Once again, Thank you, Jim. I thought about it all night and decided to call the United Healthcare Nurse Case Manager assigned to me because of my many problems. She told me not to let them go ahead with the paying upfront $750 and signing away my rights should the insurance not come through for me. She told me it was too big a risk to take and gave me the phone numbers to call and fax. I want them to pre certify my device before we proceed so that I don't get stuck in a corner. They told me they would appeal after a denial and appeal up until one year and then work out a payment plan for me to pay the $7,000. Next month they would charge my card $750 and would get that back once Sound Bite payment is approved. I am not happy with this plan and told everybody so. It's sticking my neck out like a giraffe. If they (Hopkins and Georgetown) can pre certify my surgeries, why can't they go to bat like the surgeons do and get everything to pass smoothly for MOI!!!! and believe me MOI is important as Miss Piggy says. They told me once the year is up, they would work out a payment plan for me to pay off the $7,000. and the $750 which is immediate. I wrote to the docs involved and to my primary care, ENT, nurse practitioner to request clinical notes and a letter from them to support my "Pre certification" and included the dentist who was part of the invention of the Sound Bite and holding partnership in the organization. I told him to tell the President whom he sees that they are getting off on the wrong foot as far as I am concerned. I would rather continue SSD than be a giraffe and stick my neck out for $7,000. I just want to let all of my Forumites out there not to let them corner you into liability of $7,000. It's too risky. The onus should be on them to get the pre certification just like our surgeons and Occipital Nerve Block pain docs do. What makes them so special that they make you give them the credit card information and say that you are billable after one year if our insurance refuses. Yes, Dr. Monfared said they are nice. Nice is nice, but this is business and I won't proceed unless they get off their buts and get the paperwork done to pre certify. I did my homework, let them do their homework the get the BUCKS.
Below is my as usual frank notes to the medical professionals and United Healthcare:
Fwd: Sonitus Pre determination request information from Dr. Douglas Feldman
Reply
Seroun Wang to physicians
show details 5:33 PM (2 hours ago)
To Dr. Feldman
I am coming in to see you next week just to ask you for help with the
Sonitus Soundbite pre-determination. I am also coming in to see if
you have any suggestions about my breathing and exercise tolerance
from the paralyzed vocal cord. I went to the Acoustic Neuroma
Assoc. Symposium last month in Cincinnati and met with several
physicians from Mayfield and House Ear Insitute and they all noticed
my breathing as I talked with them. So did the doctors in Neuro at
Georgetown.
Thanks again and looking forward to meeting you and discussing this.
Sincerely,
Seroun M. Wang
---------- Forwarded message ----------
From: Seroun Wang <seroun@gmail.com>
Date: 2011/7/27
Subject: Fwd: Sonitus Pre determination request
To: Ashkan Monfared <amonfared@mfa.gwu.edu>, Rachel Lazaro
<rlazaro@mfa.gwu.edu>, Ben Wu <benwu@ucla.edu>, Dr Theodore Li
<tli@foxhallinternists.com>, Maureen Moriarity <mmscrnp@hotmail.com>
I hope you don't mind my changing the signature line to read "pending
pre-authorization" This is what my United Heathcare Case nurse case
manager told me to do to keep things clean and straightforward for me,
the patient. I have to protect myself and I hope you will
understand. It is too much of a risk. I'm sure Sonitus will
understand. They can wait and I can go in the next batch of
patients, but I am pretty sure that this way the Nurse Case Manager
advised me to do is protecting me. I am recently retired on
disability and home taking care of my 97 year old father so there are
many things going on in my life.
I am asking Dr. Li, my primary Care doctor, Dr. Feldman, my ENT doctor
and Dr. Maureen Moriarity to send over what UHC predetermination has
requested. I am acting fast on this. The requests to them have
already been sent out, so I expect a decision very soon from
Pre-determination.
Thank you, Ben for the information on the EMFs and IEEE requirements
which I ran by five of my father's colleagues who are all Fellows of
the IEEE. Please tell the Sonitus President the next time you see him
my feedback. As I told the Audiologist yesterday, we are treading on
unchartered waters and I believe that they are starting off on the
wrong foot.
CC: ANAUSA.org: Hearing thread on Sonitus...Good News for us so
that everyone interested will know how I think they should proceed.
Take care all and best wishes,
SMW
---------- Forwarded message ----------
From: Seroun Wang <seroun@gmail.com>
Date: Wed, Jul 27, 2011 at 4:16 PM
Subject: Sonitus Pre determination request
To: Maureen Moriarity <mmscrnp@hotmail.com>
Dear Dr. Moriarity, Dr. Feldman and Dr. Li:
I hope you are doing fine and cool today. Tomorrow it's supposed to
warm up again.
I wanted to ask you a favor. I went to see Dr. Monfared yesterday
about the hearing device and he told me everything about how we would
proceed. They are getting the first group of patients all fitted and
we will be given the devices sometime in September with the entire
group at the same time....like a party.
The major problem I have with this is that he and Sonitus plan is to
have me submit $750. 00 in September and they would file the
additional $6,000 + and if it gets denied, they would work on it for
one year and then if no reimbursement comes through at the end of the
year, they would work out a payment plan. I called my assigned Nurse
Case Manager at United Healthcare and she said NO NO No. Don't do
that. Get it pre-authorized before you proceed. I faxed over to
the Sonitus Medical Order and Insurance office the forms the
audiologist gave me yesterday but I crossed out the part that they are
allowed to bill my credit card for the initial $750. I wrote next to
it: Pending Pre Authorization, but I included my American Express
number ... not giving them permission to bill to it. I am expecting
them to push for pre-authorization just as Johns Hopkins and
Georgetown did for my surgery and Physical Therapy. This is the
first time they are doing this and they are treading on uncharted
waters. I want to apply for pre-authoization and not have to wait
to get back my $750. and then get billed $6000 +
She told me to call Pre authorization Claims Dept and they told me to
have my doctor call (they prefer a call because they said it would be
faster OR Fax medical reports, clinical records and a statement from
you as to why I need this hearing device. It has to be called a
device not a hearing aid, otherwise it won't get reimbursed. It was
approved by the FDA under Devices and I think is being filed as a
prosthetic device.
The number to call in the report is: 1 866 297 9393 Care
Coordination Dept.
Fwd: Sonitus Pre determination request information from Dr. Douglas Feldman
Reply
Seroun Wang to physicians
show details 5:33 PM (2 hours ago)
To Dr. Feldman
I am coming in to see you next week just to ask you for help with the
Sonitus Soundbite pre-determination. I am also coming in to see if
you have any suggestions about my breathing and exercise tolerance
from the paralyzed vocal cord. I went to the Acoustic Neuroma
Assoc. Symposium last month in Cincinnati and met with several
physicians from Mayfield and House Ear Insitute and they all noticed
my breathing as I talked with them. So did the doctors in Neuro at
Georgetown.
Thanks again and looking forward to meeting you and discussing this.
Sincerely,
Seroun M. Wang
---------- Forwarded message ----------
From: Seroun Wang <seroun@gmail.com>
Date: 2011/7/27
Subject: Fwd: Sonitus Pre determination request
To: Ashkan Monfared <amonfared@mfa.gwu.edu>, Rachel Lazaro
<rlazaro@mfa.gwu.edu>, Ben Wu <benwu@ucla.edu>, Dr Theodore Li
<tli@foxhallinternists.com>, Maureen Moriarity <mmscrnp@hotmail.com>
I hope you don't mind my changing the signature line to read "pending
pre-authorization" This is what my United Heathcare Case nurse case
manager told me to do to keep things clean and straightforward for me,
the patient. I have to protect myself and I hope you will
understand. It is too much of a risk. I'm sure Sonitus will
understand. They can wait and I can go in the next batch of
patients, but I am pretty sure that this way the Nurse Case Manager
advised me to do is protecting me. I am recently retired on
disability and home taking care of my 97 year old father so there are
many things going on in my life.
I am asking Dr. Li, my primary Care doctor, Dr. Feldman, my ENT doctor
and Dr. Maureen Moriarity to send over what UHC predetermination has
requested. I am acting fast on this. The requests to them have
already been sent out, so I expect a decision very soon from
Pre-determination.
Thank you, Ben for the information on the EMFs and IEEE requirements
which I ran by five of my father's colleagues who are all Fellows of
the IEEE. Please tell the Sonitus President the next time you see him
my feedback. As I told the Audiologist yesterday, we are treading on
unchartered waters and I believe that they are starting off on the
wrong foot.
CC: ANAUSA.org: Hearing thread on Sonitus...Good News for us so
that everyone interested will know how I think they should proceed.
Take care all and best wishes,
SMW
---------- Forwarded message ----------
From: Seroun Wang <seroun@gmail.com>
Date: Wed, Jul 27, 2011 at 4:16 PM
Subject: Sonitus Pre determination request
To: Maureen Moriarity <mmscrnp@hotmail.com>
Dear Dr. Moriarity, Dr. Feldman and Dr. Li:
I hope you are doing fine and cool today. Tomorrow it's supposed to
warm up again.
I wanted to ask you a favor. I went to see Dr. Monfared yesterday
about the hearing device and he told me everything about how we would
proceed. They are getting the first group of patients all fitted and
we will be given the devices sometime in September with the entire
group at the same time....like a party.
The major problem I have with this is that he and Sonitus plan is to
have me submit $750. 00 in September and they would file the
additional $6,000 + and if it gets denied, they would work on it for
one year and then if no reimbursement comes through at the end of the
year, they would work out a payment plan. I called my assigned Nurse
Case Manager at United Healthcare and she said NO NO No. Don't do
that. Get it pre-authorized before you proceed. I faxed over to
the Sonitus Medical Order and Insurance office the forms the
audiologist gave me yesterday but I crossed out the part that they are
allowed to bill my credit card for the initial $750. I wrote next to
it: Pending Pre Authorization, but I included my American Express
number ... not giving them permission to bill to it. I am expecting
them to push for pre-authorization just as Johns Hopkins and
Georgetown did for my surgery and Physical Therapy. This is the
first time they are doing this and they are treading on uncharted
waters. I want to apply for pre-authoization and not have to wait
to get back my $750. and then get billed $6000 +.
---------- Forwarded message ----------
From: Seroun Wang <seroun@gmail.com>
Date: 2011/7/27
Subject: Fwd: Sonitus Pre determination request
To: Ashkan Monfared <amonfared@mfa.gwu.edu>, Rachel Lazaro
<rlazaro@mfa.gwu.edu>, Ben Wu <benwu@ucla.edu>, Dr Theodore Li
<tli@foxhallinternists.com>, Maureen Moriarity <mmscrnp@hotmail.com>
I hope you don't mind my changing the signature line to read "pending
pre-authorization" This is what my United Heathcare Case nurse case
manager told me to do to keep things clean and straightforward for me,
the patient. I have to protect myself and I hope you will
understand. It is too much of a risk. I'm sure Sonitus will
understand. They can wait and I can go in the next batch of
patients, but I am pretty sure that this way the Nurse Case Manager
advised me to do is protecting me. I am recently retired on
disability and home taking care of my 97 year old father so there are
many things going on in my life.
I am asking Dr. Li, my primary Care doctor, Dr. Feldman, my ENT doctor
and Dr. Maureen Moriarity to send over what UHC predetermination has
requested. I am acting fast on this. The requests to them have
already been sent out, so I expect a decision very soon from
Pre-determination.
Thank you, Ben for the information on the EMFs and IEEE requirements
which I ran by five of my father's colleagues who are all Fellows of
the IEEE. Please tell the Sonitus President the next time you see him
my feedback. As I told the Audiologist yesterday, we are treading on
unchartered waters and I believe that they are starting off on the
wrong foot.
CC: ANAUSA.org: Hearing thread on Sonitus...Good News for us so
that everyone interested will know how I think they should proceed.
Take care all and best wishes,
SMW
---------- Forwarded message ----------
From: Seroun Wang <seroun@gmail.com>
Date: Wed, Jul 27, 2011 at 4:16 PM
Subject: Sonitus Pre determination request
To: Maureen Moriarity <mmscrnp@hotmail.com>
Dear Dr. Moriarity, Dr. Feldman and Dr. Li:
I hope you are doing fine and cool today. Tomorrow it's supposed to
warm up again.
I wanted to ask you a favor. I went to see Dr. Monfared yesterday
about the hearing device and he told me everything about how we would
proceed. They are getting the first group of patients all fitted and
we will be given the devices sometime in September with the entire
group at the same time....like a party.
The major problem I have with this is that he and Sonitus plan is to
have me submit $750. 00 in September and they would file the
additional $6,000 + and if it gets denied, they would work on it for
one year and then if no reimbursement comes through at the end of the
year, they would work out a payment plan. I called my assigned Nurse
Case Manager at United Healthcare and she said NO NO No. Don't do
that. Get it pre-authorized before you proceed. I faxed over to
the Sonitus Medical Order and Insurance office the forms the
audiologist gave me yesterday but I crossed out the part that they are
allowed to bill my credit card for the initial $750. I wrote next to
it: Pending Pre Authorization, but I included my American Express
number ... not giving them permission to bill to it. I am expecting
them to push for pre-authorization just as Johns Hopkins and
Georgetown did for my surgery and Physical Therapy. This is the
first time they are doing this and they are treading on uncharted
waters. I want to apply for pre-authoization and not have to wait
to get back my $750. and then get billed $6000 +
She told me to call Pre authorization Claims Dept and they told me to
have my doctor call (they prefer a call because they said it would be
faster OR Fax medical reports, clinical records and a statement from
you as to why I need this hearing device. It has to be called a
device not a hearing aid, otherwise it won't get reimbursed. It was
approved by the FDA under Devices and I think is being filed as a
prosthetic device.
The number to call in the report is: 1 866 297 9393 Care
Coordination Dept.
If instead you want to fax or do both because I think faxing the
records from your hard drive might be easier, then the Fax Number is
pre determination fax 866 756 9733
The website for the device is SonitusMedical.com. They are in San Mateo, CA
I hope this works. Thank you for your help.
Sincerely,
Mei Mei
The number to call in the report is: 1 866 297 9393 Care
Coordination Dept.
If instead you want to fax or do both because I think faxing the
records from your hard drive might be easier, then the Fax Number is
pre determination fax 866 756 9733
If instead you want to fax or do both because I think faxing the
records from your hard drive might be easier, then the Fax Number is
pre determination fax 866 756 9733
The website for the device is SonitusMedical.com. They are in San Mateo, CA
I hope this works. Thank you for your help.
Sincerely,
Mei Mei