LTHFAdvocate
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- Nov 8, 2006
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Boy, I disappear for two months (my house almost burned down and right after that, I had to have surgery) and all heck breaks loose.
Thank goodness someone had the common sense to actually contact me (BTW, ALL of my contact information is available online) to let me know the lies that were being posted about the Foundation.
Jillio, I'm sorry to say you clearly have no clue about the financial operations of either non-profits or cochlear implant centers. Cochlear implant centers are a MONEY LOSING operation across the board. I don't know of a single CI center in the US that is operating at a profit, and I'm pretty familiar with most of them. 75 % of the 1200 people at the CI conference in Charlotte this past April cited financial losses as their number one concern about the ongoing operation of their implant clinic. Every CI surgery we do, we lose money. Period. In general, hearing aids sales, service and maintenance are far more profitable to otology clinics than CIs. So your statement that
Sorry, it doesn't work that way either. The facility where the implant surgery is done is the one that buys the CI and charges the patient for it. Not the surgeon, or the medical clinic or the audiology clinic. If there is "profit" to be made from the sale of the device (and really there isn't, a lot of these facilities are getting reimbursed $6,000 or even more under their cost of the device) it is not being made by either your surgeon or your audiologist.
Since we lose money on implants, that argument is completely specious.
I guess you missed the part where we do advocate for HAs, services, and other non-CI related issues? We are barred by law from lobbying for legislation, we can assist other people who want to try to get laws passed (which we do all the time) but we can't undertake trying to get legislation passed ourselves.
Remind me again what my financial incentive is? The foundation doesn't make money on implants, doesn't charge for most appeals, doesn't make money off the device, and 97 % of our appeals patients go to clinics other than ours. So, no financial incentive there. Let me think, it must be MY personal financial gain. Except that I work 80 hour weeks, answer e-mail at 10 pm at night, and my salary is about 1/2 of what I would be earning if I were working at a firm or as corporate counsel at a for-profit.
How about this as an answer? Eleven years ago, Blue Cross completely pissed me off by withholding approval for my daughter's hearing impairment related surgery for seven months. My daughter finally got her surgery, and gained five grade levels in reading in seven months after the surgery, and I was so overjoyed that I made a commitment to myself and God that every family who wanted this should have the same opportunities my daughter had, and not just because they happened to have a mom who was a lawyer with resources available. That's when I started doing appeals for free (that was about 1000 appeals ago, BTW).
And that is exactly why the Advocacy Program is not co-located with the clinic, we are in the "low rent" district in a very industrial section of Menlo Park.
Thank goodness someone had the common sense to actually contact me (BTW, ALL of my contact information is available online) to let me know the lies that were being posted about the Foundation.
Jillio, I'm sorry to say you clearly have no clue about the financial operations of either non-profits or cochlear implant centers. Cochlear implant centers are a MONEY LOSING operation across the board. I don't know of a single CI center in the US that is operating at a profit, and I'm pretty familiar with most of them. 75 % of the 1200 people at the CI conference in Charlotte this past April cited financial losses as their number one concern about the ongoing operation of their implant clinic. Every CI surgery we do, we lose money. Period. In general, hearing aids sales, service and maintenance are far more profitable to otology clinics than CIs. So your statement that
could actually not be FARTHER from the truth. If you want the truth, check with the person who KNOWS the truth, don't make up something that fits with your view of the world and then put the "truth" label on it with zero fact checking.I am simply pointing out the truth behind the organizations efforts toward CI as opposed to HA. The motivation has nothing todo with altruism, but is based on financial gain.
That does make alot of sense. CI does cost alot more money than HA therefore they would have more to gain by supporting them than the HA company would.
Sorry, it doesn't work that way either. The facility where the implant surgery is done is the one that buys the CI and charges the patient for it. Not the surgeon, or the medical clinic or the audiology clinic. If there is "profit" to be made from the sale of the device (and really there isn't, a lot of these facilities are getting reimbursed $6,000 or even more under their cost of the device) it is not being made by either your surgeon or your audiologist.
If implants are not done, they loose their main source of finanacial support.
Since we lose money on implants, that argument is completely specious.
What we need is a deaf advocate that will advocate for HA and medical insurance coverage
I guess you missed the part where we do advocate for HAs, services, and other non-CI related issues? We are barred by law from lobbying for legislation, we can assist other people who want to try to get laws passed (which we do all the time) but we can't undertake trying to get legislation passed ourselves.
But the fact of the matter is, had their not been financial incentive for them, they would not have been there to assist you. To believe that you were helped simply because they are caring and sensitive people is naive.
Remind me again what my financial incentive is? The foundation doesn't make money on implants, doesn't charge for most appeals, doesn't make money off the device, and 97 % of our appeals patients go to clinics other than ours. So, no financial incentive there. Let me think, it must be MY personal financial gain. Except that I work 80 hour weeks, answer e-mail at 10 pm at night, and my salary is about 1/2 of what I would be earning if I were working at a firm or as corporate counsel at a for-profit.
How about this as an answer? Eleven years ago, Blue Cross completely pissed me off by withholding approval for my daughter's hearing impairment related surgery for seven months. My daughter finally got her surgery, and gained five grade levels in reading in seven months after the surgery, and I was so overjoyed that I made a commitment to myself and God that every family who wanted this should have the same opportunities my daughter had, and not just because they happened to have a mom who was a lawyer with resources available. That's when I started doing appeals for free (that was about 1000 appeals ago, BTW).
And the big offices,e tc. that you speak of do nothing in the way of helping a population of people needing service
And that is exactly why the Advocacy Program is not co-located with the clinic, we are in the "low rent" district in a very industrial section of Menlo Park.
It sets precedence, vallee. And once precedence is set, it provides them with a foundation for their legal arguments.</QUOTE>
Uh, no it doesn't. Getting denials overturned are almost always good for that patient only. Not one of our cases (even the handful that have gone to court) have set any type of legally binding precedent. If it did, why would we still need to be arguing the same points over and over and over again with the insurers? We would have been out of business with our first bilateral CI win in 2004 using your logic.
The legal department still gets paid for the assistance they provide, and the assistance they provide sets precedence so that they may more easily achieve decisions favoring implant from courts.
How do you remove the emotion from an argument? Stick to the facts.
You ought to consider following your own advice Jillio, since your "facts" are so far from the truth. We don't get paid for the assistance we provide (VERY rarely, we get reimbursed for fixed costs) and the rulings don't set precedence.
Would this foundation help me, as a HA user, get new HAs or digital HAs?
Yes, though right now due to our crushing workload and lack of funding, we are only accepting HA appeals for children. Too bad we aren't making those amazing profits that Jillio keeps talking about, then we COULD do HA appeals for everyone.
But can't you see, vallee, that this places some people in the position of making a decision for CI that they would not otherwise make because it is the only way that they can receive assistance? I personally see that as very manipulative.
As Vallee pointed out, we only accept appeals after a denial has already been issued. Therefore we have no involvement with the person's decision to get an implant, that decision is made generally months before people come to us for help.
There also seems to be a lot of confusion regarding the sliding scale. That has zero to do with the advocacy program. The sliding scale is for clinic patients, not advocacy program clients. We have clinics in Palo Alto and San Ramon, which is why the sliding scale is just for those areas. The advocacy program is currently only charging for patients who have selected Cochlear devices, and that is only because we've run out of funding to cover the costs of those appeals. All other appeals continue to be free.
And they advocate for insurance payment in order that they receive the insurance payment from their patients
Wrong again. Remember, 97 % of the advocacy program clients (like Vallee) are patients at OTHER clinics, so those patients provide exactly zero money to the clinic. Even for the 3 % who are clinic patients, we are not contracted with any insurers, therefore, the clinic never receives insurance payments, the payments go directly to the families.
why the need for all the board members and employees with financial management backgrounds if they have no profits to manage
You must be joking. Remind me again how a non-profit can have "profits to manage"? We have budgets, we have fundraising, we write grant applications, and we try to manage our limited money to the best of our abilities. Frankly, I am GRATEFUL we have such experienced board members and staff committed to this cause, otherwise, we would be able to help far fewer people.
Stick to the facts people, not what you just imagine the facts to be.
Sheri