Author Topic: Insurance Bad News  (Read 8700 times)

dalern

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Re: Insurance Bad News
« Reply #15 on: September 08, 2010, 08:40:56 pm »
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
Dale Barnes, RN, MSN, CLNC
Tarzana, CA
1998 Sudden Onset Idiopathic Sensorineural  hearing loss diagnosed at House Ear Institute, Los Angeles
BAHA June 30, 2010 Dr. Jeffrey Harris UCSD San Diego

Funnydream

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Re: Insurance Bad News
« Reply #16 on: September 08, 2010, 10:23:55 pm »
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.
Age 42, AN left, 2.8cm
left hearing gone, balance getting better.
16 hour Surgery 9-27-10 CSF leak fix 10-4-10 3 hours
Miracle I feel my left face and tongue again.
If we evolved from monkeys into humans? When do we stop being human and become something else? What would that something else be?

Jim Scott

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Re: Insurance Bad News
« Reply #17 on: September 09, 2010, 01:16:55 pm »
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

« Last Edit: September 09, 2010, 03:20:45 pm by Jim Scott »
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

Brendalu

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Re: Insurance Bad News
« Reply #18 on: September 10, 2010, 05:26:05 am »
Thanks, Jan, I will check it out!
Brenda
Brenda Oberholtzer
AN surgery 7/28/05
Peyman Pakzaban, NS
Chester Strunk, ENT

dalern

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Re: Insurance Bad News
« Reply #19 on: September 10, 2010, 03:28:27 pm »
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
Dale Barnes, RN, MSN, CLNC
Tarzana, CA
1998 Sudden Onset Idiopathic Sensorineural  hearing loss diagnosed at House Ear Institute, Los Angeles
BAHA June 30, 2010 Dr. Jeffrey Harris UCSD San Diego

Jim Scott

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Re: Insurance Bad News
« Reply #20 on: September 10, 2010, 04:26:16 pm »
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
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

Goldie

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Re: Insurance Bad News
« Reply #21 on: September 14, 2010, 07:11:01 pm »
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.
GK 5/06 at Mayo for small AN after balance and slight hearing issues.  Progressive hearing loss following GK.
3/09 - facial spasms began.  MRI shows tumor growth.
9/09 - MRI shows further growth.  "GK failure."  Translab 10/1/09 success!  BAHA 10/8/10.

dalern

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Re: Insurance Bad News
« Reply #22 on: September 14, 2010, 09:21:26 pm »
Good luck, Denise, and I am so glad it was approved.  I'm just holding my breath now until my bill gets paid!
~Dale
Dale Barnes, RN, MSN, CLNC
Tarzana, CA
1998 Sudden Onset Idiopathic Sensorineural  hearing loss diagnosed at House Ear Institute, Los Angeles
BAHA June 30, 2010 Dr. Jeffrey Harris UCSD San Diego

Kencutus

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Re: Insurance Bad News
« Reply #23 on: September 15, 2010, 02:05:00 am »
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.
"Hearing Resistance is Futile!"
Treacher Collin's Syndrome
First surgery left side 12-08, Baha Intenso 3-09
Abbutment came loose on 5-09
Bilateral Baha surgery 6-09 Baha refitted 9-09
Richard & Mark Wiet MD from Ear Institute of Chicago.

Kencutus

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Re: Insurance Bad News
« Reply #24 on: September 16, 2010, 09:39:19 am »
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.
"Hearing Resistance is Futile!"
Treacher Collin's Syndrome
First surgery left side 12-08, Baha Intenso 3-09
Abbutment came loose on 5-09
Bilateral Baha surgery 6-09 Baha refitted 9-09
Richard & Mark Wiet MD from Ear Institute of Chicago.

leapyrtwins

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Re: Insurance Bad News
« Reply #25 on: September 16, 2010, 09:52:27 am »
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
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways