, bleeding, and intolerance to blood thinners. Other patient-specific risks may also apply. The long-term effects of this device (beyond seven to ten years) are unknown. Adherence to follow-up and compliance with medications are critical.