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Unread 11-13-2006, 12:34 PM   #1 (permalink)
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Cochlear Freedom Upgrade - Insurance help

Hi -

I was wondering if anyone has any information for me on how to go about getting help from cochlear, or anyone to help fight BCBS insurance.

I have requested that Blue Cross Blue Shield pay for an upgrade to my Cochlear ESprit Processor - I would like the new Freedom Processor because it has added benefits. My insurance company has denied me after 2 appeals, and now we are going through a grievance procedure. My argument is that this processor I have is over 10 years old, and I have to send it back a lot for repair. There response is that itís not "Medically Necessary".

Has anyone found a way around this? I am looking for info ASAP since my grievance hearing is soon.

Thank you for any help!
Ryan
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Unread 11-13-2006, 04:45 PM   #2 (permalink)
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Have you contacted Cochlear Corp by e-mail or phone call? What was their response?

Does your insurance pay for your processor for all of these repairs? If so, you can ask them if they want to continue paying for repair that could be reduced with a new implant. I am not sure, but if you're unsuccessful contact cochlear insurance department for help.
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Unread 11-13-2006, 07:58 PM   #3 (permalink)
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Ryan,

Why not PM LTHAdvocate who posts here in the CI forum and she can put you into touch with people who will help and advocate for you. I've noticed the name Blue Cross pops up a lot in people's CI insurance battles so I get the impression that it's an insurance company that is known for being obstinate.
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Unread 11-13-2006, 11:38 PM   #4 (permalink)
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I was also denied by Humana insurance and i also appealed and right now its pending. The advice my audi gave me was to insist it's not a hearing aid but that it is prostetic. In my case i had to replace my 3G a couple of times, so i explained that it would be cheaper just to replace. We'll see. Well good luck, i hope you get approved.
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Unread 11-14-2006, 10:02 PM   #5 (permalink)
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We aren't doing cochlear implant processor upgrade appeals yet. We were initially hoping to start doing them on December 4th, but that's before all the funding hassles got in the way. Check on our website around Xmas

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