Met with an EP today

I met with an EP at Kaiser today. He and Dr. Natale share the facilities at Scripps La Jolla, but they don't cross paths. At least he actively listened when I requested a C-reactive Protein test and a RBC Magnesium. He did order me the C-reactive protein lab work, but said Kaiser doesn't do the RBC Magnesium and suggested I get that done through a naturopath or a homeopath. I have no idea how to find a good one.

Aside: Years ago, when my collie was dx with cancer, and wanting to leave no stone unturned, I went to a holistic "vet" for a consultation, but he was just Mr. Snake Oil. I half expected him to pull out a pendant on a chain and wave it in front of my dog, and so now I am very skeptical and hesitant about things that are outside of western medicine for both people and dogs.

The EP I met today only does about 75 ablations a year, and he's been doing this for 10 years, he explained things very thoroughly and answered all my questions in detail, offered a PIP option should my symptoms worsen, and also mentioned upping or changing or adding medication, should I want to try those options before going for an ablation.

I told him at this point, my symptoms seem mild to me, my medications control much of the a-fib symptoms, and when I do have symptoms, they are not daily and they resolve quickly. Of course, this could change at any time. I was glad to hear that he did not offer digoxin, like cardiologist I saw (and I only saw the cardiologist in order to jump through the hoops to get a referral to an EP).

Doing only 75 ablation procedures a year is a far cry from what Dr. Natale does. I didn't bother to ask the EP about how often he does other procedures.

He did say that I could probably take an extra extended release metoprolol (I'm on the lowest dose) if the a-fib episodes bother me... does anyone have any experience with doing this???

I guess my next step is to call Member Services at Kaiser and see if they'll cover a second opinion consult with Dr. Natale, and then I'll try to get an appointment with Dr. Natale. If Kaiser doesn't pay for a second opinion, I'll pay out-of-pocket (does anyone know what the consultation might run me?).

Suggestions, ideas, support and warm fuzzies are appreciated!
Thanks!
Sue
edited to add a part I forgot to include



Edited 1 time(s). Last edit at 03/15/2018 03:25AM by SueChef.

An extra metoprolol will slow your heart rate more and lower your BP more. This might make you feel fatigued, but it will lessen the symptoms of the afib so it's a tradeoff. All you can do is try it and see how it affects you.

I have no idea what a consultation with Natale costs because mine was bundled in with all the other costs associated with my ablation, but I would imagine you can simply call his office and ask. Shannon would probably also know so you might sent him a PM.

I dug up my insurance billing from last year (only $409,000 holy cow pie), and it looks like the brief consultation was billed at less than $1000 (probably about $400), and with insurance it was negotiated even lower. There are about a dozen entries for that day as I did the consult and MRI the same day, and the ablation the next. The highest line item for the day of the consult was $1000. IIRC, I read somewhere that the cash cost for a Natale ablation was around 75K, but don't take that figure as gospel. While my total billing to insurance was over 400k last year, it was negotiated down to just under half that amount by insurance. Interestingly enough, my expert ablation by the best of the best was significantly less than what my failed marathon 12 hour FIRM procedure cost in my state of residence.

It would make perfect sense that the cost of the consultation is whatever a standard office visit would be.



Edited 1 time(s). Last edit at 03/15/2018 03:42PM by AB Page.

Thanks, Carey, for the info! I will send Shannon a PM.

Thanks, AB Page, for the info, too--I appreciate your digging up your insurance billing! I have no idea about the cost of a consultations etc outside of Kaiser...but I'll be asking about this when I call Member Services.
Sue

750 ablations over 10 years is a pretty low number. I’d find another EP if possible.

And trying to decipher insurance billing may have side-effects including depression, loss of appetite, and psychosis!

Hi Sue,

I had some thoughts about your post and situation.

I had my ablation at California Pacific Medical Center in San Francisco in December, 2013. At the time we had United Choice Plus insurance, it was very sweet. Everyone was in my network, including Dr. Natale, heck I could have had my pick of any of the staff at the Cleveland Clinc, the Mayo Clinic, or MD Anderson....green checks everywhere! So, of course I booked an appt with Dr. Natale. We don't have that insurance now! lol I did see the billing from my ablation, and Wolf is right, it's just about heart stopping. They billed my insurance $150K, and United ended up paying about $125K after some sort of discount.

I thought I read somewhere (Shannon?) around the time of my ablation that the cash price for Natale to do an ablation in Austin, including pickup at the airport was $80K, No clue what it is now.

I also have no clue what just a consult with Natale runs. But you did say that "my symptoms seem mild to me, my medications control much of the a-fib symptoms, and when I do have symptoms, they are not daily and they resolve quickly"

When I had my consult with Natale's staff, I strongly got the feeling that there was a criteria for a Natale ablation, to actually get the appt. booked for a slot. You don't actually get to see Dr. Natale without getting through his staff a bit first, quite a lot actually. Dr. Natale's NP did do an extensive history with me verbally as well as reviewed my records with me at this meeting, it lasted about an hour. When I said the words "A-Fib is ruining my life" towards the end of this review, she immediately looked up at me and said "you qualify for the program". Around this time Dr. Natale entered the room, sat down and I met with him for only a very few minutes. He would have spoken to me longer, but at that point I had been reading about him for three or four years, I was ready, I mentally had turned myself over to his process. I told him I really didn't have any questions, that I was ready. I was so desperate for a fix, my life was really in ruins, I almost couldn't work anymore. I felt disabled.

The reason I mention all of this is because there are people with A-Fib where Dr. Natale tells them to come back when their A-Fib becomes more symptomatic. I've seen it here on this board. And I got that same impression in the meeting I had.

Hopefully Shannon can elaborate more about this, I just have my own experience, Shannon knows the process deeply, of course.

Finally, you asked about RBC Magnesium, a blood test for it. You can order your own tests, and the results are sent to you. No one else, it's private. You can check your thyroid, your hormones, do a CBC, anything. Forget those "gate keepers"! Here is one of the labs we use, just enter RBC Magnesium in the search.
[www.directlabs.com]

My wife and I order our own labs every six months on a bunch of stuff. My wife is on bio identicals , has NASH, and has three auto immune diseases, and I of course have a cardiac history.

Take good care, Neil

edit: there are other places to order labs, many of them. We have used Direct Labs that I linked above, we also use Life Extension, and Discounted Labs. The prices go back and forth on who's the cheapest, we jump around. All of them use LabCorp for the lab and blood draw, there are little LabCorp offices everywhere, many of them. The price of the test INCLUDES the blood draw, it's all inclusive and there are no additional charges. Once you pay for the test, you are sent the blood draw sheet via email, you print it and take it with you to LabCorp, it says the test of course you ordered, and "prepaid" in the notes. The staff of these places don't ask for an insurance card, no ID, no questions. The results are emailed to you, PDF, within 3 or 4 days, max. It does not go to your doctor, unless you choose to do so and carry it to him.



Edited 3 time(s). Last edit at 03/16/2018 01:19AM by onewaypockets.

Quote
wolfpack
750 ablations over 10 years is a pretty low number. I’d find another EP if possible.

And trying to decipher insurance billing may have side-effects including depression, loss of appetite, and psychosis!

Thanks wolfpack! I was told by the EP that the procedure takes 3 to 5 hours, and was also told Kaiser gets a 70-75% success rate. That percentage doesn't float my boat at all.
Sue

Hi, Neil,

Thank you so much for the info about LabCorp...there's one really close to me!! Unless the other suggested labs are super cheap, I'll be glad to stay local.

I really appreciate your thoughts about my situation--wow, you did have awesome insurance coverage at that time!

I appreciate your input about the cost of things as well, reflective of the time you had your procedure done.
The way I see it, and Kaiser may not see it this way at all, is that Dr. Natale already has privileges at Scripps, La Jolla, which is the very same facility that the Kaiser EPs use, so why not ask Kaiser to work with me and I'll pay half for Dr. Natale's fee, and Kaiser will pay the other half of his fee and Kaiser will also pay for the rest of everything as they would have, had I used on of their more inexperienced EPs. That might be totally wishful thinking on my part but I can always ask, and then take my request up the chain of command.

Quote

"When I had my consult with Natale's staff, I strongly got the feeling that there was a criteria for a Natale ablation, to actually get the appt. booked for a slot."

^^^^ This makes total sense to me. Since my symptoms are mild, I probably wouldn't qualify nor would I get through the screening process unless I used the magic words "A-Fib is ruining my life" -- and I wouldn't use those words unless I felt as you did, that it was time to take the next step and get things done. At least in the doctor's notes from my cardiologist appointment, and from my EP appointment, my name-dropping "Dr. Natale" was noted. I'm thinking of that as laying the groundwork, should it be helpful in the future.

I did send Shannon a PM, and he so kindly and helpfully replied, and we are going to be in contact with one another.

Perhaps you and your wife already know this regarding NASH - the use of silymarin (milk thistle) has seemed very helpful for many people in terms of supporting and perhaps restoring liver function. I know it comes in liquid form, but not sure if it comes in pills or tablets.

Thanks again!
Sue
edited for clarity because my keyboard often has a mind of its own, and poor grammar too!



Edited 1 time(s). Last edit at 03/16/2018 05:02AM by SueChef.

Hi Sue,

Well, no matter who you buy the blood test from, you would still be going to LabCorp.

How it works is LabCorp is a very large nationwide corporation. A big buck operation. They don't sell tests to individuals, only to "qualified" parties. There are much smaller outfits that can buy, wholesale, these tests from LabCorp. Places like Life Extension, Discounted Labs, and dozens of others. These smaller places take individual LabCorp test codes, I'll give you one example. They might take , sensitive estrodial, free testosterone, total testosterone, progesterone, and a CBC....and they would bundle them together and call it "female hormone panel $199".

So, in this manner they can repackage popular individual tests together and call them anti-aging panel, thyroid panel, male hormone panel, etc. They also let you get a panel like this, and do a ala carte additional like adding a Vitamin D test, or that RBC Magnesium test.

So, you can order a lot, or order a little. It basically works as these smaller companies are brokers, they package, collect money, pay LabCorp, and take a small profit for their trouble. Essentially these smaller parties are accounting operations, they market, collect money, and email results.

Hi onewaypockets,

Thanks for the extra info-- I misunderstood how it works!

Sue

Glad I could help Sue. It took me a while to figure out the whole blood testing thing. When I found out about it, some years ago, I said "what, I can order my own tests, MYSELF???". It's so empowering. Pretty thrilling actually. Well, at least to me.

Quote
SueChef
was also told Kaiser gets a 70-75% success rate. That percentage doesn't float my boat at all.

It shouldn't float your boat, and you should ask how they define "success." It's common for some centers to consider ablations successful even if antiarrhythmic drugs are required to maintain normal sinus rhythm. Clearly, if you need AADs to remain in NSR then your ablation was not successful, and yet many will count it as so.

As I mentioned to SueChef on the phone the other day, A non-insurance funded stand-alone consult with Dr Natale and his staff at St Davids should run between $250 and $300. Exact confirmation must come from the St Davids Business office, but this came from pretty much the horses mouth as a close estimate.

Hope that helps. My recommendation, if you cant get Kaiser to refer you out to Dr Natale ( odds are very hiugh you will not be able to as they are uber strictly on not referring anyone out of their tightly controlled HMO, and you have your heart set on partnering with Dr Natale being the man behind your entire 'expert ablation process' (very wise choice by the way!), then either take a 1 to 1.5 year hiatus from Kaiser and buy another more flexible insurance plan tax accepts Dr Natale as most plans do, and after you are sure your AFIB is durably silent after a once to two ABL process with Dr Natale, then you can either resign up with Kaiser again if you really wish too, or you might find that the more flexible plan you moved too, will handle your needs just fine going forward.

A number of our previously Kaiser plan holders who eventually went to Dr Natale for their ABL, did just what I describe above. A couple of them rejoined Kaiser after their AFIB was vanquished at St Davids, Scripps or CPMC, but most of these folks carried on with their new insurance plans to the best of my recollection.

Cheers!
Shannon

Thank you, Shannon, for your wise council, and your very helpful & informative phone call!
Sue