Re: THe New BAHA and a RANT!!!!!!

[Guest guest]

Hi - congratulations on your son's successful surgery - isn't that a

relief?! I'm glad he's doing well.

Re: the insurance company - yes, you should get a letter written by your

doctor to the insurance company stating that the device is medically

necessary. Being an insurance company, they may not realize that in

order for the surgery that was done that they paid for to work, you also

need the receiver for it to work so that should be included in the

letter. Our insurance company pays for hearing aids and wasn't going to

pay for earmolds until I pointed out the aids wouldn't work without

them. We actually had our boys' pediatrician sign the letter (and not

the ENT) since she's the " manager " of their care - for us, it did the

trick. A copy of the letter she wrote is on the Listen-up website here:

http://listen-up.org/haidfund.htm

Our insurance company still turned it down after we wrote the letter - I

then called and asked that a case manager review our request. When they

did, they then approved our request.

Good luck with this!

Barbara

hurstk_2000 wrote:

> Hello all! It has been a little bit since i have posted anything but

> i have been responding! Anyway, I wanted to update you all on my

> son, Kristian's BAHA (Bone Anchored Hearing Aid)... he had the

> surgery and he is doing well. he had it in the 10th of this month

> and had absolutely NO PAIN whatsoever! that was amazing! He had 2

> holes drilled into his skull-because, one was not in a place where

> his skull bone could support the maechanism. There as another

> drilled, and that worked perfectly! he is doing fine and again, was

> out for a week and is going back to school on Tuesday!

>

> Now as for my venting and i must at this moment- we went to our

> follow-up appointment a week later and everything was fine and the

> doctor removed the dressing and the packing around his area. Anyway,

> we left the doctor and moved on to the audiologist to find out about

> the receiver that he is going to need in order to hear. well, get

> this, the insurance company paid and APPROVED the surgery but wont

> approve the reciever!!! How insane is that? I am then told that i

> need to either come up with the $3000 for the receiver at once (on

> our fitting appointment in May) or check with the insurance company!

> so i leave the office flustered thinking where in the heck am I

> going to come up with 3 grand by May? i callt he insurance company

> and get the rudest woman on the planet and she says that i need to

> have the doctor write a letter saying that the device is medically

> necessary and then they will look over it and decide whether or not

> to pay for it. How insane! so in my ranting i say why the hell do we

> pay for health insurance when you dont want to take care of what

> needs to be taken care of? why do you take fees out of my check

> every other week for what??? i was irate...just irate! well i have

> calmed down since Friday but i am still a little miffed...if anyone

> has any suggestions PLEASeLET ME KNOW!!!

>

> Other than that, all is well with my sweet baby and his surgery!!!

>

>

>

>

>

> 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]

Hi - congratulations on your son's successful surgery - isn't that a

relief?! I'm glad he's doing well.

Re: the insurance company - yes, you should get a letter written by your

doctor to the insurance company stating that the device is medically

necessary. Being an insurance company, they may not realize that in

order for the surgery that was done that they paid for to work, you also

need the receiver for it to work so that should be included in the

letter. Our insurance company pays for hearing aids and wasn't going to

pay for earmolds until I pointed out the aids wouldn't work without

them. We actually had our boys' pediatrician sign the letter (and not

the ENT) since she's the " manager " of their care - for us, it did the

trick. A copy of the letter she wrote is on the Listen-up website here:

http://listen-up.org/haidfund.htm

Our insurance company still turned it down after we wrote the letter - I

then called and asked that a case manager review our request. When they

did, they then approved our request.

Good luck with this!

Barbara

hurstk_2000 wrote:

> Hello all! It has been a little bit since i have posted anything but

> i have been responding! Anyway, I wanted to update you all on my

> son, Kristian's BAHA (Bone Anchored Hearing Aid)... he had the

> surgery and he is doing well. he had it in the 10th of this month

> and had absolutely NO PAIN whatsoever! that was amazing! He had 2

> holes drilled into his skull-because, one was not in a place where

> his skull bone could support the maechanism. There as another

> drilled, and that worked perfectly! he is doing fine and again, was

> out for a week and is going back to school on Tuesday!

>

> Now as for my venting and i must at this moment- we went to our

> follow-up appointment a week later and everything was fine and the

> doctor removed the dressing and the packing around his area. Anyway,

> we left the doctor and moved on to the audiologist to find out about

> the receiver that he is going to need in order to hear. well, get

> this, the insurance company paid and APPROVED the surgery but wont

> approve the reciever!!! How insane is that? I am then told that i

> need to either come up with the $3000 for the receiver at once (on

> our fitting appointment in May) or check with the insurance company!

> so i leave the office flustered thinking where in the heck am I

> going to come up with 3 grand by May? i callt he insurance company

> and get the rudest woman on the planet and she says that i need to

> have the doctor write a letter saying that the device is medically

> necessary and then they will look over it and decide whether or not

> to pay for it. How insane! so in my ranting i say why the hell do we

> pay for health insurance when you dont want to take care of what

> needs to be taken care of? why do you take fees out of my check

> every other week for what??? i was irate...just irate! well i have

> calmed down since Friday but i am still a little miffed...if anyone

> has any suggestions PLEASeLET ME KNOW!!!

>

> Other than that, all is well with my sweet baby and his surgery!!!

>

>

>

>

>

> 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]

Hi - congratulations on your son's successful surgery - isn't that a

relief?! I'm glad he's doing well.

Re: the insurance company - yes, you should get a letter written by your

doctor to the insurance company stating that the device is medically

necessary. Being an insurance company, they may not realize that in

order for the surgery that was done that they paid for to work, you also

need the receiver for it to work so that should be included in the

letter. Our insurance company pays for hearing aids and wasn't going to

pay for earmolds until I pointed out the aids wouldn't work without

them. We actually had our boys' pediatrician sign the letter (and not

the ENT) since she's the " manager " of their care - for us, it did the

trick. A copy of the letter she wrote is on the Listen-up website here:

http://listen-up.org/haidfund.htm

Our insurance company still turned it down after we wrote the letter - I

then called and asked that a case manager review our request. When they

did, they then approved our request.

Good luck with this!

Barbara

hurstk_2000 wrote:

> Hello all! It has been a little bit since i have posted anything but

> i have been responding! Anyway, I wanted to update you all on my

> son, Kristian's BAHA (Bone Anchored Hearing Aid)... he had the

> surgery and he is doing well. he had it in the 10th of this month

> and had absolutely NO PAIN whatsoever! that was amazing! He had 2

> holes drilled into his skull-because, one was not in a place where

> his skull bone could support the maechanism. There as another

> drilled, and that worked perfectly! he is doing fine and again, was

> out for a week and is going back to school on Tuesday!

>

> Now as for my venting and i must at this moment- we went to our

> follow-up appointment a week later and everything was fine and the

> doctor removed the dressing and the packing around his area. Anyway,

> we left the doctor and moved on to the audiologist to find out about

> the receiver that he is going to need in order to hear. well, get

> this, the insurance company paid and APPROVED the surgery but wont

> approve the reciever!!! How insane is that? I am then told that i

> need to either come up with the $3000 for the receiver at once (on

> our fitting appointment in May) or check with the insurance company!

> so i leave the office flustered thinking where in the heck am I

> going to come up with 3 grand by May? i callt he insurance company

> and get the rudest woman on the planet and she says that i need to

> have the doctor write a letter saying that the device is medically

> necessary and then they will look over it and decide whether or not

> to pay for it. How insane! so in my ranting i say why the hell do we

> pay for health insurance when you dont want to take care of what

> needs to be taken care of? why do you take fees out of my check

> every other week for what??? i was irate...just irate! well i have

> calmed down since Friday but i am still a little miffed...if anyone

> has any suggestions PLEASeLET ME KNOW!!!

>

> Other than that, all is well with my sweet baby and his surgery!!!

>

>

>

>

>

> 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]

thank you soo very much! that is nice to know. I know that my insurance pays for

hearing aids! that i know...i am going to make a copy of that information as

well.

I was soo worried but i know that it is necessary and they should see that. we

have until May 11 to get this all done and reviewed and i have already requested

a letter from the doctor. I DID THAT THAT SAME DAY!!!

I know that it will all work out and i thank you again for the reassurance!

Keisha

Barbara Mellert wrote:

Hi - congratulations on your son's successful surgery - isn't that a

relief?! I'm glad he's doing well.

Re: the insurance company - yes, you should get a letter written by your

doctor to the insurance company stating that the device is medically

necessary. Being an insurance company, they may not realize that in

order for the surgery that was done that they paid for to work, you also

need the receiver for it to work so that should be included in the

letter. Our insurance company pays for hearing aids and wasn't going to

pay for earmolds until I pointed out the aids wouldn't work without

them. We actually had our boys' pediatrician sign the letter (and not

the ENT) since she's the " manager " of their care - for us, it did the

trick. A copy of the letter she wrote is on the Listen-up website here:

http://listen-up.org/haidfund.htm

Our insurance company still turned it down after we wrote the letter - I

then called and asked that a case manager review our request. When they

did, they then approved our request.

Good luck with this!

Barbara

hurstk_2000 wrote:

> Hello all! It has been a little bit since i have posted anything but

> i have been responding! Anyway, I wanted to update you all on my

> son, Kristian's BAHA (Bone Anchored Hearing Aid)... he had the

> surgery and he is doing well. he had it in the 10th of this month

> and had absolutely NO PAIN whatsoever! that was amazing! He had 2

> holes drilled into his skull-because, one was not in a place where

> his skull bone could support the maechanism. There as another

> drilled, and that worked perfectly! he is doing fine and again, was

> out for a week and is going back to school on Tuesday!

>

> Now as for my venting and i must at this moment- we went to our

> follow-up appointment a week later and everything was fine and the

> doctor removed the dressing and the packing around his area. Anyway,

> we left the doctor and moved on to the audiologist to find out about

> the receiver that he is going to need in order to hear. well, get

> this, the insurance company paid and APPROVED the surgery but wont

> approve the reciever!!! How insane is that? I am then told that i

> need to either come up with the $3000 for the receiver at once (on

> our fitting appointment in May) or check with the insurance company!

> so i leave the office flustered thinking where in the heck am I

> going to come up with 3 grand by May? i callt he insurance company

> and get the rudest woman on the planet and she says that i need to

> have the doctor write a letter saying that the device is medically

> necessary and then they will look over it and decide whether or not

> to pay for it. How insane! so in my ranting i say why the hell do we

> pay for health insurance when you dont want to take care of what

> needs to be taken care of? why do you take fees out of my check

> every other week for what??? i was irate...just irate! well i have

> calmed down since Friday but i am still a little miffed...if anyone

> has any suggestions PLEASeLET ME KNOW!!!

>

> Other than that, all is well with my sweet baby and his surgery!!!

>

>

>

>

>

> 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]

thank you soo very much! that is nice to know. I know that my insurance pays for

hearing aids! that i know...i am going to make a copy of that information as

well.

I was soo worried but i know that it is necessary and they should see that. we

have until May 11 to get this all done and reviewed and i have already requested

a letter from the doctor. I DID THAT THAT SAME DAY!!!

I know that it will all work out and i thank you again for the reassurance!

Keisha

Barbara Mellert wrote:

Hi - congratulations on your son's successful surgery - isn't that a

relief?! I'm glad he's doing well.

Re: the insurance company - yes, you should get a letter written by your

doctor to the insurance company stating that the device is medically

necessary. Being an insurance company, they may not realize that in

order for the surgery that was done that they paid for to work, you also

need the receiver for it to work so that should be included in the

letter. Our insurance company pays for hearing aids and wasn't going to

pay for earmolds until I pointed out the aids wouldn't work without

them. We actually had our boys' pediatrician sign the letter (and not

the ENT) since she's the " manager " of their care - for us, it did the

trick. A copy of the letter she wrote is on the Listen-up website here:

http://listen-up.org/haidfund.htm

Our insurance company still turned it down after we wrote the letter - I

then called and asked that a case manager review our request. When they

did, they then approved our request.

Good luck with this!

Barbara

hurstk_2000 wrote:

> Hello all! It has been a little bit since i have posted anything but

> i have been responding! Anyway, I wanted to update you all on my

> son, Kristian's BAHA (Bone Anchored Hearing Aid)... he had the

> surgery and he is doing well. he had it in the 10th of this month

> and had absolutely NO PAIN whatsoever! that was amazing! He had 2

> holes drilled into his skull-because, one was not in a place where

> his skull bone could support the maechanism. There as another

> drilled, and that worked perfectly! he is doing fine and again, was

> out for a week and is going back to school on Tuesday!

>

> Now as for my venting and i must at this moment- we went to our

> follow-up appointment a week later and everything was fine and the

> doctor removed the dressing and the packing around his area. Anyway,

> we left the doctor and moved on to the audiologist to find out about

> the receiver that he is going to need in order to hear. well, get

> this, the insurance company paid and APPROVED the surgery but wont

> approve the reciever!!! How insane is that? I am then told that i

> need to either come up with the $3000 for the receiver at once (on

> our fitting appointment in May) or check with the insurance company!

> so i leave the office flustered thinking where in the heck am I

> going to come up with 3 grand by May? i callt he insurance company

> and get the rudest woman on the planet and she says that i need to

> have the doctor write a letter saying that the device is medically

> necessary and then they will look over it and decide whether or not

> to pay for it. How insane! so in my ranting i say why the hell do we

> pay for health insurance when you dont want to take care of what

> needs to be taken care of? why do you take fees out of my check

> every other week for what??? i was irate...just irate! well i have

> calmed down since Friday but i am still a little miffed...if anyone

> has any suggestions PLEASeLET ME KNOW!!!

>

> Other than that, all is well with my sweet baby and his surgery!!!

>

>

>

>

>

> 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 live this situation every week, with prescriptions, medical procedures,

copays, diagnostic tests, etc. The bottom line is that most things can be

covered if you have a letter of medical necessity from your doctor. The

important thing is that you MUST have the letter before ordering the external

device. If the letter comes AFTER the item is ordered, then it won't be

covered. You must at a minimum have the letter in place. IMMEDIATELY, call

your doctor's office and get their kindest/most efficient referral specialist to

help you get this letter processed as soon as possible...your goal is to get it

no later than the next day. Once that is done, tackle the insurance company.

Call the toll free number repeatedly and hang up unless you get someone who

sounds like a really nice, helpful person. Don't rant or say anything bad. Be

a very needy mom who is so worried. Cry if you feel like it as the tears help.

What I usually say is, " I really need some help and I'm so worried that I don't

know what to do. I sure hope that you can help me because you sound so nice and

so competent. " You would say something like, " My baby just had a procedure

that was really scary. We're really lucky because it can restore his hearing.

We got the scary part over with, but when we went to hook everything up, we

found out that we either have to come up with the 3 thousand dollars or the

surgery will be for nothing and he won't be able to hear " ...then explain the

device and how it works..Then say something like, " Is there anything that you

can do to help me expedite the process and get this device covered. Three

thousand dollars is a lot of money for us! " Usually, they'll say, " Yes, that's

alot of money for me too! " You have to realize that these are usually poorly

paid clerical people who empathize with someone having to spend alot of money

and doesn't have it. You then can tell them that you have a letter of medical

necessity but don't know what to do with it. Often they'll tell you to send it

to them personally and they will hand carry it through. Pepper the conversation

with lots of " Thank you so much " You're so sweet " You're so kind " " Thank good

ness I got the nicest/most helpful person there to help me! " " You don't know

what this means to me! " Whatever you can do to make them feel powerful and

needed makes their job feel worthwhile and they'll go out of their way to show

you that they actually CAN help you.

Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

Hope this info helps!

[Guest guest]

I live this situation every week, with prescriptions, medical procedures,

copays, diagnostic tests, etc. The bottom line is that most things can be

covered if you have a letter of medical necessity from your doctor. The

important thing is that you MUST have the letter before ordering the external

device. If the letter comes AFTER the item is ordered, then it won't be

covered. You must at a minimum have the letter in place. IMMEDIATELY, call

your doctor's office and get their kindest/most efficient referral specialist to

help you get this letter processed as soon as possible...your goal is to get it

no later than the next day. Once that is done, tackle the insurance company.

Call the toll free number repeatedly and hang up unless you get someone who

sounds like a really nice, helpful person. Don't rant or say anything bad. Be

a very needy mom who is so worried. Cry if you feel like it as the tears help.

What I usually say is, " I really need some help and I'm so worried that I don't

know what to do. I sure hope that you can help me because you sound so nice and

so competent. " You would say something like, " My baby just had a procedure

that was really scary. We're really lucky because it can restore his hearing.

We got the scary part over with, but when we went to hook everything up, we

found out that we either have to come up with the 3 thousand dollars or the

surgery will be for nothing and he won't be able to hear " ...then explain the

device and how it works..Then say something like, " Is there anything that you

can do to help me expedite the process and get this device covered. Three

thousand dollars is a lot of money for us! " Usually, they'll say, " Yes, that's

alot of money for me too! " You have to realize that these are usually poorly

paid clerical people who empathize with someone having to spend alot of money

and doesn't have it. You then can tell them that you have a letter of medical

necessity but don't know what to do with it. Often they'll tell you to send it

to them personally and they will hand carry it through. Pepper the conversation

with lots of " Thank you so much " You're so sweet " You're so kind " " Thank good

ness I got the nicest/most helpful person there to help me! " " You don't know

what this means to me! " Whatever you can do to make them feel powerful and

needed makes their job feel worthwhile and they'll go out of their way to show

you that they actually CAN help you.

Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

Hope this info helps!

[Guest guest]

I had similar bizarre insurance story, but our ENT was prepared to fight it

for us.

Ian had surgery to hopefully replace one of his middle ear bones. Once

inside our little guy's ear, they found it was a different bone and the surgery

needed was too dangerous. So, nothing was done.

After the surgery, we received a letter from the insurance company stating

that they would cover everything except the tiny plastic bone. Their reason was

that they don't cover prosthetics, citing the issues of loss and damage due

to daily usage. I was dumbfounded. How stupid can they be!? The whole purpose

of the surgery was to put that little bone in place!

I took the letter with us to the follow-up visit and our doctor shook his

head. He told me not to worry about it, had the bone been needed, he would have

written the insurance company and gotten it covered. It wasn't needed so it

was a dead issue.

He explained that doctors are use to this. The paperwork at the insurance

company is processed by people with little or no medical knowledge. The initial

rejection is done by people who follow basic guidelines and the insurance

companies know that only a few people will appeal them and that keeps the costs

lower.

They denied payment to our pediatrician when my son was born because there

was " no reason for him to be in attendance at the birth. " Yet NY State law

requires a pediatrician be there for a C-section. Our pediatrician just laughed

at that one and said he gets that all the time. He even had a form letter all

ready to send out.

So, get your doctor to write the letter. This is like getting the inner

portion of the CI covered because it's inside the head but not covering the

outer

portion. It's stupid and a waste of their money. If they've approved the

procedure, then I'd argue that they're approving all of it or it won't work.

Check out the Listen-Up site. There are letters there which were sued to

fight insurance companies.

Best -- Jill

[Guest guest]

I had similar bizarre insurance story, but our ENT was prepared to fight it

for us.

Ian had surgery to hopefully replace one of his middle ear bones. Once

inside our little guy's ear, they found it was a different bone and the surgery

needed was too dangerous. So, nothing was done.

After the surgery, we received a letter from the insurance company stating

that they would cover everything except the tiny plastic bone. Their reason was

that they don't cover prosthetics, citing the issues of loss and damage due

to daily usage. I was dumbfounded. How stupid can they be!? The whole purpose

of the surgery was to put that little bone in place!

I took the letter with us to the follow-up visit and our doctor shook his

head. He told me not to worry about it, had the bone been needed, he would have

written the insurance company and gotten it covered. It wasn't needed so it

was a dead issue.

He explained that doctors are use to this. The paperwork at the insurance

company is processed by people with little or no medical knowledge. The initial

rejection is done by people who follow basic guidelines and the insurance

companies know that only a few people will appeal them and that keeps the costs

lower.

They denied payment to our pediatrician when my son was born because there

was " no reason for him to be in attendance at the birth. " Yet NY State law

requires a pediatrician be there for a C-section. Our pediatrician just laughed

at that one and said he gets that all the time. He even had a form letter all

ready to send out.

So, get your doctor to write the letter. This is like getting the inner

portion of the CI covered because it's inside the head but not covering the

outer

portion. It's stupid and a waste of their money. If they've approved the

procedure, then I'd argue that they're approving all of it or it won't work.

Check out the Listen-Up site. There are letters there which were sued to

fight insurance companies.

Best -- Jill

[Guest guest]

I had similar bizarre insurance story, but our ENT was prepared to fight it

for us.

Ian had surgery to hopefully replace one of his middle ear bones. Once

inside our little guy's ear, they found it was a different bone and the surgery

needed was too dangerous. So, nothing was done.

After the surgery, we received a letter from the insurance company stating

that they would cover everything except the tiny plastic bone. Their reason was

that they don't cover prosthetics, citing the issues of loss and damage due

to daily usage. I was dumbfounded. How stupid can they be!? The whole purpose

of the surgery was to put that little bone in place!

I took the letter with us to the follow-up visit and our doctor shook his

head. He told me not to worry about it, had the bone been needed, he would have

written the insurance company and gotten it covered. It wasn't needed so it

was a dead issue.

He explained that doctors are use to this. The paperwork at the insurance

company is processed by people with little or no medical knowledge. The initial

rejection is done by people who follow basic guidelines and the insurance

companies know that only a few people will appeal them and that keeps the costs

lower.

They denied payment to our pediatrician when my son was born because there

was " no reason for him to be in attendance at the birth. " Yet NY State law

requires a pediatrician be there for a C-section. Our pediatrician just laughed

at that one and said he gets that all the time. He even had a form letter all

ready to send out.

So, get your doctor to write the letter. This is like getting the inner

portion of the CI covered because it's inside the head but not covering the

outer

portion. It's stupid and a waste of their money. If they've approved the

procedure, then I'd argue that they're approving all of it or it won't work.

Check out the Listen-Up site. There are letters there which were sued to

fight insurance companies.

Best -- Jill

[Guest guest]

I agree with here - be as sweet and nice and grateful as you can

be when you talk to them. There were many times when we were requesting

the exception for our boys' hearing aids that I had to bite my tongue

(stupid people - grrr!) but I think being nice and willing to work with

them and understanding their plight made them more amenable to helping me!

Barbara

semesky@... wrote:

> I live this situation every week, with prescriptions, medical procedures,

copays, diagnostic tests, etc. The bottom line is that most things can be

covered if you have a letter of medical necessity from your doctor. The

important thing is that you MUST have the letter before ordering the external

device. If the letter comes AFTER the item is ordered, then it won't be

covered. You must at a minimum have the letter in place. IMMEDIATELY, call

your doctor's office and get their kindest/most efficient referral specialist to

help you get this letter processed as soon as possible...your goal is to get it

no later than the next day. Once that is done, tackle the insurance company.

Call the toll free number repeatedly and hang up unless you get someone who

sounds like a really nice, helpful person. Don't rant or say anything bad. Be

a very needy mom who is so worried. Cry if you feel like it as the tears help.

What I usually say is, " I really need some help and I'm so worri!

> ed that I don't know what to do. I sure hope that you can help me because

you sound so nice and so competent. " You would say something like, " My baby

just had a procedure that was really scary. We're really lucky because it can

restore his hearing. We got the scary part over with, but when we went to hook

everything up, we found out that we either have to come up with the 3 thousand

dollars or the surgery will be for nothing and he won't be able to hear " ...then

explain the device and how it works..Then say something like, " Is there anything

that you can do to help me expedite the process and get this device covered.

Three thousand dollars is a lot of money for us! " Usually, they'll say, " Yes,

that's alot of money for me too! " You have to realize that these are usually

poorly paid clerical people who empathize with someone having to spend alot of

money and doesn't have it. You then can tell them that you have a letter of

medical necessity but don't know what to do w!

> ith it. Often they'll tell you to send it to them personally and they

> will hand carry it through. Pepper the conversation with lots of " Thank you

so much " You're so sweet " You're so kind " " Thank good ness I got the

nicest/most helpful person there to help me! " " You don't know what this means

to me! " Whatever you can do to make them feel powerful and needed makes their

job feel worthwhile and they'll go out of their way to show you that they

actually CAN help you.

>

> Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

>

> Hope this info helps!

>

>

>

[Guest guest]

I agree with here - be as sweet and nice and grateful as you can

be when you talk to them. There were many times when we were requesting

the exception for our boys' hearing aids that I had to bite my tongue

(stupid people - grrr!) but I think being nice and willing to work with

them and understanding their plight made them more amenable to helping me!

Barbara

semesky@... wrote:

> I live this situation every week, with prescriptions, medical procedures,

copays, diagnostic tests, etc. The bottom line is that most things can be

covered if you have a letter of medical necessity from your doctor. The

important thing is that you MUST have the letter before ordering the external

device. If the letter comes AFTER the item is ordered, then it won't be

covered. You must at a minimum have the letter in place. IMMEDIATELY, call

your doctor's office and get their kindest/most efficient referral specialist to

help you get this letter processed as soon as possible...your goal is to get it

no later than the next day. Once that is done, tackle the insurance company.

Call the toll free number repeatedly and hang up unless you get someone who

sounds like a really nice, helpful person. Don't rant or say anything bad. Be

a very needy mom who is so worried. Cry if you feel like it as the tears help.

What I usually say is, " I really need some help and I'm so worri!

> ed that I don't know what to do. I sure hope that you can help me because

you sound so nice and so competent. " You would say something like, " My baby

just had a procedure that was really scary. We're really lucky because it can

restore his hearing. We got the scary part over with, but when we went to hook

everything up, we found out that we either have to come up with the 3 thousand

dollars or the surgery will be for nothing and he won't be able to hear " ...then

explain the device and how it works..Then say something like, " Is there anything

that you can do to help me expedite the process and get this device covered.

Three thousand dollars is a lot of money for us! " Usually, they'll say, " Yes,

that's alot of money for me too! " You have to realize that these are usually

poorly paid clerical people who empathize with someone having to spend alot of

money and doesn't have it. You then can tell them that you have a letter of

medical necessity but don't know what to do w!

> ith it. Often they'll tell you to send it to them personally and they

> will hand carry it through. Pepper the conversation with lots of " Thank you

so much " You're so sweet " You're so kind " " Thank good ness I got the

nicest/most helpful person there to help me! " " You don't know what this means

to me! " Whatever you can do to make them feel powerful and needed makes their

job feel worthwhile and they'll go out of their way to show you that they

actually CAN help you.

>

> Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

>

> Hope this info helps!

>

>

>

[Guest guest]

I agree with here - be as sweet and nice and grateful as you can

be when you talk to them. There were many times when we were requesting

the exception for our boys' hearing aids that I had to bite my tongue

(stupid people - grrr!) but I think being nice and willing to work with

them and understanding their plight made them more amenable to helping me!

Barbara

semesky@... wrote:

> I live this situation every week, with prescriptions, medical procedures,

copays, diagnostic tests, etc. The bottom line is that most things can be

covered if you have a letter of medical necessity from your doctor. The

important thing is that you MUST have the letter before ordering the external

device. If the letter comes AFTER the item is ordered, then it won't be

covered. You must at a minimum have the letter in place. IMMEDIATELY, call

your doctor's office and get their kindest/most efficient referral specialist to

help you get this letter processed as soon as possible...your goal is to get it

no later than the next day. Once that is done, tackle the insurance company.

Call the toll free number repeatedly and hang up unless you get someone who

sounds like a really nice, helpful person. Don't rant or say anything bad. Be

a very needy mom who is so worried. Cry if you feel like it as the tears help.

What I usually say is, " I really need some help and I'm so worri!

> ed that I don't know what to do. I sure hope that you can help me because

you sound so nice and so competent. " You would say something like, " My baby

just had a procedure that was really scary. We're really lucky because it can

restore his hearing. We got the scary part over with, but when we went to hook

everything up, we found out that we either have to come up with the 3 thousand

dollars or the surgery will be for nothing and he won't be able to hear " ...then

explain the device and how it works..Then say something like, " Is there anything

that you can do to help me expedite the process and get this device covered.

Three thousand dollars is a lot of money for us! " Usually, they'll say, " Yes,

that's alot of money for me too! " You have to realize that these are usually

poorly paid clerical people who empathize with someone having to spend alot of

money and doesn't have it. You then can tell them that you have a letter of

medical necessity but don't know what to do w!

> ith it. Often they'll tell you to send it to them personally and they

> will hand carry it through. Pepper the conversation with lots of " Thank you

so much " You're so sweet " You're so kind " " Thank good ness I got the

nicest/most helpful person there to help me! " " You don't know what this means

to me! " Whatever you can do to make them feel powerful and needed makes their

job feel worthwhile and they'll go out of their way to show you that they

actually CAN help you.

>

> Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

>

> Hope this info helps!

>

>

>

[Guest guest]

Thank you soo much! What is the deal with these insurance companies? They are a

mess arent they? I needed to hear that i am not the only person that is going

through this. I am going to follow-up with the doctors office at the end of this

week to see what the progress is and where they are in their steps and if i need

to do anything additional.

JillcWood@... wrote: I had similar bizarre insurance story, but our ENT was

prepared to fight it

for us.

Ian had surgery to hopefully replace one of his middle ear bones. Once

inside our little guy's ear, they found it was a different bone and the surgery

needed was too dangerous. So, nothing was done.

After the surgery, we received a letter from the insurance company stating

that they would cover everything except the tiny plastic bone. Their reason was

that they don't cover prosthetics, citing the issues of loss and damage due

to daily usage. I was dumbfounded. How stupid can they be!? The whole purpose

of the surgery was to put that little bone in place!

I took the letter with us to the follow-up visit and our doctor shook his

head. He told me not to worry about it, had the bone been needed, he would have

written the insurance company and gotten it covered. It wasn't needed so it

was a dead issue.

He explained that doctors are use to this. The paperwork at the insurance

company is processed by people with little or no medical knowledge. The initial

rejection is done by people who follow basic guidelines and the insurance

companies know that only a few people will appeal them and that keeps the costs

lower.

They denied payment to our pediatrician when my son was born because there

was " no reason for him to be in attendance at the birth. " Yet NY State law

requires a pediatrician be there for a C-section. Our pediatrician just laughed

at that one and said he gets that all the time. He even had a form letter all

ready to send out.

So, get your doctor to write the letter. This is like getting the inner

portion of the CI covered because it's inside the head but not covering the

outer

portion. It's stupid and a waste of their money. If they've approved the

procedure, then I'd argue that they're approving all of it or it won't work.

Check out the Listen-Up site. There are letters there which were sued to

fight insurance companies.

Best -- Jill

[Guest guest]

You guys are soo wonderful!

This advice is going to be followed along with getting the doctor to write a

script as well. One of the other moms suggested that as well.

Barbara Mellert wrote:

I agree with here - be as sweet and nice and grateful as you can

be when you talk to them. There were many times when we were requesting

the exception for our boys' hearing aids that I had to bite my tongue

(stupid people - grrr!) but I think being nice and willing to work with

them and understanding their plight made them more amenable to helping me!

Barbara

semesky@... wrote:

> I live this situation every week, with prescriptions, medical procedures,

copays, diagnostic tests, etc. The bottom line is that most things can be

covered if you have a letter of medical necessity from your doctor. The

important thing is that you MUST have the letter before ordering the external

device. If the letter comes AFTER the item is ordered, then it won't be

covered. You must at a minimum have the letter in place. IMMEDIATELY, call

your doctor's office and get their kindest/most efficient referral specialist to

help you get this letter processed as soon as possible...your goal is to get it

no later than the next day. Once that is done, tackle the insurance company.

Call the toll free number repeatedly and hang up unless you get someone who

sounds like a really nice, helpful person. Don't rant or say anything bad. Be

a very needy mom who is so worried. Cry if you feel like it as the tears help.

What I usually say is, " I really need some help and I'm so worri!

> ed that I don't know what to do. I sure hope that you can help me because

you sound so nice and so competent. " You would say something like, " My baby

just had a procedure that was really scary. We're really lucky because it can

restore his hearing. We got the scary part over with, but when we went to hook

everything up, we found out that we either have to come up with the 3 thousand

dollars or the surgery will be for nothing and he won't be able to hear " ...then

explain the device and how it works..Then say something like, " Is there anything

that you can do to help me expedite the process and get this device covered.

Three thousand dollars is a lot of money for us! " Usually, they'll say, " Yes,

that's alot of money for me too! " You have to realize that these are usually

poorly paid clerical people who empathize with someone having to spend alot of

money and doesn't have it. You then can tell them that you have a letter of

medical necessity but don't know what to do w!

> ith it. Often they'll tell you to send it to them personally and they

> will hand carry it through. Pepper the conversation with lots of " Thank you

so much " You're so sweet " You're so kind " " Thank good ness I got the

nicest/most helpful person there to help me! " " You don't know what this means

to me! " Whatever you can do to make them feel powerful and needed makes their

job feel worthwhile and they'll go out of their way to show you that they

actually CAN help you.

>

> Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

>

> Hope this info helps!

>

>

>

[Guest guest]

You guys are soo wonderful!

This advice is going to be followed along with getting the doctor to write a

script as well. One of the other moms suggested that as well.

Barbara Mellert wrote:

I agree with here - be as sweet and nice and grateful as you can

be when you talk to them. There were many times when we were requesting

the exception for our boys' hearing aids that I had to bite my tongue

(stupid people - grrr!) but I think being nice and willing to work with

them and understanding their plight made them more amenable to helping me!

Barbara

semesky@... wrote:

> I live this situation every week, with prescriptions, medical procedures,

copays, diagnostic tests, etc. The bottom line is that most things can be

covered if you have a letter of medical necessity from your doctor. The

important thing is that you MUST have the letter before ordering the external

device. If the letter comes AFTER the item is ordered, then it won't be

covered. You must at a minimum have the letter in place. IMMEDIATELY, call

your doctor's office and get their kindest/most efficient referral specialist to

help you get this letter processed as soon as possible...your goal is to get it

no later than the next day. Once that is done, tackle the insurance company.

Call the toll free number repeatedly and hang up unless you get someone who

sounds like a really nice, helpful person. Don't rant or say anything bad. Be

a very needy mom who is so worried. Cry if you feel like it as the tears help.

What I usually say is, " I really need some help and I'm so worri!

> ed that I don't know what to do. I sure hope that you can help me because

you sound so nice and so competent. " You would say something like, " My baby

just had a procedure that was really scary. We're really lucky because it can

restore his hearing. We got the scary part over with, but when we went to hook

everything up, we found out that we either have to come up with the 3 thousand

dollars or the surgery will be for nothing and he won't be able to hear " ...then

explain the device and how it works..Then say something like, " Is there anything

that you can do to help me expedite the process and get this device covered.

Three thousand dollars is a lot of money for us! " Usually, they'll say, " Yes,

that's alot of money for me too! " You have to realize that these are usually

poorly paid clerical people who empathize with someone having to spend alot of

money and doesn't have it. You then can tell them that you have a letter of

medical necessity but don't know what to do w!

> ith it. Often they'll tell you to send it to them personally and they

> will hand carry it through. Pepper the conversation with lots of " Thank you

so much " You're so sweet " You're so kind " " Thank good ness I got the

nicest/most helpful person there to help me! " " You don't know what this means

to me! " Whatever you can do to make them feel powerful and needed makes their

job feel worthwhile and they'll go out of their way to show you that they

actually CAN help you.

>

> Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

>

> Hope this info helps!

>

>

>

[Guest guest]

You guys are soo wonderful!

This advice is going to be followed along with getting the doctor to write a

script as well. One of the other moms suggested that as well.

Barbara Mellert wrote:

I agree with here - be as sweet and nice and grateful as you can

be when you talk to them. There were many times when we were requesting

the exception for our boys' hearing aids that I had to bite my tongue

(stupid people - grrr!) but I think being nice and willing to work with

them and understanding their plight made them more amenable to helping me!

Barbara

semesky@... wrote:

> I live this situation every week, with prescriptions, medical procedures,

copays, diagnostic tests, etc. The bottom line is that most things can be

covered if you have a letter of medical necessity from your doctor. The

important thing is that you MUST have the letter before ordering the external

device. If the letter comes AFTER the item is ordered, then it won't be

covered. You must at a minimum have the letter in place. IMMEDIATELY, call

your doctor's office and get their kindest/most efficient referral specialist to

help you get this letter processed as soon as possible...your goal is to get it

no later than the next day. Once that is done, tackle the insurance company.

Call the toll free number repeatedly and hang up unless you get someone who

sounds like a really nice, helpful person. Don't rant or say anything bad. Be

a very needy mom who is so worried. Cry if you feel like it as the tears help.

What I usually say is, " I really need some help and I'm so worri!

> ed that I don't know what to do. I sure hope that you can help me because

you sound so nice and so competent. " You would say something like, " My baby

just had a procedure that was really scary. We're really lucky because it can

restore his hearing. We got the scary part over with, but when we went to hook

everything up, we found out that we either have to come up with the 3 thousand

dollars or the surgery will be for nothing and he won't be able to hear " ...then

explain the device and how it works..Then say something like, " Is there anything

that you can do to help me expedite the process and get this device covered.

Three thousand dollars is a lot of money for us! " Usually, they'll say, " Yes,

that's alot of money for me too! " You have to realize that these are usually

poorly paid clerical people who empathize with someone having to spend alot of

money and doesn't have it. You then can tell them that you have a letter of

medical necessity but don't know what to do w!

> ith it. Often they'll tell you to send it to them personally and they

> will hand carry it through. Pepper the conversation with lots of " Thank you

so much " You're so sweet " You're so kind " " Thank good ness I got the

nicest/most helpful person there to help me! " " You don't know what this means

to me! " Whatever you can do to make them feel powerful and needed makes their

job feel worthwhile and they'll go out of their way to show you that they

actually CAN help you.

>

> Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

>

> Hope this info helps!

>

>

>

[Guest guest]

Thank you soo much! I dotn know why i thought it was just me....i was just

floored when i heard the news! I thought wowzers, i dont have that kind of

money...but we are going to work this out-completely!

semesky@... wrote: I live this situation every week, with

prescriptions, medical procedures, copays, diagnostic tests, etc. The bottom

line is that most things can be covered if you have a letter of medical

necessity from your doctor. The important thing is that you MUST have the

letter before ordering the external device. If the letter comes AFTER the item

is ordered, then it won't be covered. You must at a minimum have the letter in

place. IMMEDIATELY, call your doctor's office and get their kindest/most

efficient referral specialist to help you get this letter processed as soon as

possible...your goal is to get it no later than the next day. Once that is

done, tackle the insurance company. Call the toll free number repeatedly and

hang up unless you get someone who sounds like a really nice, helpful person.

Don't rant or say anything bad. Be a very needy mom who is so worried. Cry if

you feel like it as the tears help. What I usually say is, " I really need some

help and I'm so worried that I don't know what to do. I sure hope that you can

help me because you sound so nice and so competent. " You would say something

like, " My baby just had a procedure that was really scary. We're really lucky

because it can restore his hearing. We got the scary part over with, but when

we went to hook everything up, we found out that we either have to come up with

the 3 thousand dollars or the surgery will be for nothing and he won't be able

to hear " ...then explain the device and how it works..Then say something like,

" Is there anything that you can do to help me expedite the process and get this

device covered. Three thousand dollars is a lot of money for us! " Usually,

they'll say, " Yes, that's alot of money for me too! " You have to realize that

these are usually poorly paid clerical people who empathize with someone having

to spend alot of money and doesn't have it. You then can tell them that you

have a letter of medical necessity but don't know

what to do with it. Often they'll tell you to send it to them personally and

they will hand carry it through. Pepper the conversation with lots of " Thank

you so much " You're so sweet " You're so kind " " Thank good ness I got the

nicest/most helpful person there to help me! " " You don't know what this means

to me! " Whatever you can do to make them feel powerful and needed makes their

job feel worthwhile and they'll go out of their way to show you that they

actually CAN help you.

Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

Hope this info helps!

[Guest guest]

Thank you soo much! I dotn know why i thought it was just me....i was just

floored when i heard the news! I thought wowzers, i dont have that kind of

money...but we are going to work this out-completely!

semesky@... wrote: I live this situation every week, with

prescriptions, medical procedures, copays, diagnostic tests, etc. The bottom

line is that most things can be covered if you have a letter of medical

necessity from your doctor. The important thing is that you MUST have the

letter before ordering the external device. If the letter comes AFTER the item

is ordered, then it won't be covered. You must at a minimum have the letter in

place. IMMEDIATELY, call your doctor's office and get their kindest/most

efficient referral specialist to help you get this letter processed as soon as

possible...your goal is to get it no later than the next day. Once that is

done, tackle the insurance company. Call the toll free number repeatedly and

hang up unless you get someone who sounds like a really nice, helpful person.

Don't rant or say anything bad. Be a very needy mom who is so worried. Cry if

you feel like it as the tears help. What I usually say is, " I really need some

help and I'm so worried that I don't know what to do. I sure hope that you can

help me because you sound so nice and so competent. " You would say something

like, " My baby just had a procedure that was really scary. We're really lucky

because it can restore his hearing. We got the scary part over with, but when

we went to hook everything up, we found out that we either have to come up with

the 3 thousand dollars or the surgery will be for nothing and he won't be able

to hear " ...then explain the device and how it works..Then say something like,

" Is there anything that you can do to help me expedite the process and get this

device covered. Three thousand dollars is a lot of money for us! " Usually,

they'll say, " Yes, that's alot of money for me too! " You have to realize that

these are usually poorly paid clerical people who empathize with someone having

to spend alot of money and doesn't have it. You then can tell them that you

have a letter of medical necessity but don't know

what to do with it. Often they'll tell you to send it to them personally and

they will hand carry it through. Pepper the conversation with lots of " Thank

you so much " You're so sweet " You're so kind " " Thank good ness I got the

nicest/most helpful person there to help me! " " You don't know what this means

to me! " Whatever you can do to make them feel powerful and needed makes their

job feel worthwhile and they'll go out of their way to show you that they

actually CAN help you.

Took me many years to figure this all out, but now I'm getting pretty good at

it. I truly mean what I say to these people because they often do end up being

very helpful and bailing us out of a financial fiasco. So, I'm not being false

when I thank them and tell them how great they are. By the time I make them

feel good about themselves, they are being special. Of course, I still

encounter a few true jerks. All I do then is call back in tears to a new

person...usually I truly am by then..and ask them to please help me because the

last person got me so upset. Then I go through the normal spiel.

Hope this info helps!