Wednesday, November 07, 2007

Pay the premiums and then what?

Insurance companies, do we love them or hate them? When you are deaf or hard of hearing and in need of a test to prove you are, it might not be covered. My insurance company is Horizon BCBS of NJ whom covers standard hearing tests at in network provider BUT the test to see if I need a hearing aid is not covered. That makes as much sense as painting an ostrich purple does because a majority of the hearing tests are the same!

  • First test is usually beeping at different frequencies at different volumes.
  • Second test requires a rather hard knob thing that they put behind your ear. This is called a Bone Conduction Test. When you feel the vibration or hear the beep, you raise your hand, say Ay, press a button or scratch your tummy and pat your head. Whatever your audiologist wants you to do.
  • Third test is when they say words and they expected you to repeat them. Words like hot dog, baseball, cowboy which most of us have memorized like the latest single on the radio (after we looked up the lyrics.)

WHERE IN THE HELL IS THE SPECIAL HEARING AID TEST?! I'll be damned if I know. Since most insurance companies do not cover hearing aids but will cover cochlear implants, some with and without a fight. You can contact DVR or the Lions Club for funding for a hearing aid. They will even pay for the tests in some cases!

While I am thankful that I did not have to fight my insurance to obtain approval for a cochlear implant, many fight and fight hard. The only issue that I had was that I could not get a straight answer from the insurance company as to whether my insurance policy covered them. Some insurance companies will only cover one cochlear implant while others will cover two cochlear implants. I am unsure if my insurance company covers bilateral but Aetna is one of the latest ones to revise their policy on bilateral cochlear implants.

I hear many stories waging a war with insurance companies with obtaining approval for the surgery because it is not cheap by a long shot. Michael Moore latest documentary "Sicko" showed a parents battle with their insurance company Cigna for bilateral cochlear implants for their daughter. It is a revelation on how political insurance companies are. To reiterate, we live in a capitalist country, the country that will discover, in complete disorder, ways to milk money out of someone regardless if you don't have enough money to buy milk. Insurance companies are in the business of making money, not spending it in sums large enough to buy a decent plot of land.

As sad as it is, there is hope. I obtained a short list from the site on which companies approve cochlear implants providing the requirements are met. is a site known for their free advocate service against an insurance company to obtain cochlear implants. They are successful most of the time but an appeal can take an awful long time to fight.

Aetna/US Healthcare, Blue Choice, BlueCross BlueShild, California Public Employees Retirement System, Cigna HMO, Great West Life PPO, Hartford Insurance, Health Texas, Medicare, Medicaid (varies by state), NYL Care, State of Minnesota Employees Insurance, Tricare - PFPWD (formerly PFTH), United HealthCare

Ironically, when we are sick we tend to visit people that went to medical school. It is a socially acceptable practice here. When the individual that graduated from medical school feels that tests are deemed medically necessary, the insurance company determines whether they are fiscally responsible. Hence, the one without a medical degree gets the final say.

Perfect nonsense.


Anonymous said...

I had to fight and fight hard against blue cross. Let Them Hear did it all for me without asking for anything.

I became so depressed over it, but now I am fully bionic and so thankful for my computers.

They will pay for batteries also. I want to order some and new ear hooks before the end of the year since I am max out on coverage and they will pay 100%. Check into that too since you had surgery this year.


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