Insurance Bad News

[dalern]

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

[leapyrtwins]

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

[Kencutus]

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.

[moe]

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

[dalern]

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

[saralynn143]

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

[pjb]

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

[leapyrtwins]

$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

[Funnydream]

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.

[Funnydream]

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/

[leapyrtwins]

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

[Brendalu]

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

[Jim Scott]

... 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

[Funnydream]

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.

[leapyrtwins]

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