ANA Discussion Forum
General Category => Hearing Issues => Topic started by: dalern on September 07, 2010, 07:17:16 pm
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I just got a packet today from my health insurance, Blue Shield of California. In addition to an increase in my premiums, they are making serious benefit changes. There is an area that has "clarifications". Here is what it says for Surgically implanted hearing aids:
Contract language has been updated to clarify that cochlear implants, bone-anchored hearing aids, and auditory brainstem implants are excluded from coverage.
I am going to write them a letter. Obviously this was decided by some business person, not a medical person, who has no idea whatsoever that hearing loss is a debilitating medical condition. I am going to call to complain. Interestingly, my implant was done on June 30th. So far, the bill has not been paid by my insurance. They said they needed more information from the provider (both physician and hospital). There is no way I can pay a $25000 bill, so I am hoping they get it squared away. They did inform the doc's billing people that the procedure was covered. We'll see.....
~Dale
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Dale -
hate to say I'm not surprised by this, but I'm not surprised by this.
IMO, lots of insurance coverage will be changing on our way to Obamacare. It's a shame that those who need hearing assistance in the form of a BAHA, a CI, and/or a ABI won't be able to get the help they need. Truly disappointing :(
I'm thankful you had your BAHA implant before the policy changed. I think writing a letter to Blue Shield of California is a great idea, but unfortunately I don't think they'll change their mind.
Jan
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I have to agree with Jan on this one. I think you should have gotten a letter of acceptance in writing before you went ahead for the surgery. I don't believe in "Hearsay" stuff anymore. I had the same problems for 4 years until BC/BS of Illinois finally gave up and let me have my surgery almost two years ago. When they did finally approved it, I asked for it in writing before I went ahead with the surgery. I have three copies of the letter from my employer and the insurance company.
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Do you really mean $ 25,000 or was that supposed to read $2,500?
No use "shoulding" on yourself on the letter thing. (I love that saying! I SHOULD have done this, I SHOULD have done that.......) What is done is done.
I hope it is covered, if not, a payment plan for life will be in order >:(
Write that letter, I'm sure you can write a darned good one!
Maureen
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Thanks, all. Yes, Moe, I did mean $25,000. That's for the doctor and the hospital, etc. all inclusive! My doctor's office did get a letter in writing. I am hoping that they do some creative coding when resending the information. I will write a letter. I come from the perspective of a health care professional AS WELL as an insurance consultant/agent. I know my small voice won't make a dent, but it's better than not verbalizing it al all.
Jan, as far as Obamacare....there are obviously many problems with that now and certainly for the future. However, the one good thing that came out of it (IMO) is that those that are not insured will be able to get coverage and pre-existing conditions will not prevent someone from getting a policy.
~Dale
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Dale, when is the letter dated? If after your surgery the change would not apply to your procedure. In any case it would be in your favor if you have to appeal. And don't overlook the possibility that the change in policy may have been prompted by paying out for your BAHA.
I'm surprised your doctor would proceed without pre-authorization from your insurance company. If he did, you will probably be able to work out a discount with him.
I think it's good that you plan to be proactive, but I think I would wait for your EOB to arrive before you send a letter.
Good luck.
Sara
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Definitely make sure of the dates and I would fight it and have your doctor's office write a good strong letter do not give in....You have to be your own advocate there are ways of getting around it if you need some help once you verify all dates you can PM me... I worked for almost 30 yrs., fighting with insurance companies and had to fight now personally and had always good to great results... Once you give them any monies you are showing that you accept this do not send them any money even if they threaten you with legal action that is normal... Make sure to keep saying to the doctor's office they did the procedure and accepted the insurance and they are very well versed with insurance companies also make sure you get copies of everything for your own records. They will try to wear you down that is their purpose so that the insureds give up and pay it makes it so easy for the doctors and the insurance companies so that they do not have the hassle. Insurance companies only look out for themselves more money in their pockets but they do give in if they you will continue to dispute the claim.
Good luck,
Pat
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$25,000 for BAHA implant surgery and a processor is actually cheap - at least where I come from.
I think your insurance company will pay for your BAHA, Dale, but you may have to fight with them. For some reason, insurance companies just like to fight - lets them keep their money a little big longer.
If you run into problems, talk to the OMS division of Cochlear (information is on their website). They'll help you fight it.
Jan
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Here is what it says for Surgically implanted hearing aids:Contract language has been updated to clarify that cochlear implants, bone-anchored hearing aids, and auditory brainstem implants are excluded from coverage.
If you look at this from a outside point of view. The insurance company is wrong on this if you go death in both ears as far as the cochlear implants go. But if your SSD. Then they are doing the right thing. I'm SSD and it sucks. But its not worth $25,000+. If I want that directional sound back. I should fit the bill. I know for a fact that BAHA would come way down in price if the public fit the bill.
I know how insurance companies work. And I would say your claim for $25,000 may have promted the change. They don't want to be saddled with paying cochlear implants for SSD.
Kinda like to find out if they have a endorsement for it? And would Medicaid pay for it?
As far as preexisting. Oh my house burn down. Can I get a policy and get it rebuilt. And a week after its rebuilt I'll drop it. Please don't say people will die if they get sick. Medicaid is for everyone but they must go broke. They get to homested the house and car. Obama care is about not going broke cuz people wanted to spend money on other things than insurance.
Sorry to be a meanie. I got surgery in 1 week and I'm FEELING very mean.
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After reading this on medicaids approach to cochlear implants.I would say Obama care in the end will not pay for Baha.
http://www.cochlear.org/sys-tmpl/medicaidandcochlearimplants/
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I'm SSD and it sucks. But its not worth $25,000+.
They don't want to be saddled with paying cochlear implants for SSD.
First and foremost, you shouldn't knock the BAHA since you don't have one. It's definitely your choice - but as a BAHA wearer, I think it was and is worth MUCH more than $25,000
Second, CIs typically aren't for those who are SSD. CIs are for those who are bilaterally deaf - as in, deaf on both sides.
Don't know about Obamacare - and don't really care since Obama will be voted out of office at the end of his term - but CIs are covered by Medicare, as are BAHAs.
Currently if an insurance company covers a CI for bilateral deafness (how the patient became bilaterally deaf is irrelevant) they are required by law to cover the BAHA for unilateral deafness. Not to do so would be considered discrimination and the patient could sue the insurance company.
Respectfully,
Jan
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Jan,
I was told by Medicare that they wouldn't cover a Baha or any other hearing device............is their a special code to get one? I sure would like to try one if there is!
Thanks,
Brenda
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... as far as Obamacare....there are obviously many problems with that now and certainly for the future. However, the one good thing that came out of it (IMO) is that those that are not insured will be able to get coverage and pre-existing conditions will not prevent someone from getting a policy.
I agree, that's great...but at what price? Dale, as you know 'there is no free lunch'. Medical care costs money. No one works for free. Somebody always pays, one way or another. Having studied the issue, I believe that ObamaCare is simply shifting costs, not reducing them. I fear that the 'price' for 'everyone' being covered and pre-existing conditions being automatically covered by any new policyholder (against sound fiscal reasoning as well as longstanding insurance underwriting standards) will (a) shrink the options for many sick people - most especially the elderly - because medical care will have to be rationed to accommodate the needs of all the newly 'covered', including those who are now medically insured for pre-existing health problems that may be very expensive to address and, (b) the cost of the expanded and all-inclusive medical insurance coverage has to rise substantially, especially when the government becomes the sole insurer, costs rise exponentially (as they will) and we have nowhere else to go to obtain medical insurance. I'm sorry that I cannot share even your cautiously optimistic view of 'ObamaCare'.
That stated, I do hope your current medical insurance will cover the high cost of your BAHA. From what you've posted, I believe they'll be obligated to do so. However, medical insurance companies are already raising premiums and shrinking coverages in anticipation of the full force of ObamaCare being implemented. My suspicion is that, eventually, the private insurers will be forced to cease operations due to the inevitable loss of profits due to the restrictions of the new law ('ObamaCare'). That will clear the way for the government, reluctantly, I'm sure, to assume control of the medical insurance business and thus, begin imposing strict controls over doctors and hospitals as well as who is allowed to have what, because, after all, 'the government will be paying for it'. In reality, we'll all be paying for it - in many ways - so I'm not sanguine about the future of medical care in America under 'ObamaCare'. However, I'm not clairvoyant and cannot claim to actually know what will happen in the future, so, I could be wrong. I hope I am...but, when it comes to the government 'running' health care, I remain skeptical, as do many Americans.
Jim
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Just got back from my ENT in FortWorth TX. I asked him if Medicaid covered the Baha he has been doing for others. He said yes. I told him others on the forums have been having problems getting coverage for Baha. He said no one that he knows has been turned down yet.
So I guess its something new with BC/BS.
Since the Government (which is the people) are forcing BC/BS to basically go out of business. They are prob going to pull every trick in the book to hang on as long as possible. Even IF the GOP takes control of the House and Senate. The GOP will NOT have super majorities. And Obama will veto anything they might be able to put together. That's a full 3 years of the Law as it is now for sure.
That's what BC/BS is looking at.
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Brendalu -
if you want to know about insurance coverage for the BAHA - and you are interested in getting a BAHA through Cochlear (not Oticon) - Cochlear will help you.
They have a division called OMS (not sure what that stands for) that helps BAHA candidates work with their insurance companies. If you go to the main website (www.cochlearamericas.com) you'll find more information on OMS.
I would suggest you contact them and ask them to start the process.
To my knowledge, Medicare (or Medicaid - I forget which one) has covered the BAHA ever since it was approved for use in the U.S. by the FDA.
It's extremely important when asking for coverage to state that the BAHA is NOT a conventional hearing aid - it IS a prothesis or implant. This distinction is usually what gets the BAHA covered. It's also important to note that most first time requests for BAHA coverage get turned down, but if the candidate is persistent, the insurance company usually agrees to cover it. Most insurance reps have no idea what a BAHA is - or why those who are SSD would need one. Education is part of the request process.
Jan
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OK, first of all....the insurance sent a letter to my physician dated 2 months PRIOR to my surgery, so I am covered there. This doctor does more of these surgeries in San Diego than any one else. He is the guru of BAHAs and UCSD is certainly skilled in billing. The did NOT bill my surgery in any way as a hearing device, but as a necessary surgical procedure to related to SSD. I don't know the CPT codes they used, but I will find out. I know I will be able to fight this. I also know that BS did not change my rates and their coverage because of MY surgery. I am only one small person in a sea of thousands on this policy. This policy change is not unique to me, but rather across the board Blue Shield policy.
My biggest concern, now and for the future, is that non-medical people, business people in fact, are the ones making the insurance policy decisions in order to save money. There are so many issues that they cannot understand. Not to pay for cochlear implants for folks with bilateral deafness is criminal. It's NOT cosmetic surgery. They do not understand the implications of SSD or bilateral deafness and the fact that it is a true disability. In fact, a disability that can be helped by modern medicine. I think their decisions are truly criminal and prevent normal people from getting much needed treatment that would make them far more functional in their work and in their lives. That's my main concern, which is why I will write a letter. I am even considering writing a letter to the editor in several California newspapers. My issues are not about Obama Care, but about the fact that healthcare is a business more than it is about patient care. This happened long before Obama. Would be happy to discuss that with any of you.
~Dale
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BS not covering CI for the deaf mid policy is very bad news. I think BS will loose in court on that one. I think the only way that will be changed is if someone is denied and then sues after the fact. I do know property insurance pays a big premium if the insurance company looses in court. So they are under the legal gun. At least in Texas they are. Not to mess around with people.
I hope the word gets out on BS doing that.
In a free market you can choose your carrier though. In my experience in insurance. They can change a policy midway if it makes since. Like the Homeowners early 1990s (HO 1-5) used to cover computers as a replacement cost. But they got hosed. Because a 1988 computer would cost $5k bran new and 5 years later be worthless. But the policy said its covered. And people would have closets full of old computers and software. They changed it mid way and the courts upheld it.
That's the worst thing I hate about all this socialistic talk. I'm stuck defending corporations that are evil bastereds.
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Dale ~
First and most importantly, I'm pleased to learn that your BAHA has been covered by your insurance, as I suspected it would be. I also realize that, as I believe I noted in my previous post addressed to you, (#12) that medical insurance premiums are currently being raised 'across the board' based on the mandates on insurers stemming from the passage of the 'ObamaCare' law last March. Many of our members have had horrendous experiences with their medical insurance carrier and have posted their stories here. So, I think we can all agree that the way medical insurance is presently managed cries out for reforms. However, that being stated, I fear that if we're unhappy now having our medical insurance administered by business people with a profit motive, (I don't consider profit a bad thing) we're going to be extremely disappointed when government bureaucrats in Washington, D.C. are in charge and our freedom of choice is gone because the only insurance available is government health insurance and if they deny you a procedure or medicine, there won't be any options. I also believe that by the government administering our health care via insurance, we'll end up paying more and getting far less. Initially, the same private insurance companies will be administering health care insurance, just as they do now, only with many government mandates and restrictions, which are prompting the current rate hikes. I posit that as the full barge of rules and regulations 'ObamaCare' demands is implemented by private insurance carriers, they will cease to be profitable and simply shut down, turning medical insurance operations over to a government bureaucracy. That way lies rationing, waiting lists for simple procedures and, inevitably, higher costs for everyone. None of those are appealing to me - or most Americans. This is why I cannot find anything to be pleased with in this new health care law. If others can, so be it. We're all entitled to our opinion. This is mine. I hasten to add that I do not purport to speak for the Acoustic Neuroma Association.
Jim
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Thanks, Jan, I will check it out!
Brenda
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Jim,
Thanks. First, Blue Shield has not yet actually paid for my insurance. They did send an authorization letter to me and my doctor's office. But....it still has not been paid. Secondly, with everyone crying that they don't want the government running insurance, I need to ask....Do they want their medicare taken away because the government runs that too. What about those on Medicaid and SSI? Also, government programs. So, yes, the system is messed up. I do believe Doctors and insurance companies are responsible for this mess, but it goes back a long way. It did not start with Obama. I am not saying that the Obama healthcare plan isn't without fault....it's full of faulty premises. But, I don't care who the president would be at this point or in the future....I don't think we have the capability of creating a perfect healthcare plan. There will be problems with either a Democratic or a Republican regime. Politicians do not understand healthcare, no matter what their affiliation. They don't have the first hand experience. That being said, Medicare and Medicaid have helped a lot of people. I for one, am looking forward to being on Medicare in 3 years so I can stop paying the ridiculous cost of Blue Shield!
~Dale
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Hi, Dale ~
I trust that Blue Shield, having authorized the procedure, will eventually pay the bill.
To answer your question regarding Medicare, a government-run health insurance program: It was well-intentioned (as they always are) but frankly, with it's limitations, I would much rather pay more, have 'regular' health insurance - and more options. Most government-run programs you specify (Medicaid, SSD) are poorly run, hideously expensive and a poor substitute for 'real' health insurance. Social Security Disability can be a nightmare just to be 'awarded' a 'benefit', as many of our members can attest. Frankly, I do not believe that a massive government program, administered by bureaucrats with essentially lifetime jobs and no real accountability can be in my best interests, and that doesn't address the always-increasing costs of these government programs. In prior posts on the issue of Obamacare, I've given the history of Medicare and how it's costs have ballooned into the stratosphere over it's 45-year existence. I won't bore anyone by repeating the information but it is factual and not simply an opinion. Americans that want 'ObamaCare' repealed has stood at a majority for most of this year so your characterization of these millions of citizens as 'crying' seems a bit overwrought. Perhaps they are simply suspicious of a gigantic government program that was literally rammed through congress and laden with unknown rules and restrictions and that was passed using bribery and coercion. When the government eventually becomes the 'sole provider' of our health insurance, a lot more Americans may well be 'crying' but to no avail. Of course, I hope that doesn't happen but as I've stated, I'm not optimistic on this issue, even if others, like you, are. We'll all know the reality, soon.
Dale, if you read my posts on this issue carefully, as I'm sure you do, you'll note that I never mention political parties or personalities, including the president. That is not an oversight but a deliberate attempt to separate the emotions of politics from the facts. I'm not interested in a 'political' discussion with anyone, as they end up causing hard feelings and, sometimes, misunderstandings that the folks perusing these forums don't need. Where a statement is my opinion, I say so, clearly. I do not hold political office and cannot change anything so my opinion is simply that, with no influence on anyone.
I'm enrolled in Medicare' and so far, it's fine...except that I haven't had to use it, yet. I'll let you know how it is if I actually make use of it. However, 'ObamaCare' will subsume Medicare by 2014 (if not repealed) so you may not get your wish to be on it. However, we'll all be on the government heath care insurance plan by then, like it or not. Perhaps you don't care to have choices but I do and that is one of many reasons I oppose this government health care plan. I certainly agree with you that politicians of any affiliation cannot realistically 'manage' our health care. This is why I wish they wouldn't try. Too late, now. That having been (exhaustively) stated, I'll wind up my comments on the issue, here. Should you wish to further discuss it, please use the PM system so as not to burden others with a discussion many may not be interested in, no matter who is having it. Thanks.
Jim
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I started to panic a bit after reading your post, Dale, as I was waiting for prior auth myself, but my approval came through yesterday. I have a feeling I'm in just under the wire and am glad I'm not putting this off any longer. I don't have my surgery date confirmed yet, but it'll likely be 10/8. Anxious to have this behind me, or behind my ear, as the case may be! ::)
Denise D.
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Good luck, Denise, and I am so glad it was approved. I'm just holding my breath now until my bill gets paid!
~Dale
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I started to panic a bit after reading your post, Dale, as I was waiting for prior auth myself, but my approval came through yesterday. I have a feeling I'm in just under the wire and am glad I'm not putting this off any longer. I don't have my surgery date confirmed yet, but it'll likely be 10/8. Anxious to have this behind me, or behind my ear, as the case may be! ::)
Denise D.
Make sure you get your approval letter from the insurance company or the doctor office before you schedule your surgery. You don't wanna be stuck without any kind of proof.
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http://cbs2chicago.com/investigations/insurance.surgery.blue.2.1915339.html (http://cbs2chicago.com/investigations/insurance.surgery.blue.2.1915339.html) I can certainly relate to this! I went thru the same thing for 4 years until I finally got my surgery in Dec. 2008 and June 2009.
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Ken -
just watched this video myself - and then sent the link on to one of my favorite docs.
I know lots of people who were denied coverage for a BAHA by BCBS of Illinos until they fought it.
Hopefully going forward they won't have to fight anymore.
Jan