Re: Just recieved an email from my insurance....

[Guest guest]

Where do you live?

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

Where do you live?

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

Yes, you have just found the BIG loophole in all of the insurance laws we all

fought so hard to get passed in our State legislatures! Large companies hire

large insurance companies to " administer " their insurance plan. The company

funds the plan itself. Under the law, self-insured plans do not have to meet

any of the requirements imposed upon insurance companies. Disgusting, but true!

-------------- Original message --------------

> For the first time it was put in black and white for me. " Hearing

> aids arent' covered by a lot of insurance companies because they are

> considered developmental and not medically necessary " . I feel like

> throwing up. I am so red with anger right now I can't even explain

> yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

> without my glasses on 'cause to me they can be put in the same

> category!!!! I am so beyond ticked off it isn't even funny. I know

> that this has been brought before many states and my state has seen

> the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

> They are a self-financed company. The law doens't apply to them. They

> can basically deny whatever they feel like denying that day!!!!!!! I'm

> contacting my insurance commisoner tomorrow. I'm not letting this end

> here.

>

>

>

>

>

>

> 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.

>

[Guest guest]

Yes, you have just found the BIG loophole in all of the insurance laws we all

fought so hard to get passed in our State legislatures! Large companies hire

large insurance companies to " administer " their insurance plan. The company

funds the plan itself. Under the law, self-insured plans do not have to meet

any of the requirements imposed upon insurance companies. Disgusting, but true!

-------------- Original message --------------

> For the first time it was put in black and white for me. " Hearing

> aids arent' covered by a lot of insurance companies because they are

> considered developmental and not medically necessary " . I feel like

> throwing up. I am so red with anger right now I can't even explain

> yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

> without my glasses on 'cause to me they can be put in the same

> category!!!! I am so beyond ticked off it isn't even funny. I know

> that this has been brought before many states and my state has seen

> the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

> They are a self-financed company. The law doens't apply to them. They

> can basically deny whatever they feel like denying that day!!!!!!! I'm

> contacting my insurance commisoner tomorrow. I'm not letting this end

> here.

>

>

>

>

>

>

> 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.

>

[Guest guest]

Yes, you have just found the BIG loophole in all of the insurance laws we all

fought so hard to get passed in our State legislatures! Large companies hire

large insurance companies to " administer " their insurance plan. The company

funds the plan itself. Under the law, self-insured plans do not have to meet

any of the requirements imposed upon insurance companies. Disgusting, but true!

-------------- Original message --------------

> For the first time it was put in black and white for me. " Hearing

> aids arent' covered by a lot of insurance companies because they are

> considered developmental and not medically necessary " . I feel like

> throwing up. I am so red with anger right now I can't even explain

> yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

> without my glasses on 'cause to me they can be put in the same

> category!!!! I am so beyond ticked off it isn't even funny. I know

> that this has been brought before many states and my state has seen

> the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

> They are a self-financed company. The law doens't apply to them. They

> can basically deny whatever they feel like denying that day!!!!!!! I'm

> contacting my insurance commisoner tomorrow. I'm not letting this end

> here.

>

>

>

>

>

>

> 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.

>

[Guest guest]

Louisiana -- want to know another disgusting thing. Since the state is in a

serious financial crisis since Hurricane Katrina, the ENTIRE newborn hearing

screening has been WIPED OUT!!!!! Gone, non existent, everyone fired. So there

isn't even anyone in the state for support anymore. I've even tried contacting

my local Hands and Voices lady and I haven't heard back. I know she lived in

one of the worst areas so I can't really expect her to be available right now.

I'm not letting this go. There has got to be a way to close that loop hole.

This is outrageous that they can so blantantly " disobey " the law.

And the fact that hearing aids aren't medically necessary - OMG - THESE people

decide our medical welfare!!!!! What idiots!

stromms@... wrote:

Where do you live?

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

Louisiana -- want to know another disgusting thing. Since the state is in a

serious financial crisis since Hurricane Katrina, the ENTIRE newborn hearing

screening has been WIPED OUT!!!!! Gone, non existent, everyone fired. So there

isn't even anyone in the state for support anymore. I've even tried contacting

my local Hands and Voices lady and I haven't heard back. I know she lived in

one of the worst areas so I can't really expect her to be available right now.

I'm not letting this go. There has got to be a way to close that loop hole.

This is outrageous that they can so blantantly " disobey " the law.

And the fact that hearing aids aren't medically necessary - OMG - THESE people

decide our medical welfare!!!!! What idiots!

stromms@... wrote:

Where do you live?

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

Louisiana -- want to know another disgusting thing. Since the state is in a

serious financial crisis since Hurricane Katrina, the ENTIRE newborn hearing

screening has been WIPED OUT!!!!! Gone, non existent, everyone fired. So there

isn't even anyone in the state for support anymore. I've even tried contacting

my local Hands and Voices lady and I haven't heard back. I know she lived in

one of the worst areas so I can't really expect her to be available right now.

I'm not letting this go. There has got to be a way to close that loop hole.

This is outrageous that they can so blantantly " disobey " the law.

And the fact that hearing aids aren't medically necessary - OMG - THESE people

decide our medical welfare!!!!! What idiots!

stromms@... wrote:

Where do you live?

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

\I

am sorry to hear about your state, as for the Hands and Voices rep. she is

very much still " there " have you gone to handsandvoices.org and wrote an email

on the La link?

Carmen

AZ. hands and voices

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

\I

am sorry to hear about your state, as for the Hands and Voices rep. she is

very much still " there " have you gone to handsandvoices.org and wrote an email

on the La link?

Carmen

AZ. hands and voices

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

\I

am sorry to hear about your state, as for the Hands and Voices rep. she is

very much still " there " have you gone to handsandvoices.org and wrote an email

on the La link?

Carmen

AZ. hands and voices

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

,

This is the La. reps email

kvmurphy@...

hope this helps

carmen

Az. hands and voices

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

,

This is the La. reps email

kvmurphy@...

hope this helps

carmen

Az. hands and voices

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

,

This is the La. reps email

kvmurphy@...

hope this helps

carmen

Az. hands and voices

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

I have her email and I haven't recieved emails from the last two. She is

usually very prompt or even calls me when I start to " freak out " . However, like

I said I am sure life is too hectic right now for very prompt responses! I just

did some research on prices to prepare for " battle " tomorrow.LOL! and I found a

website that listed 7 different manufacturers and their combined 39 different

types of hearing aids. Of those 39 - only one was analog (that is what they are

suggesting she should have gotten). That one was still FIVE TIMES the price of

what the insurance paid - twice what the insuracne " allowed " . Then I found

another site that states the price of " conventional " aids - which wouldn't do

anything for her loss - is STILL more than what they paid. Then I couldn't find

a manufacturer of them.

The seven manufacturers were Siemans, Phonak, GN Rsound, Sonic Innovation,

Widex, Starkey, and Oticon. Does anyone know of any other that I can add? Ok

and of those prices - Hannah's fall right in the middle!

carmen wrote:

\I

am sorry to hear about your state, as for the Hands and Voices rep. she is very

much still " there " have you gone to handsandvoices.org and wrote an email on

the La link?

Carmen

AZ. hands and voices

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

I have her email and I haven't recieved emails from the last two. She is

usually very prompt or even calls me when I start to " freak out " . However, like

I said I am sure life is too hectic right now for very prompt responses! I just

did some research on prices to prepare for " battle " tomorrow.LOL! and I found a

website that listed 7 different manufacturers and their combined 39 different

types of hearing aids. Of those 39 - only one was analog (that is what they are

suggesting she should have gotten). That one was still FIVE TIMES the price of

what the insurance paid - twice what the insuracne " allowed " . Then I found

another site that states the price of " conventional " aids - which wouldn't do

anything for her loss - is STILL more than what they paid. Then I couldn't find

a manufacturer of them.

The seven manufacturers were Siemans, Phonak, GN Rsound, Sonic Innovation,

Widex, Starkey, and Oticon. Does anyone know of any other that I can add? Ok

and of those prices - Hannah's fall right in the middle!

carmen wrote:

\I

am sorry to hear about your state, as for the Hands and Voices rep. she is very

much still " there " have you gone to handsandvoices.org and wrote an email on

the La link?

Carmen

AZ. hands and voices

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

I have her email and I haven't recieved emails from the last two. She is

usually very prompt or even calls me when I start to " freak out " . However, like

I said I am sure life is too hectic right now for very prompt responses! I just

did some research on prices to prepare for " battle " tomorrow.LOL! and I found a

website that listed 7 different manufacturers and their combined 39 different

types of hearing aids. Of those 39 - only one was analog (that is what they are

suggesting she should have gotten). That one was still FIVE TIMES the price of

what the insurance paid - twice what the insuracne " allowed " . Then I found

another site that states the price of " conventional " aids - which wouldn't do

anything for her loss - is STILL more than what they paid. Then I couldn't find

a manufacturer of them.

The seven manufacturers were Siemans, Phonak, GN Rsound, Sonic Innovation,

Widex, Starkey, and Oticon. Does anyone know of any other that I can add? Ok

and of those prices - Hannah's fall right in the middle!

carmen wrote:

\I

am sorry to hear about your state, as for the Hands and Voices rep. she is very

much still " there " have you gone to handsandvoices.org and wrote an email on

the La link?

Carmen

AZ. hands and voices

Just recieved an email from my insurance....

For the first time it was put in black and white for me. " Hearing

aids arent' covered by a lot of insurance companies because they are

considered developmental and not medically necessary " . I feel like

throwing up. I am so red with anger right now I can't even explain

yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

without my glasses on 'cause to me they can be put in the same

category!!!! I am so beyond ticked off it isn't even funny. I know

that this has been brought before many states and my state has seen

the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

They are a self-financed company. The law doens't apply to them. They

can basically deny whatever they feel like denying that day!!!!!!! I'm

contacting my insurance commisoner tomorrow. I'm not letting this end

here.

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.

[Guest guest]

OK, let me start by saying that I'm the insurance advocate for the Let Them

Hear Foundation, and appealing insurance denials is my entire life. Deep

breath. The enemy isn't Aetna, the enemy is your employer

Self insured companies mean that INSTEAD of paying premiums, the company is

trying to save money by creating it's own insurance pool. Typically this is

done by larger companies (i.e. more than 500 employees). Self funded

insurance means your employer is the insurer, Aetna is only the 3rd party

administrator, processing claims on behalf of your employer, paying money

out of the pool of funds that the employer created. Following the rules set

by . . . you guessed it . . . your employer. Because self-insured plans are

governed by federal law, not state law, and federal law pre-empts

conflicting state law, there is absolutely zero that anyone in your state

goverment can do to help you.

Here is where you need to get creative.

1) Appeal the insurance denial by using one of the very fine templates on

the listen-up.org web site. Several people have had success in overturning

hearing aid denials

2) If the denial is overturned, request an ERISA arbitration where a third

party (not connected with either Aetna or your employer) gets to decide

whether or not hearing aids are medically necessary for your child's

particular condition

3) Work the situation from the inside. Contact the person in your HR

department in charge of benefits and ask them if they know that they

specifically excluded this. If you feel you have a strong employement

position, go to your boss and let him know you're unhappy with the situation

and ask if he will intervene or perhaps work out a one time bonus to you to

pay for the hearing aids (companies love this solution because it's

relatively cheap, makes the employee happy, and doesn't set a precedent for

other hearing aid payments).

If you need help with either the appeal or the ERISA arbitration let me

know, you can contact me at my work e-mail at sbyrne@...,

although I should tell you that I'm taking emergency appeals until January

3rd since I am totally swamped right now.

Good luck,

Sheri

>Message: 16

> Date: Tue, 20 Dec 2005 01:16:29 -0000

>

>Subject: Just recieved an email from my insurance....

>

>For the first time it was put in black and white for me. " Hearing

>aids arent' covered by a lot of insurance companies because they are

>considered developmental and not medically necessary " . I feel like

>throwing up. I am so red with anger right now I can't even explain

>yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

>without my glasses on 'cause to me they can be put in the same

>category!!!! I am so beyond ticked off it isn't even funny. I know

>that this has been brought before many states and my state has seen

>the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

>They are a self-financed company. The law doens't apply to them. They

>can basically deny whatever they feel like denying that day!!!!!!! I'm

>contacting my insurance commisoner tomorrow. I'm not letting this end

>here.

[Guest guest]

OK, let me start by saying that I'm the insurance advocate for the Let Them

Hear Foundation, and appealing insurance denials is my entire life. Deep

breath. The enemy isn't Aetna, the enemy is your employer

Self insured companies mean that INSTEAD of paying premiums, the company is

trying to save money by creating it's own insurance pool. Typically this is

done by larger companies (i.e. more than 500 employees). Self funded

insurance means your employer is the insurer, Aetna is only the 3rd party

administrator, processing claims on behalf of your employer, paying money

out of the pool of funds that the employer created. Following the rules set

by . . . you guessed it . . . your employer. Because self-insured plans are

governed by federal law, not state law, and federal law pre-empts

conflicting state law, there is absolutely zero that anyone in your state

goverment can do to help you.

Here is where you need to get creative.

1) Appeal the insurance denial by using one of the very fine templates on

the listen-up.org web site. Several people have had success in overturning

hearing aid denials

2) If the denial is overturned, request an ERISA arbitration where a third

party (not connected with either Aetna or your employer) gets to decide

whether or not hearing aids are medically necessary for your child's

particular condition

3) Work the situation from the inside. Contact the person in your HR

department in charge of benefits and ask them if they know that they

specifically excluded this. If you feel you have a strong employement

position, go to your boss and let him know you're unhappy with the situation

and ask if he will intervene or perhaps work out a one time bonus to you to

pay for the hearing aids (companies love this solution because it's

relatively cheap, makes the employee happy, and doesn't set a precedent for

other hearing aid payments).

If you need help with either the appeal or the ERISA arbitration let me

know, you can contact me at my work e-mail at sbyrne@...,

although I should tell you that I'm taking emergency appeals until January

3rd since I am totally swamped right now.

Good luck,

Sheri

>Message: 16

> Date: Tue, 20 Dec 2005 01:16:29 -0000

>

>Subject: Just recieved an email from my insurance....

>

>For the first time it was put in black and white for me. " Hearing

>aids arent' covered by a lot of insurance companies because they are

>considered developmental and not medically necessary " . I feel like

>throwing up. I am so red with anger right now I can't even explain

>yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

>without my glasses on 'cause to me they can be put in the same

>category!!!! I am so beyond ticked off it isn't even funny. I know

>that this has been brought before many states and my state has seen

>the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

>They are a self-financed company. The law doens't apply to them. They

>can basically deny whatever they feel like denying that day!!!!!!! I'm

>contacting my insurance commisoner tomorrow. I'm not letting this end

>here.

[Guest guest]

OK, let me start by saying that I'm the insurance advocate for the Let Them

Hear Foundation, and appealing insurance denials is my entire life. Deep

breath. The enemy isn't Aetna, the enemy is your employer

Self insured companies mean that INSTEAD of paying premiums, the company is

trying to save money by creating it's own insurance pool. Typically this is

done by larger companies (i.e. more than 500 employees). Self funded

insurance means your employer is the insurer, Aetna is only the 3rd party

administrator, processing claims on behalf of your employer, paying money

out of the pool of funds that the employer created. Following the rules set

by . . . you guessed it . . . your employer. Because self-insured plans are

governed by federal law, not state law, and federal law pre-empts

conflicting state law, there is absolutely zero that anyone in your state

goverment can do to help you.

Here is where you need to get creative.

1) Appeal the insurance denial by using one of the very fine templates on

the listen-up.org web site. Several people have had success in overturning

hearing aid denials

2) If the denial is overturned, request an ERISA arbitration where a third

party (not connected with either Aetna or your employer) gets to decide

whether or not hearing aids are medically necessary for your child's

particular condition

3) Work the situation from the inside. Contact the person in your HR

department in charge of benefits and ask them if they know that they

specifically excluded this. If you feel you have a strong employement

position, go to your boss and let him know you're unhappy with the situation

and ask if he will intervene or perhaps work out a one time bonus to you to

pay for the hearing aids (companies love this solution because it's

relatively cheap, makes the employee happy, and doesn't set a precedent for

other hearing aid payments).

If you need help with either the appeal or the ERISA arbitration let me

know, you can contact me at my work e-mail at sbyrne@...,

although I should tell you that I'm taking emergency appeals until January

3rd since I am totally swamped right now.

Good luck,

Sheri

>Message: 16

> Date: Tue, 20 Dec 2005 01:16:29 -0000

>

>Subject: Just recieved an email from my insurance....

>

>For the first time it was put in black and white for me. " Hearing

>aids arent' covered by a lot of insurance companies because they are

>considered developmental and not medically necessary " . I feel like

>throwing up. I am so red with anger right now I can't even explain

>yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

>without my glasses on 'cause to me they can be put in the same

>category!!!! I am so beyond ticked off it isn't even funny. I know

>that this has been brought before many states and my state has seen

>the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

>They are a self-financed company. The law doens't apply to them. They

>can basically deny whatever they feel like denying that day!!!!!!! I'm

>contacting my insurance commisoner tomorrow. I'm not letting this end

>here.

[Guest guest]

In #2 below, should have said " If the denial is NOT overturned "

That will teach me to post messages before I've had my first cup of

coffee.

Sheri

>

> OK, let me start by saying that I'm the insurance advocate for the

Let Them

> Hear Foundation, and appealing insurance denials is my entire life.

Deep

> breath. The enemy isn't Aetna, the enemy is your employer

>

> Self insured companies mean that INSTEAD of paying premiums, the

company is

> trying to save money by creating it's own insurance pool. Typically

this is

> done by larger companies (i.e. more than 500 employees). Self funded

> insurance means your employer is the insurer, Aetna is only the 3rd

party

> administrator, processing claims on behalf of your employer, paying

money

> out of the pool of funds that the employer created. Following the

rules set

> by . . . you guessed it . . . your employer. Because self-insured

plans are

> governed by federal law, not state law, and federal law pre-empts

> conflicting state law, there is absolutely zero that anyone in your

state

> goverment can do to help you.

>

> Here is where you need to get creative.

>

> 1) Appeal the insurance denial by using one of the very fine

templates on

> the listen-up.org web site. Several people have had success in

overturning

> hearing aid denials

>

> 2) If the denial is overturned, request an ERISA arbitration where a

third

> party (not connected with either Aetna or your employer) gets to decide

> whether or not hearing aids are medically necessary for your child's

> particular condition

>

> 3) Work the situation from the inside. Contact the person in your HR

> department in charge of benefits and ask them if they know that they

> specifically excluded this. If you feel you have a strong employement

> position, go to your boss and let him know you're unhappy with the

situation

> and ask if he will intervene or perhaps work out a one time bonus to

you to

> pay for the hearing aids (companies love this solution because it's

> relatively cheap, makes the employee happy, and doesn't set a

precedent for

> other hearing aid payments).

>

> If you need help with either the appeal or the ERISA arbitration let me

> know, you can contact me at my work e-mail at sbyrne@l...,

> although I should tell you that I'm taking emergency appeals until

January

> 3rd since I am totally swamped right now.

>

> Good luck,

>

> Sheri

>

>

>

> >Message: 16

> > Date: Tue, 20 Dec 2005 01:16:29 -0000

> > From: " saraandchadd " <saraandchadd@y...>

> >Subject: Just recieved an email from my insurance....

> >

> >For the first time it was put in black and white for me. " Hearing

> >aids arent' covered by a lot of insurance companies because they are

> >considered developmental and not medically necessary " . I feel like

> >throwing up. I am so red with anger right now I can't even explain

> >yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

> >without my glasses on 'cause to me they can be put in the same

> >category!!!! I am so beyond ticked off it isn't even funny. I know

> >that this has been brought before many states and my state has seen

> >the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

> >They are a self-financed company. The law doens't apply to them. They

> >can basically deny whatever they feel like denying that day!!!!!!! I'm

> >contacting my insurance commisoner tomorrow. I'm not letting this end

> >here.

>

[Guest guest]

In #2 below, should have said " If the denial is NOT overturned "

That will teach me to post messages before I've had my first cup of

coffee.

Sheri

>

> OK, let me start by saying that I'm the insurance advocate for the

Let Them

> Hear Foundation, and appealing insurance denials is my entire life.

Deep

> breath. The enemy isn't Aetna, the enemy is your employer

>

> Self insured companies mean that INSTEAD of paying premiums, the

company is

> trying to save money by creating it's own insurance pool. Typically

this is

> done by larger companies (i.e. more than 500 employees). Self funded

> insurance means your employer is the insurer, Aetna is only the 3rd

party

> administrator, processing claims on behalf of your employer, paying

money

> out of the pool of funds that the employer created. Following the

rules set

> by . . . you guessed it . . . your employer. Because self-insured

plans are

> governed by federal law, not state law, and federal law pre-empts

> conflicting state law, there is absolutely zero that anyone in your

state

> goverment can do to help you.

>

> Here is where you need to get creative.

>

> 1) Appeal the insurance denial by using one of the very fine

templates on

> the listen-up.org web site. Several people have had success in

overturning

> hearing aid denials

>

> 2) If the denial is overturned, request an ERISA arbitration where a

third

> party (not connected with either Aetna or your employer) gets to decide

> whether or not hearing aids are medically necessary for your child's

> particular condition

>

> 3) Work the situation from the inside. Contact the person in your HR

> department in charge of benefits and ask them if they know that they

> specifically excluded this. If you feel you have a strong employement

> position, go to your boss and let him know you're unhappy with the

situation

> and ask if he will intervene or perhaps work out a one time bonus to

you to

> pay for the hearing aids (companies love this solution because it's

> relatively cheap, makes the employee happy, and doesn't set a

precedent for

> other hearing aid payments).

>

> If you need help with either the appeal or the ERISA arbitration let me

> know, you can contact me at my work e-mail at sbyrne@l...,

> although I should tell you that I'm taking emergency appeals until

January

> 3rd since I am totally swamped right now.

>

> Good luck,

>

> Sheri

>

>

>

> >Message: 16

> > Date: Tue, 20 Dec 2005 01:16:29 -0000

> > From: " saraandchadd " <saraandchadd@y...>

> >Subject: Just recieved an email from my insurance....

> >

> >For the first time it was put in black and white for me. " Hearing

> >aids arent' covered by a lot of insurance companies because they are

> >considered developmental and not medically necessary " . I feel like

> >throwing up. I am so red with anger right now I can't even explain

> >yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

> >without my glasses on 'cause to me they can be put in the same

> >category!!!! I am so beyond ticked off it isn't even funny. I know

> >that this has been brought before many states and my state has seen

> >the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

> >They are a self-financed company. The law doens't apply to them. They

> >can basically deny whatever they feel like denying that day!!!!!!! I'm

> >contacting my insurance commisoner tomorrow. I'm not letting this end

> >here.

>

[Guest guest]

In #2 below, should have said " If the denial is NOT overturned "

That will teach me to post messages before I've had my first cup of

coffee.

Sheri

>

> OK, let me start by saying that I'm the insurance advocate for the

Let Them

> Hear Foundation, and appealing insurance denials is my entire life.

Deep

> breath. The enemy isn't Aetna, the enemy is your employer

>

> Self insured companies mean that INSTEAD of paying premiums, the

company is

> trying to save money by creating it's own insurance pool. Typically

this is

> done by larger companies (i.e. more than 500 employees). Self funded

> insurance means your employer is the insurer, Aetna is only the 3rd

party

> administrator, processing claims on behalf of your employer, paying

money

> out of the pool of funds that the employer created. Following the

rules set

> by . . . you guessed it . . . your employer. Because self-insured

plans are

> governed by federal law, not state law, and federal law pre-empts

> conflicting state law, there is absolutely zero that anyone in your

state

> goverment can do to help you.

>

> Here is where you need to get creative.

>

> 1) Appeal the insurance denial by using one of the very fine

templates on

> the listen-up.org web site. Several people have had success in

overturning

> hearing aid denials

>

> 2) If the denial is overturned, request an ERISA arbitration where a

third

> party (not connected with either Aetna or your employer) gets to decide

> whether or not hearing aids are medically necessary for your child's

> particular condition

>

> 3) Work the situation from the inside. Contact the person in your HR

> department in charge of benefits and ask them if they know that they

> specifically excluded this. If you feel you have a strong employement

> position, go to your boss and let him know you're unhappy with the

situation

> and ask if he will intervene or perhaps work out a one time bonus to

you to

> pay for the hearing aids (companies love this solution because it's

> relatively cheap, makes the employee happy, and doesn't set a

precedent for

> other hearing aid payments).

>

> If you need help with either the appeal or the ERISA arbitration let me

> know, you can contact me at my work e-mail at sbyrne@l...,

> although I should tell you that I'm taking emergency appeals until

January

> 3rd since I am totally swamped right now.

>

> Good luck,

>

> Sheri

>

>

>

> >Message: 16

> > Date: Tue, 20 Dec 2005 01:16:29 -0000

> > From: " saraandchadd " <saraandchadd@y...>

> >Subject: Just recieved an email from my insurance....

> >

> >For the first time it was put in black and white for me. " Hearing

> >aids arent' covered by a lot of insurance companies because they are

> >considered developmental and not medically necessary " . I feel like

> >throwing up. I am so red with anger right now I can't even explain

> >yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

> >without my glasses on 'cause to me they can be put in the same

> >category!!!! I am so beyond ticked off it isn't even funny. I know

> >that this has been brought before many states and my state has seen

> >the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

> >They are a self-financed company. The law doens't apply to them. They

> >can basically deny whatever they feel like denying that day!!!!!!! I'm

> >contacting my insurance commisoner tomorrow. I'm not letting this end

> >here.

>

[Guest guest]

So I've done most of those,

My doctor has filed an appeal and the original decision was upheld.

Here's the tickler. PFChangs - my husbands employer - is saying that they

have a " contract " with the doctor. After severeal hours of question is comes out

that they don't have a contract but instead use what Medicaid uses as a payment

guidline. Medicaid doesn not cover digital hearing aids because they feel they

are " excess " and that analog hearing aids will suffice. As we all know that is

not true and analog hearing aids are becoming extinct.

Here's the list of people I have spoken to

1) Director of Benefits at PFChangs - a totally wench - she won't even get on

the phone with me anymore and she is the one who sent me that email - well I got

the name of her superior and she is my next call

2)the person who approve the hearing aids in the first place

3)the manager at our local store who said he would call

4)Aetna who is telling me to call PFChangs - who in turn tells me to contact

Aetna

5)Louisiana Medicaire office - PFChangs says they use Medicare as a guidline

when actually Medicare pays MORE than what PFChangs is paying. Medicare

(Medicaid?) pays 575 per aid. PFChangs is paying about 450.

6)School for the deaf

7)Insurance Commissioner-- its out of their hands because they are a self

funded insurance - it falls under the Department of Labor - which is my next

stop

The man at the Medicaid off says he feels that if I can get several doctors to

write letters about the benefits of digital versus analog especially for

moderate to severe hearing impairments and send those to the Secretary of Health

and Hospitals for Louisiana then we have a very good case on our hands to get

Medicaid to raise the amount alloted for hearing aids. He said he had no idea

that there were differences in the abilities of analog and digital (I told him

about volume and sound location, etc.) My next step is to call the Secretary of

Health and Hospitals. I'm not stoping here with this. It is absurd that an

insurance company that I pay for is using Medicaid as a guidline when they have

nothing to do with me. What is the use of paying for insurance then?

Sheri Byrne wrote:

OK, let me start by saying that I'm the insurance advocate for the Let Them

Hear Foundation, and appealing insurance denials is my entire life. Deep

breath. The enemy isn't Aetna, the enemy is your employer

Self insured companies mean that INSTEAD of paying premiums, the company is

trying to save money by creating it's own insurance pool. Typically this is

done by larger companies (i.e. more than 500 employees). Self funded

insurance means your employer is the insurer, Aetna is only the 3rd party

administrator, processing claims on behalf of your employer, paying money

out of the pool of funds that the employer created. Following the rules set

by . . . you guessed it . . . your employer. Because self-insured plans are

governed by federal law, not state law, and federal law pre-empts

conflicting state law, there is absolutely zero that anyone in your state

goverment can do to help you.

Here is where you need to get creative.

1) Appeal the insurance denial by using one of the very fine templates on

the listen-up.org web site. Several people have had success in overturning

hearing aid denials

2) If the denial is overturned, request an ERISA arbitration where a third

party (not connected with either Aetna or your employer) gets to decide

whether or not hearing aids are medically necessary for your child's

particular condition

3) Work the situation from the inside. Contact the person in your HR

department in charge of benefits and ask them if they know that they

specifically excluded this. If you feel you have a strong employement

position, go to your boss and let him know you're unhappy with the situation

and ask if he will intervene or perhaps work out a one time bonus to you to

pay for the hearing aids (companies love this solution because it's

relatively cheap, makes the employee happy, and doesn't set a precedent for

other hearing aid payments).

If you need help with either the appeal or the ERISA arbitration let me

know, you can contact me at my work e-mail at sbyrne@...,

although I should tell you that I'm taking emergency appeals until January

3rd since I am totally swamped right now.

Good luck,

Sheri

>Message: 16

> Date: Tue, 20 Dec 2005 01:16:29 -0000

>

>Subject: Just recieved an email from my insurance....

>

>For the first time it was put in black and white for me. " Hearing

>aids arent' covered by a lot of insurance companies because they are

>considered developmental and not medically necessary " . I feel like

>throwing up. I am so red with anger right now I can't even explain

>yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

>without my glasses on 'cause to me they can be put in the same

>category!!!! I am so beyond ticked off it isn't even funny. I know

>that this has been brought before many states and my state has seen

>the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

>They are a self-financed company. The law doens't apply to them. They

>can basically deny whatever they feel like denying that day!!!!!!! I'm

>contacting my insurance commisoner tomorrow. I'm not letting this end

>here.

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.

[Guest guest]

So I've done most of those,

My doctor has filed an appeal and the original decision was upheld.

Here's the tickler. PFChangs - my husbands employer - is saying that they

have a " contract " with the doctor. After severeal hours of question is comes out

that they don't have a contract but instead use what Medicaid uses as a payment

guidline. Medicaid doesn not cover digital hearing aids because they feel they

are " excess " and that analog hearing aids will suffice. As we all know that is

not true and analog hearing aids are becoming extinct.

Here's the list of people I have spoken to

1) Director of Benefits at PFChangs - a totally wench - she won't even get on

the phone with me anymore and she is the one who sent me that email - well I got

the name of her superior and she is my next call

2)the person who approve the hearing aids in the first place

3)the manager at our local store who said he would call

4)Aetna who is telling me to call PFChangs - who in turn tells me to contact

Aetna

5)Louisiana Medicaire office - PFChangs says they use Medicare as a guidline

when actually Medicare pays MORE than what PFChangs is paying. Medicare

(Medicaid?) pays 575 per aid. PFChangs is paying about 450.

6)School for the deaf

7)Insurance Commissioner-- its out of their hands because they are a self

funded insurance - it falls under the Department of Labor - which is my next

stop

The man at the Medicaid off says he feels that if I can get several doctors to

write letters about the benefits of digital versus analog especially for

moderate to severe hearing impairments and send those to the Secretary of Health

and Hospitals for Louisiana then we have a very good case on our hands to get

Medicaid to raise the amount alloted for hearing aids. He said he had no idea

that there were differences in the abilities of analog and digital (I told him

about volume and sound location, etc.) My next step is to call the Secretary of

Health and Hospitals. I'm not stoping here with this. It is absurd that an

insurance company that I pay for is using Medicaid as a guidline when they have

nothing to do with me. What is the use of paying for insurance then?

Sheri Byrne wrote:

OK, let me start by saying that I'm the insurance advocate for the Let Them

Hear Foundation, and appealing insurance denials is my entire life. Deep

breath. The enemy isn't Aetna, the enemy is your employer

Self insured companies mean that INSTEAD of paying premiums, the company is

trying to save money by creating it's own insurance pool. Typically this is

done by larger companies (i.e. more than 500 employees). Self funded

insurance means your employer is the insurer, Aetna is only the 3rd party

administrator, processing claims on behalf of your employer, paying money

out of the pool of funds that the employer created. Following the rules set

by . . . you guessed it . . . your employer. Because self-insured plans are

governed by federal law, not state law, and federal law pre-empts

conflicting state law, there is absolutely zero that anyone in your state

goverment can do to help you.

Here is where you need to get creative.

1) Appeal the insurance denial by using one of the very fine templates on

the listen-up.org web site. Several people have had success in overturning

hearing aid denials

2) If the denial is overturned, request an ERISA arbitration where a third

party (not connected with either Aetna or your employer) gets to decide

whether or not hearing aids are medically necessary for your child's

particular condition

3) Work the situation from the inside. Contact the person in your HR

department in charge of benefits and ask them if they know that they

specifically excluded this. If you feel you have a strong employement

position, go to your boss and let him know you're unhappy with the situation

and ask if he will intervene or perhaps work out a one time bonus to you to

pay for the hearing aids (companies love this solution because it's

relatively cheap, makes the employee happy, and doesn't set a precedent for

other hearing aid payments).

If you need help with either the appeal or the ERISA arbitration let me

know, you can contact me at my work e-mail at sbyrne@...,

although I should tell you that I'm taking emergency appeals until January

3rd since I am totally swamped right now.

Good luck,

Sheri

>Message: 16

> Date: Tue, 20 Dec 2005 01:16:29 -0000

>

>Subject: Just recieved an email from my insurance....

>

>For the first time it was put in black and white for me. " Hearing

>aids arent' covered by a lot of insurance companies because they are

>considered developmental and not medically necessary " . I feel like

>throwing up. I am so red with anger right now I can't even explain

>yet. NOT MEDICALLY NECESSARY!!!! I think I might drive tonight

>without my glasses on 'cause to me they can be put in the same

>category!!!! I am so beyond ticked off it isn't even funny. I know

>that this has been brought before many states and my state has seen

>the ignorance in this comment. HOWEVER, Aetna has found a loop hole.

>They are a self-financed company. The law doens't apply to them. They

>can basically deny whatever they feel like denying that day!!!!!!! I'm

>contacting my insurance commisoner tomorrow. I'm not letting this end

>here.

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.