insurance question

March 27, 2006

Thanks - Thats a great point!! Ken.heatherbenjaminnicholas <heatherbenjaminnicholas@...> wrote: --Ken,THe only advice I can give in this area is make sure the plan covers hospital stays,not limit them. We almost changed plans last summer that would have capped my days in the hospital, that would have been a financil nightmare for us.CHeck the tiny details about hospitilization....just my 2 cents.. <pa- In , Ken Leonard <kclnt777@...> wrote:>> Hello All - > > Some of you will recall that I was needing to wait to get 2nd, 3rd opinions until I could switch to a PPO... Well, It's finally Open Enrollment and while I know I want to switch from an HMO to a PPO - I am hoping for some advice (based on

your personal experience) regarding the "type" of PPO....... > For Example: Higher Deductable/Lower Monthly Payment or Lower Deductable/Higher Monthly Payment... > > Thanks for any input on this... Ken.> > > ---------------------------------> New Messenger with Voice. Call regular phones from your PC for low, low rates.>

Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+ countries) for 2¢/min or less.

April 14, 2006

In a message dated 4/14/2006 10:16:34 AM Central Standard Time,

jmfritze@... writes:

> If I am not having any current

> symptoms that would warrent my levels be checked, will insurance still

> cover it? has anyone had any experience with this? Thanks!

>

For the insurance WE have, they will cover pretty much anything the doc deems

" Medically necessary " . So it's really up to the doc. My primary care provider

was a practice of two docs. When was dx'd and the ID/Immuno heard my

history, she was kind of thinking I might be the link. Even though I was having

some infections around that time, the doc in my practice that I asked said she

would not give me an order for testing, that it wasn't necessary. I really

just wanted it because had been dx'd, I was curious where it came from.

A couple years later, and some more infections later, the OTHER doc in the

practice happily gave me the order. I didn't really NEED the testing, he knew it

was more a curiosity thing, but he agreed to it. By the way, my IgG, IgM, IgA

came back normal. I would have bet money I had IgA def. I still wonder about

pneumo abs, but with everything else coming back normal, I didn't dare ask for

that testing. It wouldn't have mattered as far as 's care, and as long

as I avoid mold, I don't seem to get infections. So mine might be more allergy

related than antibody related, anyway.

So what I'm saying in a very roundabout way, is often times (depending on the

insurance), it's up to your doc. I'm sure other types of insurance might have

different requirements, though. Only your practice/insurance can tell you for

sure.

(mom to , age 7, dairy intolerant-related GERD -- currently has

polysaccharide antibody def, previously had transient IgG, IgA, t-cell & other

defs... and also to Kate, age 3!, more dairy intolerant but very healthy!)

April 14, 2006

So it's really up to the doc.

Thanks, that is kind of what I was thinking, but wasn't sure. I'll

see what he says.

April 17, 2006

My dh had his levels tested last fall after Cole's dx. My dh wasn't

necessarily having any symptoms, but his sister had a def and so we

thought maybe he was the link to Cole's problems. (As is turns out,

he has a def, but it is Hyper IgM, not at all like Cole's.) Our

insurance had no trouble covering the testing. I think as long as

your doctor writes it the right way it should go through.

Good luck! Are you feeling any better pregnancy-wise?

-Rogena (Mom to 4 boys, including Cole -IgA & IgG Subclass Def,

GERD, possible Celiac)

>

> Ana's immunologist has requested I get my levels checked at my

> symptoms that would warrent my levels be checked, will insurance

still

> cover it? has anyone had any experience with this? Thanks!

>

> Ana 14 mo

>

April 18, 2006

I think as long as

> your doctor writes it the right way it should go through.

>

> Good luck! Are you feeling any better pregnancy-wise?

>

I had the blood drawn yesterday, we will see! I'm curious myself!!!

I am doing ok with the pregnancy...just feel like crap! Thanks!

Ana has her abdominal ultrasound tomorrow....wish us luck, I am

nervous she will scream the whole time because she is scared. She

went to my ultrasound with me yesteday, but she is so young I don't

know how to help prepare her.

Ana 14 mo

April 18, 2006

In a message dated 4/18/2006 6:27:09 AM Pacific Daylight Time,

jmfritze@... writes:

Thanks!

Ana has her abdominal ultrasound tomorrow....wish us luck, I am

nervous she will scream the whole time because she is scared.

--

I hope it goes well. When my son was little and they wanted to scan him,

they sand-bagged him. I know it sounds cruel--but it worked. He held still

and fell asleep!! I preferred this to them knocking him out as he would often

have the after affects of the meds for a week.

Sandi, Mom to --age 13--CVID

January 10, 2007

Not really, the secondary insurance will just pay for what the primary

one does not cover. So if you have a test, and only a percent is

covered by BC, then Medicaid will pay the rest of it.

It just saves you out of pocket.

>

> Maybe I'm just being paranoid, but is it a bad thing for Blue Cross

> Blue Shield to know if you have a secondary insurance? What if the

> secondary insurance is a medicaid insurance, one that requires to be

> the secondary?

>

March 4, 2007

Hi

I am glad that I was of help in giving you things to ask your doctor. You

will find that this group is great about helping each other. I know my doctor

is very very conservative so he may be cautious in doing the balance testing but

I would rather be safe than sorry. He actually was not pro bilateral until

recent studies have shown the benefit. Until a year ago he felt that the cost

and risk did not out weigh the benefit. I am so glad he has changed his mind.

As for your insurance question I have been going through the same thing

wondering if my request will denied and then what did I needed to do.

Fortunately I was not denied so all my worry was for nothing.

One thing I would suggest doing (I did it for my insurance and seeing it in

black and white was great) is do a google search using your insurance company's

name and the words medical policies. If you insurance is a larger carrier then

a page should come up that you can do a search and find their cochlear implant

medical policy.

I know this was not what you asked but I thought maybe it would help. I think

you said you were in MA. My daughter works at MA General Hospital in Boston.

Where in MA do you live?

Connie

<jmc62@...> wrote:

Does anybody know how long it takes for an insurance company to deny

your request for a second CI, and then deny the appeal? I have to wait

for the denial on the appeal before AB will donate the second CI for

the research study I'm thinking of participating in. My worry is that

this could take a long time, and I'm axious to have this surgery NOW!!

If I just go with the one CI and not participate in the study, then I

could have my surgery within the next few weeks, but if I decide to

participate in this bilateral CI study, then I have to wait for my

insurance company to deny my first request for the second CI, and then

also deny the appeal for the second CI. I have Blue Cross Blue Shield

of MA for insurance. Does anyone know anything about how long it

usually takes? I would appreciate your help! Thanks so much!

" The Miracle at Ohio State "

aka Nucleus Freedom

Implanted 10/04/2005

Activated 11/1/2005

Surgery: Ohio State University

Surgeon: Dr. Bradley Welling

http://internalmedicine.osu.edu/article.cfm?ID=2021

March 4, 2007

Connie,

I'm not going bilateral but at your suggestion and my being curious

I googled my Insurance Company Medical Policy on Cochlear Implants

and was surprised to see that they only approve Bilateral Implants

for children ages 12 months to 8 years just effective March 2007. It

was interesting reading all the other information there too. Thanks

for the Tip!

>

> Hi

>

One thing I would suggest doing (I did it for my insurance and

seeing it in black and white was great) is do a google search using

your insurance company's name and the words medical policies. If

you insurance is a larger carrier then a page should come up that

you can do a search and find their cochlear implant medical policy.

>

> Connie

>

March 4, 2007

Hi ,

If we could tell how long insurance companies take, we could probably

all win the lottery as well. I would think if you are going to

participate in bilaterals that AB would help move the process along.

You asked Ted if it would be easier to insert the electrode array

since you've only been deaf a short while. That would have nothing to do

with it. Long term or short term deafness unless it's caused by

something like meningitis, doesn't change the ear structure nor the

cochlea itself.

But your learning to hear again should be easier because you have

years of auditory memory. You KNOW what words sound like. It will be

different hearing with an implant, but at least you've heard words.

Good luck,

I have to wait for my

insurance company to deny my first request for the second CI, and then

also deny the appeal for the second CI. I have Blue Cross Blue Shield

of MA for insurance. Does anyone know anything about how long it

usually takes? I would appreciate your help! Thanks so much!

March 4, 2007

If its GENUINE research, to help AB and other users, I dont know why

they are piddling around with insurance claims. Research is usually

funded.

Ted F.

>

> Does anybody know how long it takes for an insurance company to

deny

> your request for a second CI, and then deny the appeal? I have to

wait

> for the denial on the appeal before AB will donate the second CI

for

> the research study I'm thinking of participating in. My worry is

that

> this could take a long time, and I'm axious to have this surgery

NOW!!

> If I just go with the one CI and not participate in the study, then

I

> could have my surgery within the next few weeks, but if I decide to

> participate in this bilateral CI study, then I have to wait for my

> insurance company to deny my first request for the second CI, and

then

> also deny the appeal for the second CI. I have Blue Cross Blue

Shield

> of MA for insurance. Does anyone know anything about how long it

> usually takes? I would appreciate your help! Thanks so much!

>

March 4, 2007

I'm with you, Ted! I feel exactly the same way! If they're going

to " donate " the CI, then why don't they just donate it? It stinks to

have to wait now for the insurance company denials. I want to

starting hearing again!!

> >

> > Does anybody know how long it takes for an insurance company to

> deny

> > your request for a second CI, and then deny the appeal? I have

to

> wait

> > for the denial on the appeal before AB will donate the second CI

> for

> > the research study I'm thinking of participating in. My worry is

> that

> > this could take a long time, and I'm axious to have this surgery

> NOW!!

> > If I just go with the one CI and not participate in the study,

then

> I

> > could have my surgery within the next few weeks, but if I decide

to

> > participate in this bilateral CI study, then I have to wait for

my

> > insurance company to deny my first request for the second CI, and

> then

> > also deny the appeal for the second CI. I have Blue Cross Blue

> Shield

> > of MA for insurance. Does anyone know anything about how long it

> > usually takes? I would appreciate your help! Thanks so much!

> >

>

March 4, 2007

Hey again, !

I should have replied to this email, too, in my last one, but I forgot.

I only asked the question about insurance in the hopes that someone had gone

through the denial process for the second implant before and could give me an

idea of how long it might take. I just don't know how long we're talking about,

if it's weeks or months.

And I didn't ask Ted about the electrode array (which I have no idea what that

even means), I asked him if my adjustment to a CI would be any easier since I

just lost my hearing, as compared to someone who lost their hearing 10, 20, or

30 years ago, or if we all sort of start out at the same place.

Thanks so much for all your help and support, . I very much appreciate

it!

Re:Insurance Question

Hi ,

If we could tell how long insurance companies take, we could probably

all win the lottery as well. I would think if you are going to

participate in bilaterals that AB would help move the process along.

You asked Ted if it would be easier to insert the electrode array

since you've only been deaf a short while. That would have nothing to do

with it. Long term or short term deafness unless it's caused by

something like meningitis, doesn't change the ear structure nor the

cochlea itself.

But your learning to hear again should be easier because you have

years of auditory memory. You KNOW what words sound like. It will be

different hearing with an implant, but at least you've heard words.

Good luck,

I have to wait for my

insurance company to deny my first request for the second CI, and then

also deny the appeal for the second CI. I have Blue Cross Blue Shield

of MA for insurance. Does anyone know anything about how long it

usually takes? I would appreciate your help! Thanks so much!

March 5, 2007

,

I did go through a denial process for the 2nd CI. I believe the actual

initial request was done in early June and denied about a month later.

Another request was sent right in and about a month later I was in surgery.

March 5, 2007

Hey , thanks for that info. What insurance do you have?

Re: Re:Insurance Question

,

I did go through a denial process for the 2nd CI. I believe the actual

initial request was done in early June and denied about a month later.

Another request was sent right in and about a month later I was in surgery.

March 5, 2007

,

I have Blue Cross through my former employer.

March 6, 2007

Hi ,

Unfortunately one insurance denial process is rarely going to be the

same as another insurance denial process. It can take days, weeks, or

months. I suggest you start e mailing them on a daily basis to speed

things up.

The Electrode array is what goes into the cochlea and sends the

signals to the auditory nerve. AB has an array with 16 electrodes.

Nucleus has an array with 22 electrodes in the cochlea and 2 grounding

electrodes outside the cochlea, but still implanted. That allows for

various mapping strategies. Nucleus has a self curling electrode array,

so that the electrodes hug the center of the cochlea and send the sounds

where they need to be in an energy efficient manner.

Adjusting to hearing with the CI is a personal thing, and it probably

will take some time even with auditory memory to help you. Because you

will be hearing in a totally different way. It took me 3 months to hear

the way I do now. Some people hear just the way they remember it with

the first mapping. Makes the rest of us wonder what we are doing wrong.

MOST of us have some time to adjust to the new sounds. But in the end,

hearing ends up being much like the typical hearing we had before going

deaf.

Hey again, !

I should have replied to this email, too, in my last one, but I forgot.

I only asked the question about insurance in the hopes that someone had

gone through the denial process for the second implant before and could

give me an idea of how long it might take. I just don't know how long

we're talking about, if it's weeks or months.

And I didn't ask Ted about the electrode array (which I have no idea what

that even means), I asked him if my adjustment to a CI would be any

easier since I just lost my hearing, as compared to someone who lost

their hearing 10, 20, or 30 years ago, or if we all sort of start out at

the same place.

Thanks so much for all your help and support, . I very much

appreciate it!

March 7, 2007

HI ,

is right. We have to keep bugging the insurance. I have

been bugging since April 2006 and finally my insurance approved last

month. I am having my first CI surgery on 20th of this month.

Also, you can ask an organization called " Let Them Hear " Foundation

for help. They have been extremely helpful with filing appeal in

legal way.

>

> Hi ,

> Unfortunately one insurance denial process is rarely going to

be the

> same as another insurance denial process. It can take days,

weeks, or

> months. I suggest you start e mailing them on a daily basis to

speed

> things up.

>

> The Electrode array is what goes into the cochlea and sends the

> signals to the auditory nerve. AB has an array with 16

electrodes.

> Nucleus has an array with 22 electrodes in the cochlea and 2

grounding

> electrodes outside the cochlea, but still implanted. That allows

for

> various mapping strategies. Nucleus has a self curling electrode

array,

> so that the electrodes hug the center of the cochlea and send the

sounds

> where they need to be in an energy efficient manner.

>

> Adjusting to hearing with the CI is a personal thing, and it

probably

> will take some time even with auditory memory to help you.

Because you

> will be hearing in a totally different way. It took me 3 months

to hear

> the way I do now. Some people hear just the way they remember it

with

> the first mapping. Makes the rest of us wonder what we are doing

wrong.

> MOST of us have some time to adjust to the new sounds. But in the

end,

> hearing ends up being much like the typical hearing we had before

going

> deaf.

>

> Hey again, !

>

> I should have replied to this email, too, in my last one, but I

forgot.

>

> I only asked the question about insurance in the hopes that

someone had

> gone through the denial process for the second implant before and

could

> give me an idea of how long it might take. I just don't know how

long

> we're talking about, if it's weeks or months.

>

> And I didn't ask Ted about the electrode array (which I have no

idea what

> that even means), I asked him if my adjustment to a CI would be any

> easier since I just lost my hearing, as compared to someone who

lost

> their hearing 10, 20, or 30 years ago, or if we all sort of start

out at

> the same place.

>

> Thanks so much for all your help and support, . I very much

> appreciate it!

>

March 8, 2007

My insurance company waited just a couple of days before my surgery date before

approving. I stayed on pins and needles. When my boss told me I was approved, I

shouted so loud I scared my co-worker drilling metal across from me. He thought

I was hurt. I was crying but I wasn't hurt.

Sharon Myers

Bilateral CI user

---------------------------------

Sucker-punch spam with award-winning protection.

Try the free Beta.

November 17, 2007

Pete - call them and ask yourself. Be sure you get the starting date! And keep

calling - there's nothing that says you can't call every day, either.

There's nothing that says you can't inquire about your own procedure(s) being

approved! Just don't take no for answer until you get to the right person that

can state the info accurately and tell you it's pending, waiting approval, etc.

Be sure to confirm your personal info with them and vice versa, so you know the

person you are talking to has " clout " to accurately give you answers.

Some times I get approval notices through my insurance company before my doctor

does. And some times I get the Pending notice before they do too - although the

doc's office requested it!

Debbie Dahl

Oklahoma

November 18, 2007

I have already tried the calling , All I get is voice mail,that never gets

returned. been calling for a week now.

Debbie Dahl <gpages@...> wrote: Pete -

call them and ask yourself. Be sure you get the starting date! And keep

calling - there's nothing that says you can't call every day, either.

There's nothing that says you can't inquire about your own procedure(s) being

approved! Just don't take no for answer until you get to the right person that

can state the info accurately and tell you it's pending, waiting approval, etc.

Be sure to confirm your personal info with them and vice versa, so you know the

person you are talking to has " clout " to accurately give you answers.

Some times I get approval notices through my insurance company before my

doctor does. And some times I get the Pending notice before they do too -

although the doc's office requested it!

Debbie Dahl

Oklahoma

December 16, 2007

Thanks! I'll get to that after Christmas! We're probably upgrading

our insurance soon because of a job change and I suspect that the new

one will cover more.

> Our insurance pays.

> You can just call up your ins and give the name of the one you

want to go to and see if they'll cover them. You could also ask the

insurance co what therapists THEY'll pay for in your area.

> Robin

>

April 3, 2008

Hi tara,

We have BC/BS Care First in land. Our plan pays unlimited Speech, ot

and pt with only a $15.00 co-pay. i was just told that a new policy will

include a $500.00 deductible then they will pay. i called Care First

many times to obtain benefits and was always told the wrong thing. I

finally had the human resources department at my husbands work call

their Care First connection and I finally got answers. If this is a

policy through work then I suggest you enlist their help. I review every

EOB to make sure that the claim was paid and paid correctly. I know we

have a great plan and I sue the heck out of it!!! Hope this helps!

Lynn

>

> Hi All,

>

> I searched the archives on this, but was wondering if anyone had any

> advice on getting the insurance company to pay for speech therapy.

> We actually have speech therapy, OT, and PT through our insurance,

> we are supposed to be reimbursed 80% after a $500 deductible. The

> problem is that it was miscoded or mishandled when the claim went

> through and whomever reviewed it thought we had a different plan.

> So we had to put it through again, and I swear, everytime you call,

> they say it's another 10-15 business days. I have heard a lot of

> great things about Carefirst, but I don't feel like we are getting

> anywhere. We are also experiencing the same thing with our old

> insurance company from last year. They haven't paid on some claims

> from September 2007! This whole part of it is so disheartening

> because we did everything we were supposed to on our part, it's the

> insurance company who isn't. Sorry for the vent, but my husband and

> I are so frustrated.

>

> Thanks,

> Tara

>

April 3, 2008

Try contacting your benefits person in HR. Sometimes they are very

good about getting problems resolved. They will either contact the

insurance company directly or they will contact the sales rep who

will intervene. It helped the couple of times we tried it.

M.

>

> Hi All,

>

> I searched the archives on this, but was wondering if anyone had

any