RE: a last minute set back...

[Guest guest]

In a message dated 3/14/2004 10:58:38 AM Pacific Standard Time,

cherrys_shorty@... writes:

that we did get a very surprising

setback.

This is one thing we all dread...... I hate it....... and I had " some "

setback but mine wasn't " denied " but it was on " hold " , pending coverage reform.

You said it was his insurance company that denied it. Was it through his

employment? If so, he can check with his HR office and enlist their help as

well.

If it was through Medicaid,,, I have heard that more and more States are

starting to deny those coverage. WA is apparently one of them. Don't let that

fear you, as I also heard that some group are fighting for it, apparently the

denials are in violation of some Federal law.

When I was told that my Medicaid " do " cover it.. my hope was up there, then

the day I saw my surgeon for pre-op, I got the bad news of " hold " , whatever it

mean, it was scary for all of us. No one expected that, the doctor office

said they never received this and I was first to get that clinic to get the

news.

Now the State are doing it on " case by case " basic, I pray that my sister

will not be denied as she just applied for CI eval.

One thing that baffled me,, you quoted " the doctor let us know that this was

not based on medical necessity " . Wonder where did he/she got this idea,,, it

is very well needed as medical necessity! If hearing aid do not work, the CI

will (in most case), it not only improve hearing, but think of others " medical

related " issue, such as emotional well-being for one.

Now,, as far as insurance, find out how the appeal process work and see if

there is a patients' advocate to help you. Enlist all the helps you can grab,

just as I did which I end up working closely with someone who works in a

Medicaid office.

Keep your chin up! Somewhere over the rainbow, there's an answer.

Lee

12-12-03 implanted

1-8-04 activation

[Guest guest]

lee

you mentioned that getting a CI is most certainly based on medical necessity

a CI is not like getting a face lift or other kinds of cosmetic surgery

ok i think my 3G is kinda cute but this is cute with a major function

which is to allow me to hear why is it that the medical insurance and even

doctors don't see that there is a real need to hear?

getting a CI should be like getting an artificial leg to walk on or getting

eye surgery to see

these would not be denied or put on hold why is it that when

people can only hear a little with HA it is thought as " good enough " when

did hearing become the low man on the totem pole? Hearing is a medical

necessity it is needed to communicate, safety reason, job related

reasons, and quality of life comes into play getting a CI is not a life

or

death situation but it is something that should be thought of as a necessity

susan

[Guest guest]

In a message dated 3/14/2004 12:26:04 PM Pacific Standard Time,

spottedlee@... writes:

One thing that baffled me,, you quoted " the doctor let us know that this was

not based on medical necessity " . Wonder where did he/she got this idea,,, it

is very well needed as medical necessity!

The " medical necessity " one was the first one they tried on me....next came

" cochlear implants are experimental " and therefore are not covered. I ended up

having to write appeal letters. The insurance department at Advanced Bionics

deals with this all the time and when I wrote my second appeal, I faxed it to

them...they added their own appeal letter and AB sent both appeals with a

package of information to my medical group and my insurance company Fed Ex

overnight. I had my approval within days.

Hopefully things will still go smoothly for Cherry's surgery. I would

imagine some phone calls will be made...I will be keeping my fingers crossed!!!

Deb H

[Guest guest]

Well spoken ,,, as I said in my post,, I said it is indeed an

necessity. But just lost for word,, but you said more and I thank you!

As for State now looking at it on case by case basic,, it has to do with

misuse of criteria, too many are getting implants when other resources hasn't

been

looked into (trying hearing aid), too much of hearing etc etc. It used to be

all whoever asked, get it automatically, but not anymore. My timing for

approval happened just at the time they decided to put everyone on hold as they

sorted out the coverage reform.

Lee

[Guest guest]

Oh ,

I so hate to hear news like that. You and Chauncey are in my prayers and I

know this will all be ironed out in the end. It is so horribly frustrating

though that you have to deal with this and make phone calls and contact

people etc., to get the story straight. It's a pain. Doesn't help with

the normal apprehension already there, of having surgery in the first place.

Here's a hug from Jaxon to Chauncey ...

Love,

Kim