ANA Discussion Forum
General Category => Insurance => Topic started by: Soundy on October 16, 2008, 12:19:21 am
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... or would be if I didn't feel like crying
still fighting insurance about assorted issues...and still say BCBS of Tennessee S sucks...
well I have been discussing BAHA with them and they say they will pay for any leftover portion of
bills after I pay out my $2400 family out of pocket /deductable , but still not for the hardaware...just
the doctor and surgery...
but when I ran it by them they will pay 80% of cost of TV ears... as we all know hearing TV is more
important than hearing the truck fixing to run over you in a parking lot...I have a November appointment
with audiologist so will take it up again with him...
Then was discussing balance retraining with them after a nurse hired by BCBS called for what she called a
Family Checkup... mostly just making sure all birthdays and allergy and info like that was right and cross checking
ongoing issues.... she suggested the retraining therapy ... told her the cost was to high and the drive to long
and benefit gained would be lost... she gets a claims person on with us in a three way call and I was told that
after my out of pocket was met they would pick up %75 and my cost per visit would only
be around $125 ... I about half jokingly said they needed to pay for a Wii Fit and I could work from home ...
she ran it and they will pay on the fit and possibly some on the Wii system itself ... the girls are getting a Wii for
Christmas... last year they got up to around $600 here if you could find one ... I had picked up one for our
Fall Festival Raffle prize last week and was given a discount coupon of $75 and used it to get another for the
girls...she said to send a copy of the receipt and to get the Fit and send that receipt too and I will get a
little back...around 20% ...
All that is fine and dandy but hey are still not paying for my treatment and want a full MRI series and a complete
cardiac workup on me (due to heart issues I had after taking Zomig ) ...the heart thing resolved and showed no
sign of damage to heart... I have to pay for both the cardiac work up (last one was around $5000) and the MRIs of
head have been from $2000 -$4000 depending on where I have had them ...
I told the claims lady that all this insurance crap was going to drive me insane ...
now here is the funny part...
in a mono tone voice she replied ...
Are you aware that you have mental health coverage under your new policy?
Do you laugh ,cry or go running off down the road nekkid and screaming ??? so far I have chose laughing so as
not to cry and running down the road nekkid would probably upset my kids
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Soundy -
I'm so sorry to hear that you are still dealing with this crap :(
The insurance person's comment is a scream :D
I'm glad you decided to laugh rather than cry - it would have been my pick also ;D
Hang in there and let's hope things get better. Insurance companies - UGH!!!
Jan
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Soundy:
My wife was a claims supervisor in a nationally-known insurance company. She knows how the 'system' works and how to get results. Still, she gets fed up dealing with Blue Cross, even though she is usually successful. Example: I turned 65 in February. I'm covered under her medical policy (she's on long-term disability leave). She called her company and asked three (3) different people if I would still be covered under BC if I opted out of Medicare. They all answered in the affirmative, and she pressed the point with each one. Surprise! When I had my last MRI, they didn't pay because they 'assumed' I was covered by Medicare! After about 8 phone calls to the company, she finally got a claims manager that admitted their mistake (my wife knows enough to ask for names of anyone she talks to on this kind of issue) and was actually contrite. She said she would pay the MRI claim (and others that followed) and personally follow any claims under my name to be sure this didn't happen again. The only 'catch': I had to agree to apply for Medicare in January. Until then, any medical bills submitted under my name will be paid - with the usual deductibles.
Think about that. My wife (the primary policyholder) asked 3 different people at various levels in the company if I would still be covered under the BC policy after I turned 65 and did not take Medicare coverage. All said 'yes'. All 3 were completely wrong. Their mistake (or ignorance) could have cost us hundreds and hundreds of dollars. Fortunately, my wife was able to find a responsible claims manager to rectify this situation. Still, it was frustrating.
I guess most of us posting in this particular forum have a story, but yours is the 'best'. You express impending insanity due to the hassles the insurance company puts you through and the brain-dead representative asks if you're aware that you have mental health coverage on your new policy. A classic that probably won't be topped for some time. You should submit it to Reader's Digest or some other publication that accepts (and pays for) reader jokes and stories. I'm positive they would publish it. Just a thought.
Here's hoping you have better luck in the future when dealing with BCBS of Tennessee.
Jim
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Oh good heavens, I'm still laughing after reading this last night AND showing it to my husband! You're right, laughing is all you can do unless you want to become hysterical or truely insane.
I'm so so sorry they are still giving you fits with this. It makes absolutely no sense to pay for part of a Wii, and something for you to hear the TV with, but not the other things. Wait, makes sense (as in logical) and insurance copanies would be polar opposites of eachother!
I really hope they will pick up more of the expenses for you! Good luck! And thank you so much for the laugh. I agree, submit this!
Andrea
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Soundy
Sorry the insurance company is such a pain in the !**! Hang in there maybe they will relent and pay for more of the costs. If they do drive you crazy at least your therapy would be covered -- thanks for the laugh ;D
Wendy
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Oh my gosh, Soundy! If I hear on the news that some woman from Tennessee was seen running down the street nekkid and screaming, I will know who it is!! ;D ;D
Insurance is a royal pain.
Sue in Vancouver, USA
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Shakes head, rolls eyes I thought I had heard it all, but that one leaves me speechless.
I am in my own insurance nightmare. They refuse to pay for a BAHA due to it's a hearing aid. I keep explaining it is not, but they have told me I lost my hearing due to chronic ear disease and need to try a more conservative approach to my "hearing loss". I pointed out they had just forked out over $100,000 for brain surgery for an AN and I had perfectly good hearing prior to surgery. When I brought this to their attention, they admitted they know nothing about BAHAs, but again denied it due to they won't pay for hearing aids.
I did tell them a BAHA would be cheaper than the mental health expenses I was going to rack up due to dealing with the insurance. They also assured me I was fully covered for mental health.
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That just stinks - so sorry that y'all are having to deal with that!! :P
K
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oHIo -
sorry to hear about your insurance problems. Don't, however, just drop this issue!
Someone told me before - maybe Judy V @ the AANA (?) - that insurance companies typically refuse to cover the BAHA on your first request, but they typically agree on your second request. Stress to them that the BAHA is NOT a hearing aid, it's an implant - which, believe it or not, in the insurance world is a huge difference. As your insurance company told you, they have no idea what a BAHA is, so it's up to you to educate them. I believe BAHAs are covered by Medicare and/or Medicaid so use that if it will strengthen your case.
Get your doc behind you with documentation telling your insurance company why you need the BAHA and that it is due to your AN surgery - not a "chronic ear disease" :( Since your hearing was perfectly good prior to surgery, ask him to send the results of your pre op hearing test.
Also, find out if your insurance company pays for Cochlear implants; many of them do. My insurance broker told me that if a company covers Cochlears, they pretty much have to cover BAHAs. Cochlears are to bilateral deafness, what BAHAs are to unilateral deafness. If they pay for Cochlears, but don't pay for BAHAs, it's discrimination.
In short, don't take no for an answer. Many, many insurance companies say no to coverage on lots of stuff and the insured gets discouraged and doesn't push the issue - saves the insurance companies big bucks. I had to fight with mine a couple of years ago to pay for my son's vision therapy. After telling me it wasn't covered, I pursued the issue until they paid for it - which saved me many thousands of dollars.
BTW, good to see you posting again; it's been a while.
Jan
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Perhaps the correct insurance code would help, as posted by Tamara in this post:
http://anausa.org/forum/index.php?topic=6200.msg58473#msg58473
Using this CPT code:
Implant, temporal = 69714 (BAHA)
should help the insurance company figure out that it is not a hearing aid.
Steve
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Still a little funny ...
I have a November appointment with audiologist and will take BAHA up again with him... I
have that code number wrote down on the back of a BAHA business card that came in the
info pack I ordered from them several months back
but my main worry is getting head pain relief ... BAHA at this point for me would be a luxury ... have
had a couple days in the last two weeks where I have just stayed in and hid from the world
with my achy head
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Thanks everyone,
We are using the correct codes, MD has had a peer to peer, I have formally appealed along with the Medicare policy enclosed that states they do not pay for hearing aids but will cover the BAHA. I intend to take it all the way, but it has been a stressful nightmare in the meantime. Yes, they pay for cochlear implants and I have mentioned discrimination. The most difficult issue has been trying to get them to tell me why it was denied. The excuses I got why they couldn't send me a letter in layman's terms, leaves me shaking my head. I am reporting the insurance company to our state board of insurance because they have violated many of my rights as a consumer. Telling me I could get online and look up the reason the BAHA was denied when they couldn't even find it to read to me was absurd.
My favorite excuse by the insurance company for refusing to pay was that a BAHA was cosmetic surgery to improve my looks. My response, "Yes, all of my friends are lining up to have a titanium post and snap sticking out of the back of their head. I hear it is the latest rage in Hollywood."
By the way, the Cochlear people are great. They have emailed me a form appeal letter, the Medicare policy that covers BAHAs, but did report that my insurance company along with another have never overturned an appeal. I plan to be the first. They just don't know my level of determination.
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You go, Debbie!
I can't believe they'd even attempt to say it's cosmetic surgery to improve your looks :o :o :o
I can't wait to hear Lori's response to that one. Who knew we were both now beauty queens ;D
If you'd like I can send your insurance company pictures of my implant and ask them if my head looks lovely with it :D
The Cochlear people are amazing and very helpful.
I'll keep my fingers crossed for you.
Keep the faith.
Jan
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My best excuse from CIGNA when we were on them was that I was too old ... said they would pay in full if
I was younger... on our policy it said if you are under 18 hearing aides are paid in full as you are in your
developmental stage of life ...evidently after that hearing is no longer important ...also would pay if hearing
was a major part of your "work experience"
Cochlear had been great sending me information and codes and letter explaining BAHA which some insurance
people I have talked to say they have never heard of ... but still haven't got anywhere with insurance as
far as paying for it ...
I have had an excess of skin that is growing in the canal of my hearing ear removed twice ... the doctor at
first thought it was a small tumor of unknown origin then said maybe a wart... but it is more like a callus ...
just thickened skin that comes back... so my hearing in the ear is good but this skin thing blocks sound... one
excuse was that if I was losing hearing in that ear the BAHA wouldn't work...which is true to a point but
since it is loss due to an obstruction BAHA would work since sound travels through the bone ...
one rep told me sound travels through the air... asked if she had headphones on...she said yes on one ear...
told her to put her finger in the ear that was uncovered and scratch the center back of her head... when she
did and could hear it , she was amazed and asked me how I did that ... she was in New Jersey (I asked )
and me in Tennessee...how she thought I made her hear something is beyond me ...
I think many of the people that are punching in codes and working claims just go by the codes and what
is in front of them and lose the reality of the situation factor... all they see is numbers and not the people or
conditions that those numbers stand for...
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one rep told me sound travels through the air... asked if she had headphones on...she said yes on one ear...
told her to put her finger in the ear that was uncovered and scratch the center back of her head... when she
did and could hear it , she was amazed and asked me how I did that ... she was in New Jersey (I asked )
and me in Tennessee...how she thought I made her hear something is beyond me ...
Extremely interesting, Soundy.
I think you're totally right about the people just punching in codes and claims and not really knowing what patients are dealing with.
And to tell you you're too old for a BAHA to be covered ??? Despicable :o
Have you talked to someone "in charge" at Cigna? or do you have access to someone like a patient advocate or patient manager there?
Sounds like you definitely need to fight this with someone who has some type of authority with Cigna.
Jan
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Jan~
I think that Soundy had to switch form Cigna to BCBS of TN...
oHIo~
That is like me getting the T3 and my eyebrows realligned b/c my face has been PARALYZED for 12 years for purely cosmetic reasons...well, I guess it did improve my looks! LOL!! :o
K
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Jan~
I think that Soundy had to switch form Cigna to BCBS of TN...
K -
you are absolutely right - thanks for correcting me :-[
I'd claim I was half asleep when I posted my response, but I noticed it was almost noon at the time, so I guess that excuse doesn't work :P
Anyway, I should have asked Soundy if she had talked to anyone "in charge" at BCBS. Sometimes you have to go all the way to the top to get things done.
Jan
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I have talked to so many people I forget who all and what position they hold on the totem
pole... I have the woman at my husbands place of work , that is our go between with BCBS working
on it too... her husband who is on her insurance and has had by pass surgery got the same letters
of denial of coverage I got saying our conditions were pre-existing (which they are ) but we were
told it would be a seamless transition and it has been anything but seamless... with her husband in the
same boat as several of us with expensive problems (and it all comes down to money) she is keeping on it ...
Going to wait to go further til I see the new doctor and how he goes about getting BAHA paid
for... he does the surgery of the post and it was his office I got the demo unit from to test drive ...
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Ah, yes, the vanity of all of us... wanting to have a metal bolt placed in our skull because it is so very attractive. What with my facial paralysis and this titatium post, I think I must be ready for the runway! Move over, Supermodels of the world!! The BAHA models are taking over!
How sad is it when the brain surgery was the easiest part of this whole experience? I think I would rather have the surgery again than have to deal with my insurance company! I finally just got my BAHA surgery - from last November - paid last week. It was pre-approved and everything. The surgeon got paid his portion, but the hospital did not. I was able to finally determine that the hospital entered the wrong code - one number off. But anytime I called the billing department, they insisted that they just enter what the doctor tells them to and they don't make mistakes. I finally got so frustrated that last month I called the hospital administrator and refused to speak to anyone else. It was taken care of the next day - and guess what - it was just a keying error on the part of the person who entered it in the computer. Gee, isn't that what I said last December??? Well, needless to say, I got phone calls from everyone apologizing and since I had written down names, titles, dates and times of conversations, I think a lot of people got read the riot act that day. Moral of the story - go right to the top of the totem pole if you want anything done.
Anyway, I have heard that BC/BS does pay for BAHA's. I remember it coming up in a conversation with my audiologist. You need to enlist the help of your audiologist and surgeon on this one. They know how to word things so they are covered.
Now, if you'll excuse me, I think I'll go admire the beautiful metal thing sticking out of my head.
Lori
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there are 4 different BCBS in Tennessee that I know of and that is because of the handbook
they gave us ... we are on a high deductible plan and it won't pay anything on anything at all until
we have paid out $2400 out of pocket... well shouldn't say they won't pay anything ... we do each
get physical each year at a cost of $20 and mammograms are paid in full...
We are part S ...S stands for sucky... my new favorite word when thinking about insurance ... an office
visit at my PCP is $59 -79 depending on if he does ...blood work ,urinalysis and the amount of time he
spends with you ...plus lab charges... on CIGNA we had a $20 co-pay and they got the rest including lab
costs... now we are suppose to pay it all when we go and they file it and keep up with how much we are
out... he will work with us if I went in and say had an x-ray and labs and visit ... he takes $20 at visit and
bills us the rest ...so far I have paid in full but nice to know I could still be seen if I didn't have it all
Many doctors in this area have quit taking part S patients becasue it take them so long to get paid...