HCSC Coverage Speaks to Rising Payer Acceptance of Mobile Outpatient Cardiac Telemetry

by Lisa Gillespie

Ten years after the launch of a mobile outpatient cardiac telemetry device from medtech company BioTelemetry, Inc., insurer Health Care Service Corp. (HCSC) has included it in its medical coverage policy. BioTelemetry says about 95% of payers now cover the diagnostic device, and many without step therapy requirements that mandate patients try other devices first.

The mobile outpatient cardiac telemetry (MOCT) device is perhaps one of the most recent medical developments used for diagnosing heart rhythm and rate abnormalities. These devices are part of a growing industry, because as more Americans develop heart disease, there's a rising demand to identify the symptoms earlier and mitigate bigger costs down the road.

Dhanunjaya Lakkireddy, M.D., a cardiologist and the medical director of Kansas City Heart Rhythm Institute at hospital system HCA Midwest Health, says for a number of years, payers wouldn't cover MOCT from any manufacturer, labeling the devices as investigative.

"Insurance companies are typically about three to four years behind technological evolution, so we had a lot of struggles to get it approved [for patients]," says Lakkireddy.

The manufacturer said it still has to work with the five Blue Cross Blue Shield companies within HCSC to establish contracts in Illinois, Montana, New Mexico, Oklahoma and Texas.

Payers often will tag newer devices as emerging or investigational as a reason for noncoverage. That's still the case for members of Blue Cross and Blue Shield of North Carolina. The insurer says in its corporate medical policy, updated in late 2019, that it considers outpatient cardiac telemetry investigational and does not cover services in that category.

Some payers cover MOCT and similar devices, but with processes similar to step therapy. For instance, CVS Health Corp.-owned insurer Aetna requires that members have a Holter monitor, which is only worn for about 24 hours, other 48-hour telemetry or infrequent symptoms of arrhythmia to qualify for the MOCT device.

BioTelemetry has also used the MOCT to start a remote monitoring program for health care providers treating patients with COVID-19. Some drugs used to treat the virus that's caused a global pandemic can cause a dramatic speeding up of the heartbeat and potential cardiac arrest.

From Health Plan Weekly