gonna be a while

[bionic_kate]

As I suspected, the journey to bilateral life will not be smooth. A second implant is a non-covered procedure per my insurance. The husband and I are gathering information in order to start the appeal process. One of his co-workers does medical billing and quite nicely volunteered to help us with some codes and so forth. It could be months

Comments

[word_geek]

As logical as your argument is, I wouldn't suggest actually proposing that to an insurance adjuster. You'd be stunned about what is and isn't considered medically necessary -- I've heard stories about people who had vital heart medication denied as not medically necessary. For myself, I once had a routine checkup denied because I asked the doctor about some dry skin on my hands. According to the insurance people, that magically changed the whole visit to a "dermatology consult," which is purely cosmetic, and therefore not medically necessary. I mean, if they don't cover routine checkups, what do they cover? Was I supposed to have a checkup, but not discuss anything with the doctor? I could go on for pages, so I'll quit now.

[jacquilynne]

Yay for living in a socialist country.

Not, I would imagine that you would immediately be offered bilateral cochlear implants here, either. But it's at least heartening to know that the guy doing the denying is some bored government functionary with no real motivation to do anything, instead of somebody with a profit motive who makes his company more money if he denies everything.

And I can see my doctor for pretty much anything (up to and including skin conditions) at no charge and with no ensuing paperwork. Actual cosmetic surgery with actual cosmetic surgeons wouldn't be covered, but you can ask your GP about whatever, and it'll still be just a doctor's visit.

[bionic_kate]

I agree that the state of health insurance in the United States is insane. What is interesting (or frustrating, depending on how I look at it) is that some insurance companies now grant second implants immediately. Some people even have surgery on both ears at the same time. My bilateral friend was able to have her second surgery just three months after the first, no problem.
I have been very pleased with Blue Cross/Blue Shield up until now; I've been able to go to the doctor easily for everything and I paid a total of $6.00 for my first implant surgery. Just one injection was not covered, isn't that funny? But BCBS are the known stickler on this bilateral implant issue, so we shall see.