Guest guest Posted September 18, 2007 Report Share Posted September 18, 2007 Hey Meghan, I have Blue Cross Blue Shield of MA and on August 21st I had simultaneous bilateral CI surgery, which BCBS paid for 100%. They used to only cover one CI, but their policy just changed to cover bilateral CI's on August 1st. I had to fight for a few months to get that second one covered, and then found out right after they approved me for two in the middle of July, that they would now be covering two CI's for anyone who qualified. Just wanted to let you know this. Also, the Let Them Hear Foundation were the ones who helped me with the appeal process and they really are awesome, so if you do happen to have any problems, I highly recommend Let Them Hear. They literally take your case and fight for you, all for free. Good luck to you and I hope you get your approval. My activation was just last Wednesday and I'm doing incredibly!! I am hearing so well, I can't even believe it. Last week at this time I was totally deaf, and right now I'm sitting here LISTENING to my TV and understanding everything!! I am soooo happy I made the decision to get these CI's. They have literally given me my life back. So if you're hesitating AT ALL, I would REALLY encourage you to do it!! All my best... > > I just found out the newspaper where I work at get their medical > insurance through Blue Cross Blue Shield. If I can continue to work > full time, I would be eligible for insurance. > > Now here's my question. Are they good about covering the implant > procedure and all? When I was evaluated yesterday, the audiologist > told me the entire procedure would cost around $105,000ish, which > surprised me as I heard 50-70,000 was the usual costs. Anyway, yeah. > Just want to know how BCBS is about covering the implant. > > > Meghan > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2007 Report Share Posted September 18, 2007 It'd be great if I could go bilateral, but the center is concerned that there might be too much ossification in the left ear, so I would only be able to do one ear. Of course, a CT scan still needs to be done but it'll be a while before I can get that done, as I don't have the money for a CT yet. Someday, though. Thanks for the info about BCBS. That really helps me with considering the insurance. Meghan > > > > I just found out the newspaper where I work at get their medical > > insurance through Blue Cross Blue Shield. If I can continue to work > > full time, I would be eligible for insurance. > > > > Now here's my question. Are they good about covering the implant > > procedure and all? When I was evaluated yesterday, the audiologist > > told me the entire procedure would cost around $105,000ish, which > > surprised me as I heard 50-70,000 was the usual costs. Anyway, > yeah. > > Just want to know how BCBS is about covering the implant. > > > > > > Meghan > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2007 Report Share Posted September 19, 2007 Hello Meghan! Before switching to United Healthcare in January, we had BCBS. We were considering the implant option for my 22 month old daughter for about 6 months before we starting getting things in motion. When exploring options with BSBS, we were told that they would cover the procedure, but would only cover one implant at a time. We were not given a hard time at all. Luckily, we switched to United...who have been unbelievable with the things they have paid for for my little one. They covered her bilateral implantation surgery - and her total hospital bill was $198,000. (so the 105,000 figure sounds about right). Kaylee has a Nucleus Freedom, and the billable amount for each implant (just the implant kit - no surgery) was between $75-80,000. Good luck! Meghan <itzhanson_fan@...> wrote: I just found out the newspaper where I work at get their medical insurance through Blue Cross Blue Shield. If I can continue to work full time, I would be eligible for insurance. Now here's my question. Are they good about covering the implant procedure and all? When I was evaluated yesterday, the audiologist told me the entire procedure would cost around $105,000ish, which surprised me as I heard 50-70,000 was the usual costs. Anyway, yeah. Just want to know how BCBS is about covering the implant. Meghan --------------------------------- Shape in your own image. Join our Network Research Panel today! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2007 Report Share Posted September 19, 2007 I have Horizon BCBS of NJ and they paid 100% of everything! If you don't have surgery they will charge you the full price. If you have insurance the hospital will accept whatever they send. You are more of a liability if you don't have insurance in most cases. -Abbie http://contradica.blogspot.com 8.27.07 - Implanted HiRes 90k 9.17.07 - Activation Harmony 120 > > I just found out the newspaper where I work at get their medical > insurance through Blue Cross Blue Shield. If I can continue to work > full time, I would be eligible for insurance. > > Now here's my question. Are they good about covering the implant > procedure and all? When I was evaluated yesterday, the audiologist > told me the entire procedure would cost around $105,000ish, which > surprised me as I heard 50-70,000 was the usual costs. Anyway, yeah. > Just want to know how BCBS is about covering the implant. > > > Meghan > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2007 Report Share Posted September 19, 2007 This is why I'm trying to get the insurance. From: " Abbie " <contradica@...> Reply- Subject: Re: blue cross blue shield Date: Wed, 19 Sep 2007 13:25:48 -0000 I have Horizon BCBS of NJ and they paid 100% of everything! If you don't have surgery they will charge you the full price. If you have insurance the hospital will accept whatever they send. You are more of a liability if you don't have insurance in most cases. -Abbie http://contradica.blogspot.com 8.27.07 - Implanted HiRes 90k 9.17.07 - Activation Harmony 120 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2010 Report Share Posted January 27, 2010 This may be the first time I have posted something, although I read the posts everyday. I have psoriatic arthritis and have been on Remicade and Celebrex for close to three years. I must say, once I was put on Remicade, my life changed. I felt normal again! But....Monday Blue Cross Blue Shield canceled my insurance because Remicade was costing too much. I'm so frustrated now. BCBS approved me to be on Remicade and it doesn't seem fair that they can just cancel me now. My husband and I own our own business, so getting affordable insurance is nearly impossible. I am assuming it will be impossible now. We have applied to Aetna, but can't get any info out of them yet whether they will insure us or not, so we are in a holding pattern right now. I have never been without health insurance before, so this is really unsettling. I really hated to cancel my Remicade infusion for tomorrow, but had no choice. I'm scared I will get as bad as a I was again before Remicade. I could barely move and I couldn't straighten my fingers out. My nails were horrid too. This really stinks! If anyone has any advice I certainly will check into it. Thanks for listening to me rant!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2010 Report Share Posted January 28, 2010 I am going to talk to my doctor and see if there is anything I can do to still get Remicade. I was waiting to see if Aetna might cover me, but I found out late yesterday afternoon that they denied me. So now I'm going to try to get covered with the Texas Risk Pool. I have to wait for Aetna to send me the denial letter, as the risk pool requires that I have proof. The funny thing about it is.... the Texas Risk Pool uses BCBS, the very same people that canceled me. I hope I qualify, as this is a pretty scary situation to be in. I never would have thought this could happen to me. I was thinking that I might send emails to our congressman/senator, like you suggested. Something needs to be done, especially with the insurance companies. " karenld75069 " <kdotson@...> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2010 Report Share Posted January 28, 2010 Dear , You could be me writing the same letter about Blue Cross. My husband and I are in the same situation but both of us don¹t have great health and so even getting on with Aetna is almost impossible. They would put us in their high risk pool, where they have to take every one and basically they are almost the same price as Blue Cross. So far with Blue Cross they have lowered my Nexium dosage, which resulted in my developing 2 ulcers. They have canceled my Provigil, which is a wonderful pill for fatigue. They have also canceled my daughter's Nexium and Provigil. She has a severe case of fibro, and I¹m actually worried also PA, but hasn¹t been diagnosed yet. They also now are insisting on approval before any MRI, CAT scan is completed, which only ties things up and makes it take forever. The last letter I got from them was on pain injections from pain management. If I need any joint injections, they are insisting on approval before they are given, which is just crazy. You go in for a pain injection because you are in pain, and the last thing you wan to do is wait weeks or months before they get around to approving it. The also denied my daughter on a MRI, her Provigil and I¹m fighting back. A lot depends on your doctor and if he is willing to take the time to write or call the company. That does make a big difference and I¹ve also heard writing directly to the president of the company helps as well. I¹lll let you know on the President situation since that¹s my next step in writing letters to see if it makes a big difference or not. My pain doctor got me approved on Provigil in 3 weeks, yet our family doctor took over 6 months just to get denied the same drug for my daughter. I think the family doctor¹s office staff is lazy though and work like snails at times too. I agree with you what we pay for being self employed is out of this world. You think we should be treated like a queen instead of dealing with roadblocks every day. I'm sure they don¹t make any money on me since I¹m on so many medications and see so many doctors. Right now we just have my husband and I on the policy and my 27 year old daughter who works at our office. We pay over $2500 a month and it goes up every year. I agree with you that it doesn¹t seem right when we sign an agreement with them; thinking we will be covered a certain way for a year and yet in the middle of the year they can change what ever they want too. I¹ve been filling out the forms on disability and who knows if I¹ll even get approved for that. Everyone tells you to expect to be denied regardless on your health condition on your first attempt. My pain specialist has told me that I should have been on it years ago, but I kept hoping that I could make it back into work or I tried to do things from home as well. I¹m still half owner of the business and I have no idea if this affects my disability or not. I could sign it all over to my husband if I have too. I would try to get your rheumy to write a letter on your behalf telling them how bad you were before Remicade and how different you are when you can take it. Maybe once they realize this they might change their minds. I know we can appeal all their decisions since they have a special address just where you send appeal letters. With the costs of these drugs anymore, I can see why they hesitate to pay all of the bills, but to just drop the drug is too much. All I can say is good luck and let me know how it turns out for you and I¹ll do the same on my end. I hope there is a solution because the last thing you feel like doing when you are sick is fighting with the insurance company to get them to pay for drugs the at basically are saving your life. Sometimes I think this is their whole strategy to get us to just give up and try and go without. Fighting back is the only thing I know to do and to try and not let the me get away with it. Take care and I¹ll be thinking of you. Fran, another Xfan of Blue Cross Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2010 Report Share Posted January 28, 2010 , I was on BCBS with an exclusion rider on it. So I applied to the risk pool in Texas and was also surprised that BCBS was the carrier ! Anyway, I think what really matters for approval is if you have insurance during the approval period. Expect to pay more than twice as much as a normal policy, but having the coverage is well worth it. T perfectlypink57@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2010 Report Share Posted January 28, 2010 Thank you Fran for your reply to me. I really appreciate and I feel for you too! I just finished filling out papers for the Texas Health Risk Pool. I will try to get all of it sent to them tomorrow. I have to wait for the rejection letter from Aetna and the cert. from BCBS that I have had insurance for the last 18 months. Ugh! I am so upset about all of this. I mean a person has to have insurance, but they don't want you to have it at the same time. I'm so frustrated and worried that I will be back to the way I used to be! Remicade worked so well for me. I was supposed to have Remicade today, but had to cancel. BCBS actually denied my last Remicade bill, so we are fighting to get the November one paid. If they weren't going to pay anymore they should have told me before I went in. I can't afford a $5200. bill! Scary!! Thanks for listening! Being self-employed just doesn't seem worth it some days!! I don't know why there can't be a self-employed group insurance. I would think it would be huge, bigger than most regular businesses that offer insurance as part of their benefits package. Well, as you can tell I'm frustrated. I have never been without insurance before. Thanks again for listening and let me know how it goes for you too. We own an appraisal company. Insurance companies hire us to appraise damage to cars, property, etc. Thanks, Quote Link to comment Share on other sites More sharing options...
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