Anyone have Ins. issues with SBI?

[sues1953]

I have done everything SBI has ask and I'm in waiting mode and its making me a little nuts!  I'm trying to be patient but I think I will call them today, they have  my referral letter from my PCP (I have an HMO), and all my records.  I was told that Dr. Shahanian would evaluate my case and then the surgery coordinator would call e to set up a consultation (on the phone), 750.00 dollars .  Surgery coordinator Eve Ra told me that for HMO's they roll all the cost together so I would not have to pay the 750.00 immediately but i do need to know exactly what all of this is going to cost before I commit. 

Has anyone heard of SBI accepting what ins is willing to pay?  If they don't I really don't think I have much of a chance of being able to go there.  My DR. here charged 350.00 and my insurance paid a little over 200.00 of it but of course that was in network.  I was totally upfront with Eva and ask her what my chances were and she encouraged me to go ahead and see if I can get my ins to cooperate.  My PCP said it would be 2 or three days for the insurance co to get back with them.  This is day 3.

Meanwhile I have a surgery date of March 15th at Michigan Ear Institute for Translab.  I have two weeks before I go in for my pre surgery tests,  I'm a wreck.  I want to call MEI and let them know what I'm doing but my family is telling me to wait. 

Anyone out there have advice for me?  Any and all is welcome.

Sue in Michigan

[Denise S]

I know we have messaged back and forth, and I don't really have much advice.  But, once again I will tell you I am very happy with MEI.   I also can't imagine even if your insurance pays for the surgery at HEI, will it pay for all of your travel too?   Plus hotel stay, food, etc.?   Just a thought.   My surgery was in Novi (the new hospital there) which is 3 1/2 hours away.  The great thing there too was they let my husband stay right in the room after the 1st night, so saved lots on a hotel fee.  They were great for us and to us.

I wish I could give you better advice, but I know I felt comfort in my decision there right away after researching a few other MI options.

Best wishes still go out to you!!!

Denise (MI)

[sues1953]

Hi Denise

Thanks for your reply.  I have been talking to a few people that had surgery at SBI and that is where I want to go but just found out yesterday that my insurance will not pay.  I am starting the appeal process but that will take time as well.  Meanwhile I start my pre op appts at MEI next week  .  I'm pretty sure that I will have to cancel or at least postpone that date.  It is making me soooo crazy. .

It's not that I don't think Dr. LaRouere is a fine surgeon I know he is and I will go there if Ins won't pay I guess but I have to exhaust all possibilities for SBI first.  It's things like....did you know that it take 4 hours of the surgery time just to get the skull open?    Most complications with this surgery are due to opening the skull and just getting to the tumor.  I have read everything I can find on SBI and I feel my time on the table and also my recuperation time will be cut in half. The hearing loss I know will be hard for me but a small price to pay in the BIG PICTURE.  I have a large tumor with few symptoms so I expect to return to my normal (  ) life soon after surgery. I am our only income right now and that will be zero until I am able to work again.

My brother (bless him) is giving me his vouchers for our travel and as far as Hotel expense I am just not going to worry about that right now .

I read your posts about Baha surgery and I know that MEI asks for 500 dollars out of pocket and from what I can figure other places get the whole thing covered.  Since its not as serious of a surgery you might want to check other options.

Wishing you the Best,

Sue in Michigan

[Denise S]

O.K., what exactly is SBI???

You do need to go where you feel comfortable.   Did you use the search engine here for MEI, Michigan Ear Institute, or the Dr. LaRoue?   Pretty sure all are pretty positive.

I have been researching the BAHA & TranEar stuff like crazy the past few days and finding most places ask for that $500 fee, but some get insurance to cover that part.   Evidentally it is something to do with Cochlear.   Not sure yet.    There is actually a doctor in Muskegon (about 50 miles from me) that comes to Ludington twice a month and he is just starting BAHA stuff.  Hasn't done one surgery yet, but man.....offered a great deal, of course that would mean I would be his guinea pig with the surgical part.   Hmmmm, he does lots of other surgeries and heard good things, but not sure.

Isn't all the decision parts just stressful??     Wishing you the best on your journey!!
Denise

[leapyrtwins]

I have been researching the BAHA & TranEar stuff like crazy the past few days and finding most places ask for that $500 fee, but some get insurance to cover that part.   Evidentally it is something to do with Cochlear.   

The $500 fee that some places ask for is for programming of the device, it has nothing to do with Cochlear. 

My BP100 is on backorder from Cochlear, but the only thing I'm playing my doc's office for is the device itself; nothing for programming.  In fact I'd never heard of this $500 charge until I read about it in a post on the Forum.  I think it was Melissa and/or Kathy M who mentioned it (?)

As for a doctor performing his first BAHA implant, I asked my doctor if you should look for someone who has performed lots and lots of BAHA implants (similar to AN surgery) and he told me it really isn't necessary.  He said it's a pretty routine surgery, so whether someone's done 3 or 300 it shouldn't really matter.  What matters more is that the doctor knows how to perform the surgery.

Jan

Almost forgot, SBI stands for Skull-Based Institute.  Dr. Shananian does endoscopic AN surgery there. 

[sues1953]

HI Cheryl

I agree with Jan I wouldn't think that the Baha implant surgery would be "Brain Surgery" and if you are getting a good deal I'd go for it. 

Last time I talked to MEI I specifically ask about the 500.00 fee and they said yes that was an out of pocket fee not covered by insurance.  I'm sure I will be in the market for a Baha and I will search out a Dr. that includes that fee in what is being billed to the insurance co.

I have done a lot of research on MEI and I am convinced that they are probably the best in my area.  I have made several requests for referrals and past patient info and they just don't come through.  Everyone here keeps telling me to go with my gut and that's what I am trying to do.  I have read positive things here about MEI but if you read closely everyone has had complications, specifically tumor regrowth.  I just read of one of Dr. LaRouere's patients having regrowth at her one year MRI and she was told after surgery that the tumor was totally removed.  MEI pouts their successes of saving the facial nerve which I agree is Very, Very important but leaving some tumor seems to be the norm.  I do understand that their are no guarantees with any surgery and this forum does not represent all outcomes of any DR ,but why can't they help me out with some prior patients?

SBI is as Jan said Skull Base Institute, they do minimally invasive endoscopic surgery.  I read that with traditional surgery up to 4 hours of the surgery is just getting to the tumor  .  I believe that my surgery and recovery time will be cut in half by going this route.  My tumor is large so my  options are few.  Dr. Shahanian has totally removed many large tumors with no regrowth while saving the facial nerve.

Good Luck with your Baha research!  Keep us posted.

Sue in Michigan

[sues1953]

OK, I just went back and looked it is KATHY, the same person who had the insurance problems with her BAHA also had regrowth at one year when she had been told that the entire tumor had been resected.  Again, I know these things happen but I can only do this thing once (i hope )  .  I don't want to have any regrets.

Thanks for listening!

Sue in Michigan                                                 

[Denise S]

Ahaa, now I know what SBI is.    I hadn't found much on that before my surgery when going through all the searching stuff like the point you are at now too..   Have to say 'whew' in a way though because as you know right now it gets overwhelming for sure!!

I say going with your gut feeling is very good.   As for all the outcomes, that is where I find this whole AN thing interesting.   There are SO MANY factors in such a tiny little area that can make the biggest impact as to how the surgery comes out.  The doctor and procedure of course have a big impact, but wow....the actual tumor size, placement, if it is sticky, etc. is the one of the main things too.      So, I think feeling comfort in your heart and gut and just knowing the outcome can very puts your mind at ease.

By the way, are you on Facebook?   I seen something on there about the endoscopic surgery.  Have to say I looked past it because I'm post surgery, but just another option...

I will be thinking of you and wish you the BEST for sure!!   (Oh just went to post and got your last post.....I LOVE this place for people listening.....even lets people vent when they need to and so many understand!!!)

Take Care,
Denise

[sues1953]

This is overwhelming!  It seems I spend every free moment I have on this forum, I feel at home here and I haven't met one person but sure hope to one day.  I took a look at your blog and what a beautiful family you have  .  Its great to have family support, your husband sounds especially wonderful.  My husband loves me but he is really unable to be of support to me.  His business (auto related) is in trouble and its his life.  I know he is feeling a double whammy 

Yes I am on facebook but don't get on there much I will take a look for endoscopic surgery.  Was it for Brain Tumors?

I will be so relieved when a decision has been made.  My insurance denied my request to have surgery at SBI but I'm appealing.  Wish me luck and I will keep you posted.

The best to you and your  lovely family.

Sue in Michigan

[Denise S]

http://www.facebook.com/group.php?gid=78633792319#   This group is called Acoustic Neuroma Association (ANA).  I think started by someone from USA.

http://www.facebook.com/group.php?gid=8190517727   This group is called Acoustic Neuroma Association / Vestibular Schwannoma.  It was started by a volunteer from ANA of Canada.  It has Many more members, photos, updates, etc.

Here are the 2 links to the facebook pages! Seems like one of them has a Discussion or Topic page that I may have seen it under.?

Suppose you're referring to my blog a & family.....THANKS so MUCH!!  I basically started a blog (AND there is Caringbridge) to help keep people informed since I know a lot of people wanted my husband to call them because we were away from home.   I use it as more a journal for myself and can look back and see how far I have come! 

If you need help with the facebook pages, let me know! 

[leapyrtwins]

I read that with traditional surgery up to 4 hours of the surgery is just getting to the tumor  . 

My AN was approximately 3 cms and my surgery only lasted 7 1/2 hours.  I don't know how long it took to get to my tumor, but 7 1/2 hours isn't bad for brain surgery.

Jan

[sues1953]

Well Jan if what I read is true then four hours of your surgery was spent just getting the skull bone off.  From what I'm reading with minimally invasive endoscopic surgery this time is cut in half.

Just searching and hoping and praying here 

Sue in Michigan

[sues1953]

Thanks Cheryl for the link for facebook I sent a post to an SBI patient.

Im home today because of the snow, I don't think you are getting it this time, your too far north.  My daughter is a teacher and I watch the kids.   We love snow days 

Sue in Michigan

[ppearl214]

Hey Sue

I had been wracking my brain on this for a couple of days and now remembered what I wanted to share with you about SBI and insurance issues.

Allegro/Laura (who I had the genuine honor of meeting last year at our local NE Brunch), had her AN surgery at SBI... and did a post late last year about some of the whoa's she has unfortunately run into, including insurance issues with SBI.

Here is the latest update she did:

http://anausa.org/forum/index.php?topic=11361.0

I'm not sure if she's been online here lately but she did take the time to share this with us.... and hoping it helps you with your question.

Hang in there!
Phyl

[Denise S]

Sue, I have to laugh, but do you realize you've referred to me twice as Cherly?   

My profile name is exactly me : Denise

Trust me, I know how confusing it can get with all these people on here..  That is why I kept my profile as my real name.

Take care 
Denise