Author Topic: translab and baha  (Read 14354 times)

Jim Scott

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Re: translab and baha
« Reply #15 on: April 20, 2012, 04:09:11 pm »
Kixit ~

From my experience with insurance companies, I would venture to guess that you now have a reasonable chance of getting your appeal granted.  :)

Jim
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

kixit

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Re: translab and baha
« Reply #16 on: April 20, 2012, 07:50:36 pm »
I certainly hope so Jim. UVA e-mailed me an estimated price---- $20,113.00 (give or take). They need an approval or money in hand by noon May 11th. That's if I want it done with my Translab on May 24th.
left side AN 9mm diagnosed 2/2012
SSD, loud tinnitis left ear
Translab 5/24/12
Baha surgery 8/1/2012 at UVA
Baha hook up 11/09/2012  : ) 

I am a happy camper : )

leapyrtwins

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Re: translab and baha
« Reply #17 on: April 22, 2012, 02:49:20 pm »
kixit -

if your insurance policy covers CIs (cochlear implants) they have to cover BAHAs or they are discriminating against you, which is illegal.

CIs are for those who are bilaterally (double-sided) deaf, while BAHAs are for those who are unilaterally (single-sided deaf).  Your insurance company can't use the tactic that you aren't "deaf enough" for them to pay for the type of hearing implant that you need.

Call your insurance company, insist on talking to someone in charge - like a supervisor - and mention "discrimination".  Include the word "lawsuit" in your conversation and see where you go from there.   They need to know that you are serious about this request - and they need to know that they are in violation of the law.

Good luck,

Jan

Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

kixit

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Re: translab and baha
« Reply #18 on: April 22, 2012, 06:47:09 pm »
Jan,

I called Anthem on Fri., straight out I was told because I have an exclusion in my company policy they won't cover. Well I mentioned descrimination, Cochlear helping with the appeal and the state commission. Anthem was going to create me a denial letter since there wasn't one already because of the exclusion. At 3 PM, Anthem called said they were putting the letter on hold because they were going to investigate my case further. My response was but you said....she said maam we are going to talk with your doctor and so on. I also left a message for human resources about being self-funded insurance (per Cochlear) and I mentioned discrimination as well  ;D. I'm fighting this like no other. My job depends on it! 

I get a lot of information from this site. The people here are so informative and supportive!!
left side AN 9mm diagnosed 2/2012
SSD, loud tinnitis left ear
Translab 5/24/12
Baha surgery 8/1/2012 at UVA
Baha hook up 11/09/2012  : ) 

I am a happy camper : )

pjb

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Re: translab and baha
« Reply #19 on: April 23, 2012, 07:15:51 am »
Jan,

I called Anthem on Fri., straight out I was told because I have an exclusion in my company policy they won't cover. Well I mentioned descrimination, Cochlear helping with the appeal and the state commission. Anthem was going to create me a denial letter since there wasn't one already because of the exclusion. At 3 PM, Anthem called said they were putting the letter on hold because they were going to investigate my case further. My response was but you said....she said maam we are going to talk with your doctor and so on. I also left a message for human resources about being self-funded insurance (per Cochlear) and I mentioned discrimination as well  ;D. I'm fighting this like no other. My job depends on it! 

I get a lot of information from this site. The people here are so informative and supportive!!


That is the game or the insurance companies wishful thinking that people do not fight it and you cannot imagine how many give up but the few that will not take no for answer will get results the insurance has a certain amount allotted for out of network cases or medically necessary and will approve it I forgot thought not sure if the Cochlear is considered a hearing aid or like the BAHA which is almost always covered. I know hearing aids are not covered at all with all insurance companies I have yet to hear of one that does .. .. Do not give up be persistent and hoping it will be covered for you. It is sad with doctors high malpractice insurance and shady doctors and the insurance companies game as to limited coverage that is has come to managed care and difficulty having to get approvals but with both it is the bottom line and that is money and the patients are the ones suffering because of it !

Best Wishes,
Diagnosed with a 1 cm. AN had Retrosigmoid
Approach surgery July of 2009, several problems after surgery.

pjb

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Re: translab and baha
« Reply #20 on: April 23, 2012, 07:45:39 am »
kixit -

if your insurance policy covers CIs (cochlear implants) they have to cover BAHAs or they are discriminating against you, which is illegal.

CIs are for those who are bilaterally (double-sided) deaf, while BAHAs are for those who are unilaterally (single-sided deaf).  Your insurance company can't use the tactic that you aren't "deaf enough" for them to pay for the type of hearing implant that you need.

Call your insurance company, insist on talking to someone in charge - like a supervisor - and mention "discrimination".  Include the word "lawsuit" in your conversation and see where you go from there.   They need to know that you are serious about this request - and they need to know that they are in violation of the law.

Good luck,

Jan

I think I wrote earlier about hearing aid so both of these should be covered by the insurance I forgot what the Cochlear was hate the brain freeze.
Diagnosed with a 1 cm. AN had Retrosigmoid
Approach surgery July of 2009, several problems after surgery.

kixit

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Re: translab and baha
« Reply #21 on: April 23, 2012, 05:27:50 pm »
Anthem called. Denial letter is in the mail. However, human resources is checking with their group administrator and is waiting to hear back from them. The insurance book that I got my information from (as I was informed) is outdated (2009)but nonetheless descriminatory. And I mentioned that to human resources. They didn't comment, lol. I have an update fee for the BAHA surgery ($20,113) and processor w/headband-I won't need the headband, ($5100) for a total of $25,213. All to be paid on or before May 11th at noon.
left side AN 9mm diagnosed 2/2012
SSD, loud tinnitis left ear
Translab 5/24/12
Baha surgery 8/1/2012 at UVA
Baha hook up 11/09/2012  : ) 

I am a happy camper : )

james e

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Re: translab and baha
« Reply #22 on: April 24, 2012, 11:11:30 am »
What type of discrimination are you talking about? Just curious.

James

kixit

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Re: translab and baha
« Reply #23 on: April 24, 2012, 02:23:07 pm »
Anthem of Va is my insurance carrier. In my employers policy there is an exclusion for bone anchored implants but it covers cochlear implants (used for bilateral hearing loss) but doesn't have any coverage for unilateral hearing loss. That is descrimintaion in my eyes..errr..ears..lol
left side AN 9mm diagnosed 2/2012
SSD, loud tinnitis left ear
Translab 5/24/12
Baha surgery 8/1/2012 at UVA
Baha hook up 11/09/2012  : ) 

I am a happy camper : )

leapyrtwins

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Re: translab and baha
« Reply #24 on: April 25, 2012, 12:00:28 pm »
This is definitely discrimination - my insurance broker confirmed that when I first approached him about whether my insurance company would cover the BAHA.  He said "if they cover Cochlear Implants, they HAVE to cover BAHAs".

There was a case here in Illinois about a year ago where BCBS-IL was denying a young girl who clearly needed a BAHA insurance coverage.  The media made such a huge case of it (it was all over the evening news) that BCBS-IL couldn't change their opinion fast enough.

Sometimes you just have to rock the boat.

Good luck, kixit.

Keep us posted.

Jan
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

nftwoed

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Re: translab and baha
« Reply #25 on: April 25, 2012, 07:33:27 pm »
kixit;

  I had thought by state law that brain surgeries required the attendance of a Neurosurgeon? Seems this is how Dr. Shahinian ( Minimally Invasive Endoscopic Neurosurgery ) at Cedars Sianii, got in trouble and involved in court hearings years ago.
  Re, BAHA; Of course most are candidates, but not all. An Audiologist must determine the pts. "air bone gap". Some do indeed hear better with a Cros Hearing aid. Some loudness levels are just better with a Cros HA.
  Not sure I'd want to call that last person a "Numbskull" :) or not. I can't run so fast anymore.
  Best wishes!

kixit

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Re: translab and baha
« Reply #26 on: April 26, 2012, 06:23:15 pm »
I had a consultation with both ear surgeon and neurosurgeon. I won't need the neurosurgeon since the AN is still  in the IAC (but he will be on standby).

I contacted HR again. She said that she has still not heard from the policy administrator and will wait till Friday to call them (it takes time to research is what I was told). I told her that I all I was waiting on is the denial letter and sending my paperwork in to Cochlear for the appeal. I want them to know I am fighting it with the company.
left side AN 9mm diagnosed 2/2012
SSD, loud tinnitis left ear
Translab 5/24/12
Baha surgery 8/1/2012 at UVA
Baha hook up 11/09/2012  : ) 

I am a happy camper : )

lrobie

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Re: translab and baha
« Reply #27 on: April 27, 2012, 08:13:59 am »
Kixit,

I find this odd that you wouldn't need a neurosurgeon, unless you are talking about just for the BAHA.  My AN is still in the IAC, but I will have both doctors.   Just my thoughts...

Lisa
6/2009 7mm x 4mm  W&W
8/2011 9.5mm x 5mm
2/2012 UPMC Follow-up , slight growth
Surgery on 7/18/12 w/Drs. Friedman & Schwartz (mid-fossa)
www.caringbridge.org/visit/lisarobie

CHD63

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Re: translab and baha
« Reply #28 on: April 27, 2012, 08:20:07 am »
Lisa .....

I thought the same thing.  The second time (when it was translab) my AN regrowth was all in the IAC.  The otolaryngologist (Dr. Friedman) did the opening and removal of the middle ear parts, then the neurosurgeon (Dr. Schwartz) did the actual tumor removal, then Dr. Friedman returned to implant the Ponto BAHA abutment.  The IAC is well within the skull so it puzzles me that a neurosurgeon would not be needed.

Clarice
Right MVD for trigeminal neuralgia, 1994, Pittsburgh, PA
Left retrosigmoid 2.6 cm AN removal, February, 2008, Duke U
Tumor regrew to 1.3 cm in February, 2011
Translab AN removal, May, 2011 at HEI, Friedman & Schwartz
Oticon Ponto Pro abutment implant at same time; processor added August, 2011

james e

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Re: translab and baha
« Reply #29 on: April 27, 2012, 10:57:06 am »
The problem with insurance policies is we never read them until we want to make a claim. I live on a river in central Texas, and flooding is not covered in my home owners policy, so I bought flood insurance from FEMA. If your policy had not purposefully discriminated against bone anchored devices, then you might be able to argue your case, but in a legal sense, they wiped their hands clean ahead of time, and you probably don't have a legal right to argue the case, because it is specifically denied in the policy...just like  flood insurance.

Do you have a copy of the policy? Have you actually read the paragraph that denies bone anchored devices? The reason I ask, sometimes we can get into a personality dispute with the person on the other end of the line, and they can make it their business to make sure you have a bad day...deny your claim..."by the way a denial letter is in the mail."

Get your hands on the policy that your employer has, the one that covers you. Post the paragraph here and let's see what it says. Sometimes there is an answer written between the lines, and I am pretty good at reading what is not printed. Maybe we can find an answer. Just claiming "discrimination" is a hollow argument and will get put on permanent hold. Get the policy, and let's have a look.

James