Mr. Ujest’s insurance company thru work is dropping their company because apparently they (insurance company) gave approval for a cochlear implant on one of the workers kids and decided to cancel the company policy effective April 1. ( or it could be that the insurance company raised their rates and the office manager will not pay for it. I don’t know the particulars.
Anywhoo. As most of you know, I lost 55% hearing in my right ear last august. If/when we go to a new company, they will not cover preexisting situations like this. The chances of my hearing returning to that ear are nearly nil and the chances of it getting worse are pretty good as I get older. ( I’m only 38.)
My ENT specialist recommend this which is still pretty new. Only 15,000 have been performed either world wide. it is not FDA approved, but I’m ok with that. It’s been tested on deaf european guinea pigs.
It involves having an incision made behind the ear and a titanium implant put in. Once it osseocalcifies ( if that is the right word) then I can have ( and this is really cool) a snap on hearing accessory. (I might ask for GPS and an MP3 player, but that might be pushing it.)
I would have to have my Dr. send a letter over to the insurance company to see if they would approve of this. It is a case by case basis situation and I understand that. If I am turned down for the surgery, I would take the hearing aid.
Until we found out about the insurance problem, I was fully intending to try an in-the-ear hearing aid for a couple of years to see how I liked it, then see if I wanted this surgery. Out of pocket cost for something like this is about $4,000. ( I actually expected it to be more costly. Like 20K.)
This is a tremendous pressure on me to do the right thing in situation that I am still getting comfortable in because my gut feeling is that I would be fine with the Baha system but what if I really don’t need something so technical and I hate it? Or it just amplifies my tennitus? What if the replacement parts are as costly as a hearing aid? What if I wear it out in the rain and electricute myself? (ok, I’m kidding on the last one.) On the other hand, what if I decide to not get it and find out I am not comfortable with an in-the-ear hearing aid?
Somehow either way, I am probably screwed and it isn’t a good feeling.
Right after i hit submit on this, I am calling the Doctor’s office to have them get the ball rolling on the official letter for the insurance company. Worse case scenario is they say no.
A quesiton that just popped into my mind is: if they say no to the Baha, the current policy covers one hearing aid for each ear ( I only need one) every 36 months. Do you think that they would bend the rule and allow to hearing aids for the same ear, that way one could be a back up hearing aid for the future and my ear will not be insured from here-on. Is that an insane request?
First of all, under federal law, you should be covered for your pre-existing condition under the new insurance plan as long as you have been continuously covered by health insurance and have not had any gaps in coverage longer than 63 days.
Second, I seriously doubt any health insurer would cover an experimental treatment, much less one that has not been approved by the FDA. Also, I seriously doubt any health insurer would “bend” any rules. They generally do whatever the minimum is that is required by law.
I research health care and insurance issues for the major association representing health insurers, so I am just going by what I have learned while researching these issues for them. They spend A LOT of money fighting these things! For example, they have us keep a close watch on legislation that would require them to cover clinical trials or experimental treatments. They do not want to cover these things if they can help it. Also, state law usually governs how insurers have to cover things like hearing aids. The state law will set forth the minimum standards for coverage, and I’m willing to bet that in your state, it’s one per ear every 36 months. I can look it up for you; what state do you live in?
I live in Michigan.
Do you have any links stating the FDA regulations you stated above?
Shirley, check out this site, everything you want to know is there: http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
Basically, under the federal Health Insurance Portability and Accountability Act (HIPAA) an insurer cannot exclude coverage for a pre-existing condition unless you have had a lapse in coverage of more than 63 days. In other words, HIPAA guarantees that people who have continuous health coverage without a gap of more than 63 days can’t be denied health insurance even if they have a pre-existing condition.
That is why if you lose your job, under the federal COBRA laws, you can opt to continue your health insurance coverage in order to avoid a gap in coverage that could affect you adversely later on in regards to pre-existing conditions. COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985, the law that added the health care continuation coverage requirements. If you are covered by an employer’s group health plan, COBRA may give you the right to stay covered even if something happens, like losing your job, that would otherwise cause you to lose coverage. This continuation coverage under an employer’s plan is called “COBRA coverage.” COBRA coverage usually lasts only for a limited time, and you usually have to pay for it.
Thank you very much! I would have never found this info without your assistance!
IANADD (I am not a deaf Doper) or a medical type. I am the father of a hearing aid-using child.
I too can not imagine any insurance company bending the rules in your favor regarding the 36 month time limit on aids. To be perfectly blunt they are in business to make money. They make the rules they do because they can and it works out in their favor.
I don’t know the particulars of your situation but would something like the Vibrant Soundbridge be a possibility? It has the advantage of having been approved by the FDA.
I can’t imagine either device or a conventional hearing aid amplifying your tinnitus by the way. They work by amplifying sound, and there is no actual sound in tinnitus AFAIK, just the perception of sound (which I realize is quite real, it isn’t “all in your mind”). I haven’t done any research on that though.
Not real helpful, I know. I hope things work out for you.
You’re welcome. They key is to never let your health insurance lapse for very long, or else you won’t be covered for pre-existing conditions, then you’re SCREWED! Thank goodness we at least have some protections through HIPAA. Although I still think it is so inherently unfair… I mean, what if you lose your job, and can’t afford to keep paying for your COBRA coverage? I mean, duh, most people who lose their jobs can’t afford that. So basically another downside to losing a job is that when you do finally get coverage again, you’re SOL in terms of your new insurance covering any condition you had before. It’s reallt fucked up when you think about it.
Like, let’s say you’re being treated for cancer. You get laid off, and can’t afford coverage for 63 days (ya know, like, it’s either pay your mortgage, eat, or pay outrageous rates for health insurance). Then any new coverage you get will exclude cancer treatment. Then you die! That SUCKS!!