PFO Check

[Kev]

Hi - has anybody out there used BUPA to have a PFO check?

I am in BUPA but they are refusing to pay for a check for me on the basis that a PFO check is screening and that my symptoms (bent as you please) were caused by diving alone.

I am hoping that if someone answers in the positive then I can use that info to have a PFO check paid for.

Thanks in advance.

Kev

[Al_Star]

Hi Kev,

Yes BUPA paid for mine. I got my GP to refer me to Dr Mark Turner (Cardiologist in Bristol) for a check-up based on a DCS incident. Once you're GP refers you then BUPA was willing to pay for it as outpatient treatment. I did have to ring them for authorisation but stated it was to test for an atrial septal defect.

Not sure where you are based but if Bristol is an option I can send you Dr Turners details as he's worked with Bupa and PFO checks numerous times.

Thanks
Al

[Kev]

Thanks - that is very interesting to me.

Hope you were OK after your dose of DCI mate.

Kev

[Hellvet]

Bupa paid for my first test With Dr Wilmshurst at Royal shrewbury.

However this gets a little complicated, or it did for me.

My Bupa cover started AFTER my bend as i took it out cos getting bent was the first time i had been in hospital and it scared me so i decided i wanted the option to get referred when and where i wanted. When i rang up they offered to cover me for a PFO as i hadn't had a diagnosis it was just statistically likely i had one, because i'd had a bend. (They won't do this now if you're a diver apparently) Cost me an extra £15/month but i figured it was likely i had one so i went with it, and its definitely paid off. they also said they'd pay for a bubble echo if that was what was neccessary to diagnose me.

Then they said they wouldn't pay for a PFO test as it was a screening test, so i disputed this as they'd previously said they would pay for it and on checking the phone records they agreed as they had already said they would, even though they were wrong to have said it under my policy. Trouble was as my bend was pre membership i'd have struggled to argue that the tests weren't screening tests, as arguing that the bend was a symptom would have meant they probably would have decided to not cover me at all!

If your bend was post membership i'd argue that a bend is potentially a symptom for a PFO, and thus its not a screening test but a diagnostic one...

[Mary]

Originally Posted by Hellvet

(They won't do this now if you're a diver apparently) ...

They won't I tried

(to be honest I would have been shocked if they had)

[Kev]

For info, my bend occurred some considerable time after I became a BUPA member.

I am annoyed to discover that BUPA do not want to cover a PFO check for me. Their argument that a bend is brought on by diving alone is absolutely ridiculous. Certainly nobody is likely to get a bend if they do not dive but that does not mean that diving is the only reason that you get a bend. Therefore a bend can be a symptom.

Arguing that a person with a bend from diving should not have their diagnostic procedures covered by BUPA because they were silly enough to go diving is directly analogous to arguing that a person with angina pain from running should not have their diagnostic procedures covered because they were silly enough to go running. I wonder if they would turn these people away?

When I have the PFO test I will probably have paid for it 3 times, once through my taxes, once through my BUPA membership fee and once out of my own pocket.

Beyond belief.

P.S. Hope you were OK after your bend as well Hellvet.

[Mary]

Kev,

To a degree it depends what kind of bend you had as to whether a PFO might be implicated. If in your case the bend was unlikely to be attributable to the PFO it seems reasonable not to test for it and such testing would then fall under screening (so not generally available on NHS or BUPA). If your bend was likely attributable to a PFO (like mine and Hellvets) then the hyperbaric doc will recommend you undergo testing which would be covered on the NHS and I suspect BUPA.

Mary

[Al_Star]

Kev,

Not sure if it's just a case of the sequence you go about it in. In my case I did the following:

1) Got DCS - chamber did not recommend PFO check
2) Spoke to Cardiologist who explained he felt testing was appropriate given the sort of diving I do (trimix & deco).
3) Spoke to GP who was happy to do what cardiologist recommended and wrote referral letter
4) Spoke to BUPA, faxed referral letter and was therefore automatically covered as the GP referred me so it was not a screening test but simply an appointment with a consultant and tests.
5) Had test - paid for by BUPA
6) Had op - was covered by BUPA, was already in their system as seeing a consultant so getting the op confirmed was straightforward.

I got DCS in September, the op was in December and I'm now diving again.

Not sure if I was just lucky. BUPA did a lot of wrangling and clearly didn't want to pay but if you follow the process then they don't have a leg to stand on and will eventually agree.

HTH
Al

[Kev]

Thank you to everybody who replied and sent pm's. I will post an update of where I get to with all of this eventually.

Cheers

Kev

[Andrea123]

I've had the whole lot done under the NHS..

went through Hyperbaric chamber Doc in Nov 06, few letters went missing but eventually got appointment with GP in Jan who immediately refered me to Dr Wilmshurst, (following my suggestion)...again a few missing letters later..
..Appointment with Wilmshurst in May...
..in for the op in Liverpool, Dr Morrison this week.
..follow up appointment will come in Aug with Dr Wilmshurst I hope, just in time for diving in Costa Rica in Sept.

ALL UNDER NHS.

The only thing you need to watch out for is 'missing letters'. They even got me in quicker based on my holiday timing !

Regards, Andrea