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Author Topic: BAHA denied at the last minute!  (Read 12267 times)

Necromancer

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BAHA denied at the last minute!
« on: March 14, 2015, 07:40:44 pm »
Scheduled for my implant on Friday, March 13, pick the date myself! Was told everything was approved. On the Wednesday night before surgery, received a phone call from insurance saying that as per policy this is not a covered procedure. I just about flipped. Made multiple phone calls to my benefits department on Thursday, to no avail. Did a little extra research on Thursday night at work. Found out that the two plans then the hospital I work at offers, cover different things. The one Aetna plan, covers BAHA and The plan I have by Qualcare does not.
Called the benefits manager in the morning and told her about this and she asked me how I knew that Aetna covered it. I told her I called the company. And they showed me where in their literature it says they cover it. She was a little dumbfounded. About an hour later I got a phone call from the director of human resources for the hospital I work at. Explain to them everything that I had found out, and he too was also surprised. But the end of our conversation, he promised that he would make sure that my plan covered everything the same way that Aetna does.
I hope this goes to show, that you can't take this lying down. You have to be your own advocate . Aetna  follows CMS guidelines as every other insurance company should. CMS is the one that sets the rules. If you have any questions please feel free to PM me
« Last Edit: March 15, 2015, 04:27:19 pm by Necromancer »
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Left SSD 5 days post flu vac. Severe vertigo x 3 weeks. Left ear AN found on MRI 11/5/14 6mm x 4mm watch and wait. 22 hyperbaric O2 tx, no change. BAHA5 Attract 4/17/15 changed to post 12/15/15 2.5 year  MRI shows no change.

Brewers7

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Re: BAHA denied at the last minute!
« Reply #1 on: March 15, 2015, 01:41:32 pm »
I had a similar problem with Meritain (a division) just before the surgery.  They finally came around.  Get preapproval letter.  So glad I did.
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Translab surgery 12/15/2008 followed by CSF leakage repair and 3 additional surgeries for MRSA of the brain (NOT typical) SSD,  facial and vocal cord paralysis, numerous reconstructive surgeries, Transear 12/2010

Necromancer

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Re: BAHA denied at the last minute!
« Reply #2 on: March 16, 2015, 04:57:05 pm »
So, the update for now is, baha rescheduled for April 17, and qualcare is going to pay for it. I will let you all know if anything else changes.
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Left SSD 5 days post flu vac. Severe vertigo x 3 weeks. Left ear AN found on MRI 11/5/14 6mm x 4mm watch and wait. 22 hyperbaric O2 tx, no change. BAHA5 Attract 4/17/15 changed to post 12/15/15 2.5 year  MRI shows no change.

ANGuy

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Re: BAHA denied at the last minute!
« Reply #3 on: March 16, 2015, 08:43:07 pm »
Good job holding them to their responsibilities and getting what you need.  I think it's a good indicator of your recovery that you have the fortitude to achieve a successful outcome on something like this.
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Diagnosed June 2014 1cm AN at 47 years of age.  Had fluctuating symptoms since 2006.    6 mos MRI (Dec 2014) showed no growth, MRI  in July 2015 showed no growth.  MRI Jan 2016 showed no growth.  MRI Aug 2016 showed no growth.  I'm gonna ride the WW train as long as I can.

Ahollo

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Re: Tricare
« Reply #4 on: March 24, 2015, 04:13:30 pm »
Just wanted to post my recent experience with Tricare for any other military active duty dependents. We had Prime when I was diagnosed and our base in San Antonio has a facility to treat almost everything- including AN's. I was denied out of network treatment for that reason. My patient advocate told me I could 1. Say I was living at an address that does not have a treatment facility with in 100 miles of where I want treatment or 2. Switch to Standard.

We had no problems changing to Tricare Standard. It was effective the day after I called to switch, and I did not need another referral to go out of network. It was almost too easy! I was told we have to pay $17 each day I'm in the hospital and 20 percent of any requested tests prior to surgery. I also just learned that Standard caps out at $3000. I'll gladly pay that to get the best care.

I hope this information is useful. Not that I'd wish this on anyone, but just in case another dependent is lurking who happens to have an AN.
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Necromancer

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Re: BAHA denied at the last minute!
« Reply #5 on: April 03, 2015, 10:18:55 pm »
So, my latest update is, MRI 4/9/15 to eval any progression in AN. Baha surgery 4/17/2015. The only change is I will be receiving the baha 5 instead, that was just released this week. I guess the first cancelation was just meant to be.
Michael
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Left SSD 5 days post flu vac. Severe vertigo x 3 weeks. Left ear AN found on MRI 11/5/14 6mm x 4mm watch and wait. 22 hyperbaric O2 tx, no change. BAHA5 Attract 4/17/15 changed to post 12/15/15 2.5 year  MRI shows no change.

Alix May

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Re: BAHA denied at the last minute!
« Reply #6 on: April 04, 2015, 04:56:22 pm »
Yay, new tech! Good luck. :)
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4mmx6mm inferior vestibular branch
diagnosed 1/30/15

Necromancer

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Re: BAHA denied at the last minute!
« Reply #7 on: April 17, 2015, 07:21:34 pm »
Well, magnet implant for the attract was done today. Post-op discomfort is minimal, may take some Tylenol before bed. Now it's 3-4 week wait before I get my device. Will post again when that happens, or if there is any change.
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Left SSD 5 days post flu vac. Severe vertigo x 3 weeks. Left ear AN found on MRI 11/5/14 6mm x 4mm watch and wait. 22 hyperbaric O2 tx, no change. BAHA5 Attract 4/17/15 changed to post 12/15/15 2.5 year  MRI shows no change.

Alix May

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Re: BAHA denied at the last minute!
« Reply #8 on: June 09, 2015, 06:02:57 pm »
How are things going?
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4mmx6mm inferior vestibular branch
diagnosed 1/30/15

Necromancer

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Re: BAHA denied at the last minute!
« Reply #9 on: June 11, 2015, 12:38:15 am »
So, all went well with surgery. Healing time of 6 weeks. Had a little drainage problem. A knot of the suture in my incision line, was keeping it from closing. Had that taken care of (snipped) in the office. Healed closed 2 days later. The next bump in the road was from the office. When they sent my baha 4 in, to exchange for the baha 5, they sent the whole box back. When I went for follow-up, all I had was the proccesors. No magnets or accesories. They were only susposed to send in the proccesors, not everything. First time the office ever did an exchange. I can't make this stuff up.
Long story short, I got hooked up last Thursday and love my baha 5. Can't believe the sounds I've missed. Had my first re-fit today, and all is going well. I can't say enough about it. Next re-fit in 2 weeks. Will let you know how it all goes.
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Left SSD 5 days post flu vac. Severe vertigo x 3 weeks. Left ear AN found on MRI 11/5/14 6mm x 4mm watch and wait. 22 hyperbaric O2 tx, no change. BAHA5 Attract 4/17/15 changed to post 12/15/15 2.5 year  MRI shows no change.

Alix May

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Re: BAHA denied at the last minute!
« Reply #10 on: June 11, 2015, 02:29:55 pm »
Man, if it can go wrong, it will, eh? I'm so glad things have progressed and are now going well (so far)!  :)
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4mmx6mm inferior vestibular branch
diagnosed 1/30/15
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