Re: Re: New Oregon law and Medicare

[Guest guest]

Thanks, Ted. I haven't totally given up just yet.

A person on another list said she got her bilateral operation via

Medicare and said that " bilateral " was mentioned by Medicare

somewhere. I did a search and found a fairly encouraging statement by

them here about a third of the way down: http://tinyurl.com/2m79vj

BTW, my only stab at bilateral hearing with hearing aids was a brief

try at a pair of in the ear aids. I might have really liked bilateral

aids but hated in the ear aids because there was no vent and my ears

felt plugged. Changing volume was a pain also. Never did try a pair

of BTE aids. 'Probably should have.

Virg

> I've got my fingers crossed for you, Virg.

>

> Ted F.

[Guest guest]

Virg,

You said " A person on another list said she got her bilateral operation

via Medicare and said that " bilateral " was mentioned by Medicare somewhere. "

I would like to know more about this case. Did Medicare actually pay

the claim? Did she get both sides done at the same time?

About the criteria, the link provided does not seem to indicate that

Medicare will pay for bilaterals. If in fact it is true, why is it that I

have yet to find such a case? I would love to find that and take it to my

clinic. By the way, its OHSU.

*---* *---* *---* *---* *---*

" What a waste it is to lose one's mind. Or not to have a mind is being very

wasteful. How true that is. "

--Al Gore

& Dreamer Doll ke7nwn

Newport, Oregon

N24C 3G 8/2000 Hookup

rclark0276@...

http://webpages.charter.net/dog_guide/

[Guest guest]

Yeah, , the page I linked to doesn't come right out and say that

Medicare will pay for bilateral implants and I don't know if she had

to fight for them or not. She did get them both at the same time. I

could ask her to write to you if you like.

I haven't dropped the issue, just have been busy with other things.

I forget just where you live. Fortunately for me OHSU is only about

45 minutes away. The " head audiologist " , Dr Plapinger, is actually

Director, Clinical Audiology. I didn't look at his actual title when

I wrote that <g>. I like everyone there at OHSU very much.

I did send her post to Dr Plapinger as well as Dr McMenomey who did my

implant and to my current audi, Elyse.

Virg

> Virg,

> You said " A person on another list said she got her bilateral

operation

> via Medicare and said that " bilateral " was mentioned by Medicare

somewhere. "

>

> I would like to know more about this case. Did Medicare

actually pay

> the claim? Did she get both sides done at the same time?

>

> About the criteria, the link provided does not seem to indicate

that

> Medicare will pay for bilaterals. If in fact it is true, why is it

that I

> have yet to find such a case? I would love to find that and take it

to my

> clinic. By the way, its OHSU.

[Guest guest]

Hi and Virg--- I was on the bilateral panel with Cochlear Americas at the

Northeast Cochlear Implant Convention this past weekend and this very very topic

came up in the discussion before the panel began the discussion of going

bilateral. The cochlear rep that was our moderator said that she only knew of 5

cases that had medicare approving bilateral CIs and THAT is with supplemental

insurance. I think the KEY here is having supplemental insurance. She did say

that she does not know of any cases without any supplemental insurance. I

mentioned that I didn't know any cases without any supplemental insurance and

only one with supplemental. So this does support . He wants proof that

Medicare paid without supplemental.... I hope that this helps...

Snoopy

Re: Re: New Oregon law and Medicare

Yeah, , the page I linked to doesn't come right out and say that

Medicare will pay for bilateral implants and I don't know if she had

to fight for them or not. She did get them both at the same time. I

could ask her to write to you if you like.

I haven't dropped the issue, just have been busy with other things.

I forget just where you live. Fortunately for me OHSU is only about

45 minutes away. The " head audiologist " , Dr Plapinger, is actually

Director, Clinical Audiology. I didn't look at his actual title when

I wrote that <g>. I like everyone there at OHSU very much.

I did send her post to Dr Plapinger as well as Dr McMenomey who did my

implant and to my current audi, Elyse.

Virg

> Virg,

> You said " A person on another list said she got her bilateral

operation

> via Medicare and said that " bilateral " was mentioned by Medicare

somewhere. "

>

> I would like to know more about this case. Did Medicare

actually pay

> the claim? Did she get both sides done at the same time?

>

> About the criteria, the link provided does not seem to indicate

that

> Medicare will pay for bilaterals. If in fact it is true, why is it

that I

> have yet to find such a case? I would love to find that and take it

to my

> clinic. By the way, its OHSU.

[Guest guest]

Virg,

Same team at OHSU. Good people. Snoopy hit the right key, its that

supplemental health insurance that some have.

And contrary to what a lister told us (dont know if he is still on

list), Medicare doesnt have an approval process nor an appeals process prior

to a procedure. What one must do is to sign an ABN (Advanced Beneficiary

Notice) form which puts you on the hook during the appeals. Who knows how

long this will take and meantime the clinic is gonna be wanting their money.

So if anyone claims they received prior approval, I am very very skeptical.

*---* *---* *---* *---* *---*

In school, every period ends with a bell. Every sentence ends with a period.

Every crime ends with a sentence.

& Dreamer Doll ke7nwn

Newport, Oregon

N24C 3G 8/2000 Hookup

rclark0276@...

http://webpages.charter.net/dog_guide/

[Guest guest]

Good points, and . I don't know if the gal had

supplemental insurance or not. I do, with Providence. I was

pre-approved for my single implant or I wouldn't have done it. I just

couldn't take the chance on being hit for $60,000 or so. The same

will apply to a possible second implant.

I did write to Senator Deckert, who sponsored the Oregon bill in the

senate, and asked not only about Medicare but about supplemental

insurance with Medicare. He responded today saying only that he was

looking into it.

Virg

> Virg,

> Same team at OHSU. Good people. Snoopy hit the right key, its

that

> supplemental health insurance that some have.

>

> And contrary to what a lister told us (dont know if he is still

on

> list), Medicare doesnt have an approval process nor an appeals

process prior

> to a procedure. What one must do is to sign an ABN (Advanced

Beneficiary

> Notice) form which puts you on the hook during the appeals. Who

knows how

> long this will take and meantime the clinic is gonna be wanting

their money.

> So if anyone claims they received prior approval, I am very very

skeptical.

>

> *---* *---* *---* *---* *---*

> In school, every period ends with a bell. Every sentence ends with a

period.

> Every crime ends with a sentence.

> & Dreamer Doll ke7nwn

> Newport, Oregon

> N24C 3G 8/2000 Hookup

> rclark0276@...

> http://webpages.charter.net/dog_guide/

>

>

>

>

[Guest guest]

Virg, $60,000? My bills showed up today. How does $112,000 sound?

Ralph

CII 8/01

Bilateral July 11, 2007

> Good points, and . I don't know if the gal had

> supplemental insurance or not. I do, with Providence. I was

> pre-approved for my single implant or I wouldn't have done it. I just

> couldn't take the chance on being hit for $60,000 or so. The same

> will apply to a possible second implant.

>

> Virg

[Guest guest]

Virg,

To point out, with Medicare, there is no pre approval necessary at all

when one meets the criteria that is set. I am not sure whow things work

when there is supplemental insurance but am surmising that if Medicare is

primary, nothing changes.

If the other insurance approves a second CI, I dont know if Medicare

will pick up co pays. But in this kind of scenario, one could get that

approval from that insurance company anyway. One of the list members has

Medicare and Medicaid and Medicaid covered the second CI for her.

*---* *---* *---* *---* *---*

If you find yourself in a hole, the first thing to do is stop diggin'.

& Dreamer Doll ke7nwn

Newport, Oregon

N24C 3G 8/2000 Hookup

rclark0276@...

http://webpages.charter.net/dog_guide/

[Guest guest]

Ralph,

My goodness did they forget to bill you for the first CI? Or double

bill you? That is one hefty bill!

*---* *---* *---* *---* *---*

If You Don't See What You Are Looking For You've Come To The Right Place.

--sign at an optometrist's office

& Dreamer Doll ke7nwn

Newport, Oregon

N24C 3G 8/2000 Hookup

rclark0276@...

http://webpages.charter.net/dog_guide/

[Guest guest]

,

As you know, I'm the list member whose second CI was covered by Medicaid. I also

have Medicare, but was told by my former CI audi that if it were not for the

fact I had Medicaid, my bilateral CI would not have been covered.

Left ear: Nucleus 24 Contour Advance with Freedom BTE

Implanted: 12/22/04 Activated: 1/18/05

Right ear: Nucleus Freedom

Implanted: 2/1/06 Activated: 3/1/06

[Guest guest]

,

Yup, it was you indeed I was thinking of. And waiting... for errr,

some, uh, emails from said list member. LOL

*---* *---* *---* *---* *---*

You can't get where you want to go if you don't know where you are.

& Dreamer Doll ke7nwn

Newport, Oregon

N24C 3G 8/2000 Hookup

rclark0276@...

http://webpages.charter.net/dog_guide/

[Guest guest]

It sounds terrible!

Virg

> Virg, $60,000? My bills showed up today. How does $112,000 sound?

>

> Ralph

> CII 8/01

> Bilateral July 11, 2007

[Guest guest]

,

After I finish writing this, a private e-mail is on the way. <smile>

Left ear: Nucleus 24 Contour Advance with Freedom BTE

Implanted: 12/22/04 Activated: 1/18/05

Right ear: Nucleus Freedom

Implanted: 2/1/06 Activated: 3/1/06