Stupid insurance!!!! *rant*

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deafmama78

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So, today I got a letter from my insurance, saying they're denying my Dr's request for the referral to go to the Mich Ear Ins on 2/27. So, now I have to go somewhere else and my CI evaluation appt will be March 21st at 8 am. Grr!! I was once again really upset when I found out I'd be waiting another few more weeks as all I wanna know right now is if I'm a good candidate, then move on to the next ste[ to get closer to getting the date set for my Cochlear Implant!

Speaking of CI, have you guys heard of this new one U of M [Michigan] is researching on. If all goes well, it'll be ready in a few yrs. I defintely want that one & will be able to upgrade to that easily if I went ahead and got CI as soon as I can. :] If you haven't heard of it and would like a link to read about it, ask and I'll provide it. :]

Take care!
 
I hope there are no more delays and that the evaluation goes ok for you.
Hang in there and Good Luck!
 
Thanks everyone!!! :]
I refuse to give up as I really think I wanna do this once I find out I'm a candidate. I'll be surprised if I'm not. :x So, yeah I'm thinking + and trying to be patient! Thanks again, everyone!
DeafMama78
 
Good Rant.

I'm sorry to hear about this... Think positive then you will be okay...
 
as I really think I wanna do this once I find out I'm a candidate
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You do sound like you're a really really good canidate....I think that insurance companies are going to be a lot stricter about implantation/evalution approval, since .....well in the past only a relatively small percentage of deaf people were eligable. So even thou it was expensive, it really wasn't too much of a financial burden. But now, a lot more people are looking into implantation............so ....*shrugs shoulders*
Definitly fight for it. Just wondering..........you said before that you were only gonna do it if it was a last resort thing. I wonder if you might get treated better if you contacted the insurance company, and asked if they could cover a "physical" with an ENT. I really think from your desciptions that you might have Meineure's..........I remember reading a case about a guy who was already deaf (good response with hearing aids) but had Meinure's/further hearing loss and had to get a CI. I think it would be worth it just to see........you might get some hearing back. Hard to say thou b/c I thought that Meineure's was unpredictable.
 
deafdyke said:
You do sound like you're a really really good canidate....I think that insurance companies are going to be a lot stricter about implantation/evalution approval, since .....well in the past only a relatively small percentage of deaf people were eligable. So even thou it was expensive, it really wasn't too much of a financial burden. But now, a lot more people are looking into implantation............so ....*shrugs shoulders*
Definitly fight for it. Just wondering..........you said before that you were only gonna do it if it was a last resort thing. I wonder if you might get treated better if you contacted the insurance company, and asked if they could cover a "physical" with an ENT. I really think from your desciptions that you might have Meineure's..........I remember reading a case about a guy who was already deaf (good response with hearing aids) but had Meinure's/further hearing loss and had to get a CI. I think it would be worth it just to see........you might get some hearing back. Hard to say thou b/c I thought that Meineure's was unpredictable.
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It turns out that my insurance only had a problem with the place that I was orginally referred to, since it was out of network, so I now have an appt scheduled for March 21st w/ another hospital, Henry Ford Hospital [For those in Mi] soo I'll just go there & talk to the Dr and do the CI evaluation then find out if I'm a candidate, where will I be sent to for the actual CI surgery? Cause I am kinda hoping to have surgery at U of M since it's close and is a awesome hospital! :]

I will ask about Meiner's Diease however you spell it. But, ack - I hope I don't have it now! That would just really suck. My main problem is really just the damn Tinnitus. It's going sooo loud as I type this & all I want is peace & quiet. Grrrrrrrrrrrrr!!!!! :(

I will keep everyone updated on my candidacy [however it's spelled] journey. :]

Hugs,
-DeafMama78
 
I will ask about Meiner's Diease however you spell it. But, ack - I hope I don't have it now! That would just really suck. My main problem is really just the damn Tinnitus. It's going sooo loud as I type this & all I want is peace & quiet.
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Well the reason you should get an ENT physical is b/c the hearing loss and tinituas associated with Meinere's can be sometimes treated with steriods. I mean if its 100% positive that you don't have Menieres, or if the steroids don't work, then the CI seems to be a reasonable option. Especially since they've found that a CI can really really help tinitias. That's so funny that you don't mind not hearing.........it's just the tinitias..........
 
Why did your insurance deny your request? Did you ask them why?
 
If not working out w/your insurance...

Tell them I quit your insurance because it's poor service and ain't helpful for approval provide you ci...

Why don't you try find another insurance and willing open door for everything your needs to meets.
 
Well, Most insurance companies only serve certain hospitals, GalaxyAngel.. So if she quit the insurance she's on now, She'd have to wait a lot longer to get the CI if she's a candiate.

Insurance companies serve a network, which is basically a group of doctors, hosptials, dentists, ect. If you go outside their network, They either refuse to pay for it or charge you MORE money to go to that doctor.

So changing insurance companies won't help her because she'd have to get off the insurance she's on now, find a new insurance, get approved for that insurance, wait for the paperwork and card that shows she has that insurance, and then find a doctor in that insurance company's network. So she's better off staying with her current insurance. cuz changing will delay getting a CI by 3 months. And I'm sure nobody would like to wait any longer than they have to.:deal:

Just a FYI. Yeah, I know insurance companies... I've had problems with them before myself :)
 
You're right on target about the whole Insurance stuff. Thanks for explaining it to the rest of the group. :)

BearBeauty said:
Well, Most insurance companies only serve certain hospitals, GalaxyAngel.. So if she quit the insurance she's on now, She'd have to wait a lot longer to get the CI if she's a candiate.

Insurance companies serve a network, which is basically a group of doctors, hosptials, dentists, ect. If you go outside their network, They either refuse to pay for it or charge you MORE money to go to that doctor.

So changing insurance companies won't help her because she'd have to get off the insurance she's on now, find a new insurance, get approved for that insurance, wait for the paperwork and card that shows she has that insurance, and then find a doctor in that insurance company's network. So she's better off staying with her current insurance. cuz changing will delay getting a CI by 3 months. And I'm sure nobody would like to wait any longer than they have to.:deal:

Just a FYI. Yeah, I know insurance companies... I've had problems with them before myself :)
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Insurers Obligations

Insurers are not obligated to approve coverage for the facility that you want, they are only obligated to provide you with a competent provider in a reasonable period of time. If the only provider is not competent (for example, CI audie who doesn't treat many children, or surgeon who has not done any simultaneous bilateral implants) then you CAN contest it and it is quite possible that you will win. The provider gets paid, and even though they are out of network, your cost will still be at the in network rates. Having to wait more than 90 days for an appointment or travelling more than 50 miles is also grounds for petitioning for out of network coverage.

That being said, it is a long drawn out hassle to do so. Most of the insurance appeals I have handled in this area have taken on the order of 3 months to resolve. So you probably don't want to go through that just for an eval, but for a surgeon or follow-up, sometimes it is worth it.

Sheri
 
This is not same doc or surgery but I had to go out of network and out of state for my daughter to have eye surgery. She needed a pediatric glaucoma doc and the closest one was in Durham, NC. 4 hours away. Her primary eye doc wrote a letter to the insurance company and they approved for us to go. Just thought I would throw this in. It is same issue in a way.
 
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