Medical Insurance Coverage for CI users

Sweet_KJ

Sweet_KJ

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Hi ya'll -- long time no see or hear!

I'm back here with a very important question: does anyone know of any reliable medical insurance who will approve coverage for an individual who already has the CI? See, I've been stressed out about finding the proper insurance for just myself (no other dependants, etc) -- I'm leaving my company (including all the benefits) to pursue my own business, but need to find approved insurance before I do this. It's a must because my own mother, whom sells insurance, says "(Insurance Company) indicates it will not offer coverage to someone w/ a CI. Their experience has been that possible upgrades to a CI as recommended by a doctor or adjustments are down the road in most CI users. Insurance companies generally can not "exclude" coverage for certain medical situations so they just decline coverage."

Then I responded: "If that is the case, I could use that as an valid excuse in re-applying for Medi-cal (so-so but free)..." She responds: "BUT isn't that availability based on income?" (Very true... I would still be working my other job -- making 1/3 of what I make now). Continued: "I think it is very wrong for insurance companies to decline based on something someone has/had that isn't health related -- should have something in its policies that a client could sign agreeing to not to rely on insurance coverage in the event of considering such "cosmetic/elective" procedure. (Especially for those who do not reconsider it -- as in my case)..." Mom: "I AGREE but attorneys shoot through such stuff. BOTTOM line medical coverage is so very important. Explore all your options before you give up what you have now. LACK of medical insurance has messed people up in both the health and financial department with life long - or shortening - consequences." :pissed: Thus this posting...

So I am researching my opinions. I'm at the end of my string. I DO NOT want to stay at my current job (who wants to be stuck doing something one dreads going to in the morning?). Medi-cal/Medi-care is for my VERY LAST RESORT.

I KNOW insurance can be so costly, but it is something I need to pursue before I turn in my resignation (hopefully sooner than later) -- any knowledge/information? Anything would be so appreciated.

Thanks!
 
It might be worth talking to the Let Them Hear Foundation about this. If your mother is right then it must be a real issue for anyone with a CI who changes jobs or funds.

Good luck and sorry you are in this possible situation.
 
i've been in somewhat similar postion with you.

what i did was i applied "employeed person with disabilities medical assistance"
in my state of minnesota.. they have it.. called MAEPD (medical assistance for employeed people with disabilities) also they have no income limits. important thing is have a prove that you have a disability.. the monthly fee will depend on ur income

in your state.. they might have something similar to that or same name?
it really helps me alot.. i just applied couple months ago.. and it takes me about 1 month to hear from them if its approval or deny. and i'm approved.. i explained all the medical cost i am paying for all the mappings, batteries, aural/speech rehabilation so they approved.. i just had to pay a small monthly fee though and its only $47 a month.. but its better than paying all the doctor's cost.

my employeer's insurance did cover my CI surgery and such.. but only to its maximum of $60,000 for lifetime. and it already reached the max for my lifetime. this is why i applied and it helps and is paying for my aurual/speech rehab and glad i did this.

just a thought?
 
This would be covered as a preexisting condition under HIPAA, right? Unless your insurance lapsed more than six months ago.
 
I have not read up on it, but I seem to recall someone with a CI being considered "pre-existing".
 
as long as it has ben less then 30 day since your inshurence has lapesed you should be ok, if you wait more then 30 days thay can call it a pre existing condhion and make you wait up to a year. inshuence is expensive I would sugest trying to find a PT job that will give you inshuerence, so you can do you own bussness at the same time.
 
All I know that my work medical insurance WILL NOT cover the CI or hearing aids... :pissed:

I need new hearing aids badly! and I am not paying 600 dollars each aid...
 
CrazyMomma said:
All I know that my work medical insurance WILL NOT cover the CI or hearing aids... :pissed:

I need new hearing aids badly! and I am not paying 600 dollars each aid...
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600 each is actually kinda cheap, the ones i no longer use cause of ci cost me 1200 each I believe.

as for not paying for them yourself, the only one responsible for your not hearing then is yourself. At one time I paid for HA's for 3 people. myself and 2 children. luckily my dispenser sold HA's for the kids at half what he charged for adults. and if you think he charged me to much, i have elderly relatives who actually shopped around and always went to him, since his service was great and the cost was comparable or less then local competetors.

as for your insurance not covering a ci, that sounds kinda weird, if you qualify according to your health insurance guidelines they should approve it. is there actually a clause in the policy saying they don't pay for it? or does it just mean they won't pay for the processer upgrades?
 
sometimes you can get medicade/medical to cover thing your inshurence wont cover you will probly have a spend down tho.
 
Crazy momma, if there is an exclusion in your insurance policy saying they do not cover CI, then that is illegal. As long as a doctor says that it is medically necessary, then they SHOULD legally cover it. While fighting for my daughters 2nd CI, I read somewhere (Let them hear foundation, I think), that the CI exclusion violates something like 6 different federal laws. My advice, if you really want a CI is to fight, fioght, fight, and then when you are worn out and tired, fight again.
 
Crazy momma, if there is an exclusion in your insurance policy saying they do not cover CI, then that is illegal. As long as a doctor says that it is medically necessary, then they SHOULD legally cover it. While fighting for my daughters 2nd CI, I read somewhere (Let them hear foundation, I think), that the CI exclusion violates something like 6 different federal laws. My advice, if you really want a CI is to fight, fioght, fight, and then when you are worn out and tired, fight again.

From fighting my old ins co. I found another opssible avenue of attack to use against them, but never got to use it. Read the policy, if it does say they exclude a CI, find out the language when the policy refers to ins coverage of prosthetics. From what I found, most ins policies state they will cover 100% of prosthetics. If memory serves, the FDA definition of a CI is a "prosthetic" cochlea. Well, if you can provide the FDA definition of a CI where it is called a prosthetic, and then show where the policy excludes a CI, you MAY have a discrimination lawsuit against the INS co. why do they say they will cover ALL prostheitcs excpet a CI? Why do they feel it is necessary to provide prosthetics for eveyone except a deaf person prohibiting them from hearing?

This si one of the plans that I was going to use if necessary.
 
Well I dont have Medicare or Medicaid from government. I had them when growing up, but I stop using them cause I have a full time job with the government and making so much money.

The insurance we go to PEIA, and our plans doesn't cover all 100%, we have to pay 20% and other 80%. I remember reading the PEIA that my insurance doesn't cover CI implants, hearing aids, walking cane, unless if we have other plan B which is like another medical insurance, which cost so much money to take off my salary. I don't want any extra money take away from my salary.
 
Interesting...

Maybe you could talk to Lion Club and see if they can help you out? Or other sponsor? It is sure sucks that your insurance do not cover but pay 20% or 80%.



CrazyMomma said:
Well I dont have Medicare or Medicaid from government. I had them when growing up, but I stop using them cause I have a full time job with the government and making so much money.

The insurance we go to PEIA, and our plans doesn't cover all 100%, we have to pay 20% and other 80%. I remember reading the PEIA that my insurance doesn't cover CI implants, hearing aids, walking cane, unless if we have other plan B which is like another medical insurance, which cost so much money to take off my salary. I don't want any extra money take away from my salary.
Click to expand...
 
Lillys dad said:
Read the policy, if it does say they exclude a CI, find out the language when the policy refers to ins coverage of prosthetics. From what I found, most ins policies state they will cover 100% of prosthetics.
.
Click to expand...

I read on the net some years back where a mom successfully argued that her childs HA's were a prostedtic device. So that is also one way to try to fight the insurance company...tho they may have found wording to completely exclude HA's now.
 
LakeTahoe said:
Interesting...

Maybe you could talk to Lion Club and see if they can help you out? Or other sponsor? It is sure sucks that your insurance do not cover but pay 20% or 80%.
Click to expand...

Insurance is really changing in non goverment jobs. 20/80 coverage is very standard.

I work for a major medical clinic and they no longer offer 100% coverage. personally my choice has always been their cheaper plan. that now has a $500 deductible per family and 20/80 coverage after that. BUT they cover primary care visits 100% under both plans. Speicalists are $25 and an ER visit is $40 (i think). This coming year they are putting some limits on testing (blood workups for cholesterol etc only once every 2 yrs or soemthing like that)

One thing you need to do is check the maximum out of pocket expense/ person. My policy is $2000/person, $4000/family) excluding the deductible, (more expesive one is $1000/person, 2000/family) My co pay was met (except for specilists they aren't included in the co pay) after the CI surgery, it was one reason I chose to have an elective surgery before the end of the year, this way I don't have to repay my co pay. :)

If you've ever bought your own policy because of self employment even the changes they've made aren't that bad. When I started my job we were paying $460/month for a policy with a $1500 deductible, they'd pay 100% of the next $500 and then it went to 20/80 up to $10000.

So you really do need to completely understand your policy. and even when you think you do they actuall do cover things you think they were stating they didn't. :)
 
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