Guest guest Posted August 23, 2001 Report Share Posted August 23, 2001 Speaking of insurance debacles. I'm so frustrated right now. We recently signed up for Pacificare through my husband's school district. Pacificare specified in their summary of benefits that Cochlear Implants were covered, and my son's pediatiritian was under their plan, so no changes would have to be made there. Great. Now his district is revamping their insurance choices and wants to get rid of Pacificare (they say Pacificare is likely to go bankrupt this year anyway) and replace it with Kaiser. Kaiser does cover the implant, but I'm not sure how good they are with the surgery and follow up. Also, Neal would have to start over with a whole new doctor. Our other choice is to switch to Blue Cross California Care, but they have told me that Cochlear Implants are not covered under their policy. That is, they are not specifically mentioned as a covered benefit, so it would have to be deemed medically necessary by our medical group and then go to a review board. So it would be a big fight to get it approved through them, but again, we wouldn't have to change doctors. What to do??? ~Rhonda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2001 Report Share Posted August 23, 2001 Speaking as an atty, I have had to help more folks write insurance commisioner complaints for bad faith and fraud against Blue Cross (in multiple states) than any other insurance company so far. If Kaiser says CIs are covered, and Blue Cross says " medically necessary " only, I would go with Kaiser and find the best pediatrician within Kaiser possible. You do not want to have to deal with Blue Cross " review boards " which are a total sham in my opinion. I am on another list for parents of kids with atresia and deformed outer ears (which my daughter Patty also has) and Blue Cross REGULARLY denies requests to approve surgery to fix these problems as they claim it is not " medically necessary " If you are in Northern California, I can probably get you a referral, I know someone in the Kaiser management hierarchy. Patty will be 10 tomorrow -- the big two digits, how time flies !! She started her Claro trial last week after waiting for seven months and the initial results are excellent. Sheri Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2001 Report Share Posted August 23, 2001 You might want to contact Angie King: http://focusonhearing.org/ Kay Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2001 Report Share Posted August 23, 2001 - when Bill Clinton was diagnosed with a hearing loss, he had to get " in the ear " hearing aids. I was on two online groups and at the time I recall many of us writing to him urging him to work on legislation to make it mandatory for hearing aids to be covered by our health insurance. Maybe you can ask him if his federal employee plan (FEP) covered his hearing aids since his administration was in power for eight years. I wrote to his administration regarding hearing aid coverage, or lack thereof - and they too palmed me off elsewhere to the office of Personnel management, who sent me in another circle. I am not sure how political the issue is and I prefer to not get into politics here but interestingly enough, a congresswoman out of land, Connie Morella - introduced a bill, HR 2321 - to make it mandatory for all federal employee health insurance policies to provide coverage for hearing aids. This was introduced in 1999 and just moves from Committee to Committee. I am writing to this administration stressing literacy in deaf children and using info from the self help for hard of hearing. Also, Angie King, who is a member of this list, knows a lot about hearing aids, cochlear implants, etc. I think she has a website. M. >From: jthomasx2@... >Reply-To: Listen-Up >To: Listen-Up >Subject: Insurance debacle >Date: Thu, 23 Aug 2001 16:22:34 -0400 > >To ALL: >I hope everyone here realizes that this issue of insurance companies " not >covering " the implant has to be resolved. FIGHT FIGHT FIGHT!!! I'd love >to know what organization I could get involved with that is fighting to >ensure that audies, HAs, implants and all related expenses cannot be >denied by any HMO or managed care plan. This not an issue of cosmetic or >elective procedures, our kids need their parents to be able to choose >among all available technologies and education programs regardless of >financial status. As for working for the federal gov't, I'm sure the >insurance would pay if one of the Cheneys needed an implant. > >I am sorry to bring politics into this, but it is already here. When I >was asked to leave my job because I couldn't give them 300% due the fact >that I had a disabled child, I had to pay $700 a month for COBRA coverage >so Em could continue getting her services. Thank God the county covers >all of her educational expenses. > >I once thought that I didn't want to get involved in deaf issues because >then my whole like would revolve around deafness. Well, I have to get >over that, because I want to make sure that all kids have the options >that I had when faced with my daughter's disability. If anyone has any >info on organizations that deal with hearing related issues, please >forward it to me. > >And Sherry, good luck to you, don't give up the fight! > > >mom to , 2, N24C at 16 months _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2001 Report Share Posted August 24, 2001 << If you are in Northern California, I can probably get you a referral, I know someone in the Kaiser management hierarchy. >> I'm in Southern CA. Thanks for that info though! ~Rhonda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2001 Report Share Posted August 24, 2001 << Kaiser has given two outside referrals , one for auditory therapy (before her CI), and also an advocate for the deaf and hearing impaired. I guess every insurance has their perks and down falls. Let me know if I can help. >> Sounds like Kaiser might be better than I thought. Again, we're in Southern CA though. I wonder if they will consider the last 6 months that Neal has had his HA's or if they will make him start all over. The director/ audiologist at his oral deaf school is writing me a letter explaining that he seems to be getting no benefit from the aids and that she recommeneds CI evaluation. Maybe that will help. She seems to be known and respected by alot of medical people. ~Rhonda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2001 Report Share Posted August 24, 2001 << We have Blue Cross Blue Shield Health Select and they not only paid for my daughters initial implant they paid for her two subsequent surgeries - one to reimplant and the last one to remove it since it didn't want to stay in her head! They also pay for all her speech therapy and her hearing aid batteries. They only pay $500 per ear every three years for hearing aids - but we do take advantage of that! >> Must be quite different than Blue Cross California care. Is it an HMO plan? ~Rhonda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2001 Report Share Posted August 24, 2001 We have Blue Cross Blue Shield Health Select and they not only paid for my daughters initial implant they paid for her two subsequent surgeries - one to reimplant and the last one to remove it since it didn't want to stay in her head! They also pay for all her speech therapy and her hearing aid batteries. They only pay $500 per ear every three years for hearing aids - but we do take advantage of that! Amy At 09:53 PM 8/23/01 EDT, you wrote: >Speaking as an atty, I have had to help more folks write insurance commisioner complaints for bad faith and fraud against Blue Cross (in multiple states) than any other insurance company so far. If Kaiser says CIs are covered, and Blue Cross says " medically necessary " only, I would go with Kaiser and find the best pediatrician within Kaiser possible. You do not want to have to deal with Blue Cross " review boards " which are a total sham in my opinion. I am on another list for parents of kids with atresia and deformed outer ears (which my daughter Patty also has) and Blue Cross REGULARLY denies requests to approve surgery to fix these problems as they claim it is not " medically necessary " > >If you are in Northern California, I can probably get you a referral, I know someone in the Kaiser management hierarchy. > >Patty will be 10 tomorrow -- the big two digits, how time flies !! She started her Claro trial last week after waiting for seven months and the initial results are excellent. > >Sheri > > >All messages posted to this list are private and confidential. Each post is the intellectual property of the author and therefore subject to copyright restrictions. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2001 Report Share Posted August 24, 2001 In a message dated 8/24/01 9:45:33 AM Central Daylight Time, momnaudrey@... writes: > Must be quite different than Blue Cross California care. Is it an HMO plan? > ~Rhonda > Even though many people have problems with one insurance company or another, I think that everything still depends on what is written into your policy. My husband's employer may use BC/BS and have different things written into it than someone else with the same insurance in the same area. Policies are different all across the board. Some of our problems could be resolved by speaking to our employers and asking if our individual policies can be different. In most cases, employers take the cost of insurance out of the employees paycheck. If I'm going to pay for insurance that way, why not include into the policy some of things that I need. We were able to have an employer add maternity benefits to a policy which didn't have one originally because my husband and I were going to be having babies. I'm sure they can add cochlear implants, rehab for post implant, speech therapy, etc. Suzette Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2001 Report Share Posted August 24, 2001 > Even though many people have problems with one insurance company or another, > I think that everything still depends on what is written into your policy. Exactly. Here in Texas, the state law says that an issuer of a group health benefit plan shall offer and make available under the plan coverage for the necessary care and treatment of loss or impairment of speech or hearing. This offer of coverage is subject to the right of the group health benefit plan holder to reject the coverage. So, in Texas, if your insurance doesn't cover hearing aids or cochlear implants, you have only your employer to blame. Hugs, Kay Quote Link to comment Share on other sites More sharing options...
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