House Ear Institute

[dalern]

It's been a while since I've been on the forum, and I've missed checking in with everyone.

I have been back in LA now for two years.  Last year I had my audiogram down in San Diego where I had my BAHA done, as I was down there for some other things anyway.  I am due for my audiogram again, and probably a tweaking of my BAHA.  I called House where I was first diagnosed with my idiopathic sensory neural hearing loss.  I asked to make an appointment for my audiogram and and to see the doctor I originally started with.  That was all pre-BAHA.  I am now on Medicare and was told that House no longer takes Medicare and that it would cost me at least $250.00.  I was stunned.  I guess it's a sign of the times.  UCLA works with BAHAs, but they want to see all my medical records and audiograms from UCSD before they decide if they will take me as a patient!  Is this bizarre or what?  It might be easier just to drive down to UCSD and visit San Diego to have my audiogram!
~Dale

[CHD63]

Hi Dale .....

My AN surgery (including a Ponto bone anchored hearing device) at House/St. Vincent's was just over two years ago.  I had (and still have) Humana Medicare (medicare and supplement rolled into one).  As I remember House did not have a contract with Humana but I gave them all of the numbers and information and their insurance department did all of the contacting for me.  Everything was covered with a possible exception of a relatively small co-pay.  They covered the whole thing ..... clinic evaluations, audiogram, other hospital required tests, surgery for AN removal, surgery for abutment, including the Ponto processor that I brought home with me to attach in 90 days.

It may be different for an office visit and audiogram ..... or they have actually changed their policy.  Since hearing loss affects a great many people over 65 I find it very odd that they are suddenly refusing to care for seniors.  I think I would pursue it a bit more.

By the way, you probably already know that Dr. Friedman is now at USC.  I suspect USC Med Center would almost certainly be required to accept medicare patients ..... but, who knows?!  It's a bit scary.

Clarice

[james e]

Good to hear from you again...happy you are doing well. Your subject line should have been "Medicare," not House Ear Institute. Medicare started in 1965, 48 years ago, collecting voluntary taxes to cover seniors 65 and over. It was a political law to collect taxes to earn the votes of elder voters.   Most private physicians do not accept Medicare because it pays so little for the treatment...they cannot keep their offices open with Medicare patients. The Congress passed a law that allows hospitals and their clinics to collect $25.00 from every patient to buffer their loss for treating Medicare patients.

House is trying to keep their doors open, and $250.00 sounds pretty reasonable. You might call them back to find out what Medicare pays. I would be willing to bet it is around $50.00.

[dalern]

Well, here is what I found out.  House has indeed changed it policies and not only do they not take Medicare anymore, they no longer take any insurance.  I spoke to an audiologist who works closely with some of the doctors there and she told me they had to drop all insurance.  UCLA does take Medicare and private insurance and they have many good audiologists and neurologists.  They do a lot of AN procedures, BAHAs and some Cochlear implants.  That is where I am going to go now.

As far as doctors not taking Medicare.....here in Los Angeles, most doctors DO take Medicare, even if they do not take private insurance.  I think it is probably different in different regions of the country. 

~Dale

[Jim Scott]

For clarification purposes - (from the House Research Institute website): http://www.houseearclinic.com/info/admission

Fee Policy of the House Clinic

We recognize the need for a definite understanding between the patient and his doctor regarding financial arrangement for medical and surgical care. The doctors of the House Clinic have established fees for professional services to their patients. The responsibility for payment of these fees is the direct obligation of the patient. The exception is for those cases where the patient's insurance provider has signed a contract with the House Clinic.

The House Clinic will be pleased to provide its standard information form to the patient for insurance purposes. While the House Clinic will take care of filing the claim for patients covered by Medicare, we would require that the Medicare charge be paid at the time of the visit. You will receive the reimbursement directly from Medicare.

This states that the House Institute will only accept insurance from companies that have a contract with House.  Also known as 'being in network'.  That information should be easy to ascertain.  For Medicare patients, House expects you to pay their fees upfront and wait to be reimbursed by Medicare.  That could be problematic for many AN patients and it seems unfair to put that burden on the patient.  However, from what I've read, Medicare payments to doctors and facilities are not only very low but also very slow, which may be why House made this requirement  I infer from this that the majority of AN patients at House are not relying on Medicare to cover their costs.   

Jim

[dalern]

OK, so I called there again to clarify.  I told them I wanted to have an audiogram and I wanted to see Dr. Luxford.  I asked specifically if they would bill Medicare and they said no. They will not file the claim.  In addition, if they do not take assignment from Medicare, Medigap or supplemental policies will not pay either.  I asked what all of their "over 65" patients do for payment and she said she really did not know, but they do not accept Medicare.  This is more than confusing.
~Dale

[james e]

Government healthcare...hows that working out for you?

[mk]

Government healthcare...hows that working out for you?

I have read this comment before on another thread. Forgive my ignorance, but from what I have read on the forum throughout the years, it seems to me that some patients above 65 cannot get private insurance coverage. If this is the case (unless I have misunderstood), what would these people do without Medicare?

Marianna

[james e]

Everyone  65 and over gets Medicare as a PRIMARY carrier. Actually you really do not "get" Medicare...you still PAY for it out of your $ocial $ecurity check. Each person is responsible for the difference between what you were billed and what Medicare paid. Most people purchase a SECONDARY policy to help cover the difference. You are still responsible for the balance.

Medicare is SLOW to pay. I got some poison ivy in December 2012 and was treated with a steroid injection. In August 2013 the clinic where I was treated still had not been paid.

I can imagine HEI bills run into tens of thousands, and waiting for 6 or 7 months to get paid is not good business. That is why they want the customers to pay up front. They will file all the paper work and then YOU can wait to get paid.

[dalern]

OK, here is the latest update.  I got a call yesterday from House.  They evidently monitor this forum and saw what I had posted. What this very nice woman told me is that both times that I called I was given incorrect information.  Here is what the situation is. First, House is no longer an official Medicare Provider, meaning they do not take assignment from Medicare.  However, they will bill Medicare for the patient, but the patient has to pay up front and wait to be reimbursed by Medicare.  So, it still means the patient has to outlay the money and wait for however long it takes Medicare to reimburse.  If you have a supplement, that will also be billed and should cover the 20% not covered by Medicare.  But if the doctor's visit and audiogram are covered by Medicare (which they should be), the patient should get reimbursed for whatever the Medicare contract rate is.  I, personally do not want to wait to be reimbursed.  That is part of the beauty of Medicare for me....no out of pocket expenses at doctor's offices or for procedures, only my premiums.  And the premiums are far less than what I was paying for private insurance. Also, House DOES take some private insurances, but they have a list of those companies with which they work.  This all being said, I am going to UCLA where there will be no initial out of pocket payment required.  USC is another option, but UCLA is closer for me.

Now, another comment was made that everyone over 65 automatically gets Medicare as their primary insurance.  That is not necessarily true.  If you are still working at age 65 and are part of a group policy, often that can remain your primary insurance.  When you leave the workforce, you can sign up for Medicare and a supplement and drug plan, or an all inclusive Medicare Advantage Plan.  Also, if a 65 year old has never worked or has not worked enough years to qualify for both A and B Medicare, the cost will be greater for them.  Long story, but if you go to www.medicare.gov you can get all your answers.
~Dale

[Jim Scott]

Dale ~

Thanks for taking the time to verify the fee payment rules at House and to explain the various caveats of Medicare.  Your contributions are appreciated.

Jim

[nftwoed]

Hi James;

   Re, "Medicare is SLOW to pay."  Oftentimes providers are slow to submit if you notice the dates.

Everyone  65 and over gets Medicare as a PRIMARY carrier. Actually you really do not "get" Medicare...you still PAY for it out of your $ocial $ecurity check. Each person is responsible for the difference between what you were billed and what Medicare paid. Most people purchase a SECONDARY policy to help cover the difference. You are still responsible for the balance.

Medicare is SLOW to pay. I got some poison ivy in December 2012 and was treated with a steroid injection. In August 2013 the clinic where I was treated still had not been paid.

I can imagine HEI bills run into tens of thousands, and waiting for 6 or 7 months to get paid is not good business. That is why they want the customers to pay up front. They will file all the paper work and then YOU can wait to get paid.

[mk]

   Have you ever thought our gov't would secretly like to see some legally euthanized to reduce the burden on gov't subsidized health care? Their health care is taken care of for life.
   

Huh? Only a few very wicked totalitarian governments in history may have done something like that. For example the Nazis by sterilizing handicapped people etc. I would like to believe that the protector of the free world does not belong to this category.
On the contrary, I could see a situation where a totally privatized system is free to deny insurance from  some people with chronic conditions or from seniors, thus limiting access from essential health care.

James, thank you for the clarifications. Obviously the money for any government subsidized program comes from somewhere: i.e. taxes, social security etc. Nothing is free. But this doesn't answer my original question (sorry for my ignorance but I don't know how the system in the States works). Are all seniors able to get PRIMARY coverage from private insurance, after retiring? And what options do they have?

Marianna

[ppearl214]

Hi all,

Been following this thread.  What a lively discussion. All of you are sharing interesting insight and it's truly appreciated.

This thread is listed under "Hearing Issues" regarding HEI.  I respect what everyone shared here and it's starting to go off course. Asking everyone to kindly get back on topic or take it off-line regarding insurance issues or take it to the "Insurance" forum.

Please remember that this is not a Political Discussion Forum, much as are offered in the World Wide Web.  What you share is definitely valuable to many newly-treated AN'ers and yet, we are starting to stretch it a bit much.

I respectfully ask we keep it reigned in a bit. 

Any questions, my inbox is always open and I try to respond within 24 hours or less.

Thanks.
Phyl