Already made.......

Fo'Shizzle

Fo'Shizzle

New Member
Joined
Apr 13, 2006
Messages
2,115
Reaction score
0
Please just bare with me on this... I know Ive created a thread about this once, but Im needing to know if anyone out there know how to fight for a ci? Im going to talk to my doctor about sumbit a pa request so medicaid won't refuse not to pay for ci, but you know how doctors can be a pain in the ass at times.. If there is other way around please tell me..
 
RoyalMajesty said:
Please just bare with me on this... I know Ive created a thread about this once, but Im needing to know if anyone out there know how to fight for a ci? Im going to talk to my doctor about sumbit a pa request so medicaid won't refuse not to pay for ci, but you know how doctors can be a pain in the ass at times.. If there is other way around please tell me..
Click to expand...

Do you test over the set percentage on the HINT sentences? I got approval through my private insurance company based on my responses in noise, only 11% on the HINT. With no noise I scored around 70% and lower then 60% is what the insurance companies and medicaid set as a standard. (that percentage is aided) We never really discussed decibal of loss, mine was mod/severe sensorial neural with a reverse slope. I was told by one of the audiologists that with my scores if I had had medicaid they'd have to just tell me tough luck, come back in a year and we'll test again. It's evidently pretty impossible to get approval if you are above the set threshold and use gov. programs. This could be why your dr. isn't even trying to get the pre approval. But perhaps you can discuss it and see if he'd at least try.
 
jag said:
Do you test over the set percentage on the HINT sentences? I got approval through my private insurance company based on my responses in noise, only 11% on the HINT. With no noise I scored around 70% and lower then 60% is what the insurance companies and medicaid set as a standard. (that percentage is aided) We never really discussed decibal of loss, mine was mod/severe sensorial neural with a reverse slope. I was told by one of the audiologists that with my scores if I had had medicaid they'd have to just tell me tough luck, come back in a year and we'll test again. It's evidently pretty impossible to get approval if you are above the set threshold and use gov. programs. This could be why your dr. isn't even trying to get the pre approval. But perhaps you can discuss it and see if he'd at least try.
Click to expand...
I haven't asked my doctor about it just yet... But about the gov programs... please tell me more about that...
 
RoyalMajesty said:
I haven't asked my doctor about it just yet... But about the gov programs... please tell me more about that...
Click to expand...

The gov. programs are medicaid and medicare. They set a threshold that if you're over it they won't approve a ci. That threshold is 60% or more correct when they read the sentences to you and you repeat them. Some here say it's a certain decible loss in the profound range I believe, we didn't discuss that just that on HINT, I scored to high and I 'should' have been getting more from my HA's. As we all know life is not a nice quiet sound boooth and when noise is added my percentage dropped to 11%. That's what got me approval. But remember I had private insurance. Medicaid and medicare come with a whole set of restrictions, which is one reason we'll keep our youngest daughter on our insurance for as long as possible.

Have you ever actually had a CI evaluation? That would be a good place to start since a CI evaluation is different then a regular hearing test.
 
LuciaDisturbed said:
I thought medicaid and medicare would never cover CI's at all? :dunno:
Click to expand...
unless you get a approved by your doctor, ask him to sumbit a pa request so medicaid can't refuse not to pay for CI
 
RoyalMajesty said:
no they don't because they don't cover them in all states
Click to expand...
Indeed, even though I didn't say all. but just that medicaid does cover it somehow.


Edit: Of course not 100% for sure..
 
Boult said:
Indeed, even though I didn't say all. but just that medicaid does cover it somehow.
Click to expand...
okay... if you don't mind me asking where do I start with medicaid??
 
RoyalMajesty said:
okay... if you don't mind me asking where do I start with medicaid??
Click to expand...
I think what you just mentioned in first post is the way to go.. that is what the first link I provided above says:
Adults

Even though EPSDT does not apply to those 21 or over, Medicaid must still cover CI for adults based on laws such as the ADA and Section 504 of the Rehabilitation Act.

Again, Medicaid's written State Plan may technically not provide benefits. But if your physician submits a PA request, they legally cannot refuse coverage. I have filed appeals in several States on behalf of adults, most recently in Arizona. In every case, the adult received coverage.

Hope this helps to clarify this information.
Click to expand...
This quote is from: http://www.listen-up.org/haidfund.htm
 
Boult said:
Royal, check this page: http://www.cochlear.org/sys-tmpl/medicaidandcochlearimplants/
Click to expand...



North Carolina Medicaid covers cochlear implant services for children under age 21. It follows FDA criteria for implantation.

Similar to most Medicaid programs, North Carolina will not provide benefits for devices that are not approved by the FDA.

Unlike most Medicaid programs, North Carolina does not require prior authorization for cochlear implants.

North Carolina still does not provide cochlear implant benefits for adults.
 
RoyalMajesty said:
North Carolina Medicaid covers cochlear implant services for children under age 21. It follows FDA criteria for implantation.

Similar to most Medicaid programs, North Carolina will not provide benefits for devices that are not approved by the FDA.

Unlike most Medicaid programs, North Carolina does not require prior authorization for cochlear implants.

North Carolina still does not provide cochlear implant benefits for adults.
Click to expand...
so you are saying you are under 21?
look at my previous post again , I edited it.
 
RoyalMajesty said:
North Carolina Medicaid covers cochlear implant services for children under age 21. It follows FDA criteria for implantation.

Similar to most Medicaid programs, North Carolina will not provide benefits for devices that are not approved by the FDA.

Unlike most Medicaid programs, North Carolina does not require prior authorization for cochlear implants.

North Carolina still does not provide cochlear implant benefits for adults.
Click to expand...
I missed the last line in that quote.. that is if you are from NC. try the "let them hear foundation" link in my other post above.
 
Boult said:
I missed the last line in that quote.. that is if you are from NC. try the "let them hear foundation" link in my other post above.
Click to expand...
I did they don't cover ci, they only cover like hotel fees and crap like that...
 
RoyalMajesty said:
Please just bare with me on this... I know Ive created a thread about this once, but Im needing to know if anyone out there know how to fight for a ci? Im going to talk to my doctor about sumbit a pa request so medicaid won't refuse not to pay for ci, but you know how doctors can be a pain in the ass at times.. If there is other way around please tell me..
Click to expand...
Once your doctor does yor CI evaluation and you are found to be a candidate, The doctor usually will give you a letter of medical necessity to send out to your insurance. I know thats the case with regular insurance, but i'm not sure about medicare.
 
kayla123 said:
Once your doctor does yor CI evaluation and you are found to be a candidate, The doctor usually will give you a letter of medical necessity to send out to your insurance. I know thats the case with regular insurance, but i'm not sure about medicare.
Click to expand...
are you sure? since im on medicaid??
 
Back
Top