Guest guest Posted November 20, 2007 Report Share Posted November 20, 2007 Although I am new here, I wanted to reply to this. After much dialogue with my insurance company, Anthem BCBS of CT, I got them to agree to make Cochlear in Network. Apparently " all " I needed to do was have my doctor contact them to inform them that Cochlear is the ONLY FDA Aproved supplier for parts to my son's particular implant. This note has been attached to his file and theoretically I should not have any difficulties with getting in network benefits paid. It's worth a try. Regards, Suzanne in CT mom to Sam, 8yo bilateral N24C, N24 double array, freedom both -------------- Original message from C J <cjcj05@...>: -------------- > Does anyone know what the Medicare codes are for Cochlear Implant replacement > parts and batteries. I was denied coverage for coils, batteries, and microphone > covers by my insurance company because Cochlear is not a participating provider, > however, coverage is given if Medicare covers it but I neet the codes. > > Thanks and Happy Thanksgiving!!! > > Connie > > > " The Miracle at Ohio State " > aka Nucleus Freedom > Bilateral Implants > 1st Implanted 10/04/2005 > 1st Activated 11/1/2005 > 2nd Implanted 03/06/2007 > 2nd Activated 05/08/2007 > Surgery: Ohio State University > Surgeon: Dr. Bradley Welling > http://internalmedicine.osu.edu/article.cfm?ID=2021 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2007 Report Share Posted November 20, 2007 Suzanne thank you so much because I have Anthem BCBS too. Does that include batteries? Happy Thanksgiving!!! Connie rextech@... wrote: Although I am new here, I wanted to reply to this. After much dialogue with my insurance company, Anthem BCBS of CT, I got them to agree to make Cochlear in Network. Apparently " all " I needed to do was have my doctor contact them to inform them that Cochlear is the ONLY FDA Aproved supplier for parts to my son's particular implant. This note has been attached to his file and theoretically I should not have any difficulties with getting in network benefits paid. It's worth a try. Regards, Suzanne in CT mom to Sam, 8yo bilateral N24C, N24 double array, freedom both -------------- Original message from C J <cjcj05@...>: -------------- > Does anyone know what the Medicare codes are for Cochlear Implant replacement > parts and batteries. I was denied coverage for coils, batteries, and microphone > covers by my insurance company because Cochlear is not a participating provider, > however, coverage is given if Medicare covers it but I neet the codes. > > Thanks and Happy Thanksgiving!!! > > Connie > > > " The Miracle at Ohio State " > aka Nucleus Freedom > Bilateral Implants > 1st Implanted 10/04/2005 > 1st Activated 11/1/2005 > 2nd Implanted 03/06/2007 > 2nd Activated 05/08/2007 > Surgery: Ohio State University > Surgeon: Dr. Bradley Welling > http://internalmedicine.osu.edu/article.cfm?ID=2021 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2007 Report Share Posted November 20, 2007 Connie, I was told that it covered everything medically related that I would / could order from Cochlear and if I had any problems, to call back and remind them to check his file. Happy Thanksgiving! Suzanne -------------- Original message from C J <cjcj05@...>: -------------- > Suzanne thank you so much because I have Anthem BCBS too. Does that include > batteries? > > Happy Thanksgiving!!! > > Connie > > rextech@... wrote: > Although I am new here, I wanted to reply to this. After much dialogue > with my insurance company, Anthem BCBS of CT, I got them to agree to make > Cochlear in Network. Apparently " all " I needed to do was have my doctor contact > them to inform them that Cochlear is the ONLY FDA Aproved supplier for parts to > my son's particular implant. This note has been attached to his file and > theoretically I should not have any difficulties with getting in network > benefits paid. It's worth a try. > > Regards, > Suzanne in CT > mom to Sam, 8yo > bilateral N24C, N24 double array, freedom both > > -------------- Original message from C J : -------------- > > > Does anyone know what the Medicare codes are for Cochlear Implant replacement > > parts and batteries. I was denied coverage for coils, batteries, and > microphone > > covers by my insurance company because Cochlear is not a participating > provider, > > however, coverage is given if Medicare covers it but I neet the codes. > > > > Thanks and Happy Thanksgiving!!! > > > > Connie > > > > > > " The Miracle at Ohio State " > > aka Nucleus Freedom > > Bilateral Implants > > 1st Implanted 10/04/2005 > > 1st Activated 11/1/2005 > > 2nd Implanted 03/06/2007 > > 2nd Activated 05/08/2007 > > Surgery: Ohio State University > > Surgeon: Dr. Bradley Welling > > http://internalmedicine.osu.edu/article.cfm?ID=2021 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2007 Report Share Posted November 21, 2007 Well gosh, ASK Cochlear. They can give you specifics from the Diagnositic and Statistical Manual. DSM codes. Call toll free: 1-800 523-5798 and ask for insurance reimbursement dept. Can't understand why someone isn't considered a provider when they are the ONLY source for parts. Insurance companies are around to make us nuts - and it's working. Bear in mind if you have Medicare, Cochlear will submit the claim for you. It's those of us who have some other insurance who have to jump through hoops to get reimbursements. Happy Turkey day, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 13, 2008 Report Share Posted August 13, 2008 First, Medicaid is for people collecting social services or so-called " welfare " due to income levels below a certain level. Medicare is the medical insurance provided to those on social security due to disability or age through Social Security. If you've been on Social Security Disability for 2 years, you are entitled to Medicare regardless of your age. Go to http://www.socialsecurity.gov/ for more information or to find contact info.phone number to call or closest SS office to visit. If you get Medicare, you can then think about purchasing a Medicare supplement policy such as offered by AARP or other carriers. Take a look at http://www.aarp.org/health/insurance for information on Medicare supplements. Hope this helps! Dorothy _____ From: [mailto: ] On Behalf Of Joanne Dubnicka Sent: Wednesday, August 13, 2008 10:37 AM Subject: [ ] medicare question I have had RA since 2000 and have worked until last year when it became impossible to work. Soon, I am going to run out of my COBRA insurance. I am currently receiving SSD. I think I need to go on Medicare; however, I am only 54 years old. Does anyone know if this is possible; if so, what do I need to do, what does it cover (I am currently on Orencia and methotrexate), what is the difference between medicare and medicade, who or what department should I talk to, and what are the additional coverages (such as AARP additional medicare coverage)? Thanks for all your help. Joanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 13, 2008 Report Share Posted August 13, 2008 Joanne, If you have been on SSDI for 2 years you are eligible for Medicare. Medicaid is usually funded by the state you live in thru the Dept of Human services.It is also based on the household income, which in most states has to be below the poverty level. I am not familiar with the new drug coverages with Medicare but I do know they have some now.You can call the Dept of Social Security and they can mail you information, or you might be able to get it on line. AARP has some great Medicare supplement Policies but be prepared to pay somewhere in the range of 250.00 per month. That figure may be different now as it is based on what it was in 2007 when I was working for homecare. Heidi M On Wed, Aug 13, 2008 at 10:37 AM, Joanne Dubnicka <windey99@...>wrote: > I have had RA since 2000 and have worked until last year when it became > impossible to work. Soon, I am going to run out of my COBRA insurance. I am > currently receiving SSD. I think I need to go on Medicare; however, I am > only 54 years old. Does anyone know if this is possible; if so, what do I > need to do, what does it cover (I am currently on Orencia and methotrexate), > what is the difference between medicare and medicade, who or what department > should I talk to, and what are the additional coverages (such as AARP > additional medicare coverage)? > > Thanks for all your help. > > Joanne > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 27, 2010 Report Share Posted April 27, 2010 A few questions here regarding Medicare. 1. Will Medicare cover/pay for home cleaning, cooking, and related non-medical items? 2. Is there a master list of all the things Medicare will potentially pay for, and the requirements (magic words to say, and not to say/do) for each to be obtained? 3. Can a relative provide care/services and get paid, rather than having to go through an agency? I have been on the SSA web site, and it is one of the most customer unfriendly web sites I have ever trudged through, imho. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 27, 2010 Report Share Posted April 27, 2010 1. Yes and No - depends on your situation. http://www.medicare.com/assisted-living/home-health-care.html What Is Home Health Care? The term " home health care " is used to describe a wide range of services provided to seniors in their home. They include medical and non-medical services. The purpose of the services is to keep seniors out of the hospital or nursing home, and as independent for as long as possible. The services provided can be as simple as help with daily activities such as cooking, cleaning, and bathing or as complicated as medical care that requires a licensed and skilled health care provider. Most people who require these services are recovering from an illness or injury, or are living with a long-term medical condition. 2. Yes - every Fall/late Fall Medicare sends out a book for the year to come. This is sent too all who are enrolled in Medicare. 3. Don't think so. Go to http://www.medicare.com/medicare-coverage-basics/index.html or phone 800 754 8910 to get the book of services and check out http://www.medicare.com/ in the meantime. Gretchen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2010 Report Share Posted September 13, 2010 Yes, Humana started as a hospital benefit program and grew from there. I'm not aware of Humana moving into the part "B" Medicare plans, but it sounds like they have. Like all "Medadvantage" programs (like Blue Cross), they take over management of the patient from Medicare and become the primary. These plans usually pay $20 on an adjustment, but because they also have $20 co-pay, we never get paid. Billing Medicare separately after the rejection notice is a waste of time, paper and ink, since Medicare won't pay as the secondary. Like Medicare they only "pay" for the adjustment. Since you're non-participating, you should get $$$ upfront from the patient at the time of service. Sure makes the billing clerk happy. I am not a Medicare guru, I just play one on TV. Christian Mathisen, DC, CCWFN 3654 S Pacific Hwy Medford, OR 97501 cmathdc@... Re: Medicare question Hello Lyndon, You described Humana Medicare as a "supplement"? I am not familiar with Humana but I think it is a medicare part C provider. If so then Humana is the only carrier you can bill. Humana "takes over" the beneficiary's medicare benefits. Like Samaritan Advantage locally, if you are not on the panel you will not be reimbursed. J. Holzapfel, DC (not so medicare guru)Albany, Oregon541-928-4060 ---------- Original Message ----------From: Lyndon McGill <twogems@...> Subject: Medicare questionDate: Fri, 10 Sep 2010 16:14:48 -0700 Dear Medicare Gurus:We have a disabled patient (age 58) who is on a Humana Medicare supplement. Humana told my billing clerk that since we are a non-participating Medicare provider, they won't pay for our services. They also said that we can't bill Medicare separately. Is this kosher?Lyndon McGill, D.C.Salem, Oregonwww.SalemSpineClinic.comEvolving Doctors Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 11, 2011 Report Share Posted January 11, 2011 Hi , As a participating doc you can charge pretty much whatever you want for services not covered by Medicare. Technically, the limiting fee is for non-par docs when charging for covered services. Personally, I charge what Medicare allows. As for the ABN, go to www.noridianmedicare.com for a copy.. J. Holzapfel, DCAlbany, Oregon541-928-4060 ----- Medicare questionDate: Tue, 11 Jan 2011 14:25:03 -0800 Dear Docs, Am I correct in my assumption that when Medicare is denying treatment because it appears to be maintenance, that I can still only charge the patient the limiting fee? I am a participating provider in Medicare. Also, where can I go on the web to get a current digital ABN form? Thanks Mike Sorah, DC Corvallis, OR Quote Link to comment Share on other sites More sharing options...
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