So wigs are considered medically necessary but hearing aids are not?

[kirstenb1]

Coding issues happen, did you get it recoded? Also, the codes come from your provider, NOT the insurance company so you need to have the clinic fix this for you.

Actually this happened a few years ago. It was Kaiser, and they were the only insurance we had that did this. But I'll remember this for future reference.

 

[golfgal]

I'm sorry--I missed the part where I mentioned profits? That seems to always come up.

Are hearing aids something that gets replaced so often that insurance companies can't help out with some of the cost?

I'm curious of what everyone's litmus for insurance coverage should be...that it only covers things that may kill you? Cover illnesses that make you out of commission to society? Cover the cast for the foot, but not the crutches to help you be mobile?

I just don't get it. But a wig would be much less needed than a hearing aid. Unless the world learns ASL--a person whose hearing can be assisted to a decent level is going to have problems functioning that will impair their ability to work. A person can function without a wig--if we were going to go to semantics over providing things that only fix function that is necessary to life.

Why pay my medical bills for my present shoulder ailment when I can just take ibuprofen at my expense? Why have anything more than catastrophic medical?

Hearing aids last about 5-7 years or so. The ones I am replacing I think are about 8 years old or so (I can't remember exactly when I got them). Kids usually need them more often because they grow and their ears grow so they don't fit. Most kids I know have the behind the ear kind so they just get new ear molds done as needed. Our state has some programs to help kids that need hearing aids as well so if a child needs a hearing aid, between insurance and the state programs, you don't usually have to pay anything for a child.

This is why many older people do no wear hearing aides-it isn't vanity like they say, the simply can't afford them.

The culprit of the person whom you quoted originally was their lifesaving chemotherapy.

If the insurance is to pay to save their life, they should help with the side effects caused by that, no?

It isn't like they aged and lost their hearing. They are being treated for cancer--and now have a condition that could keep them unemployed without the hearing aid. So your solution is to feel sorry for them, feel their plight, but then essentially imply they suck it up and deal b/c the insurance companies shouldn't pay for such things.


I just don't get it.

I didn't have cancer. My hearing loss is from unknown causes-I pretty much woke up one morning and couldn't hear-well I have some hearing. I didn't realize what had happened really until I went to the dr several months later thinking I had an ear infection though.

I was 29 years old when my hearing went. It happens.

For those that don't think it is "medically necessary", go buy some foam ear plugs and wear them for a day. Try to talk on the phone, listen to your children, go through your day without your hearing and then come back and tell me that it is a "quality of life" issue. Even with my hearing aids in I have no hearing in the upper registers so I can't hear a phone ring, a smoke alarm go off, my car's warning that I left my lights on, etc. I had to retire from my old job because I could no longer hear on the phone but it still wasn't enough to qualify for disability coverage because with hearing aids my loss wasn't "enough"-but nevermind that you can't use your hearing aids while on the phone or they squeal through the whole conversation .

I no longer watch tv because I can't understand what people are saying-yes, I can turn up the volume but then everything gets distorted because of how loud it is-never mind that you also turn up the background music which is a lot of why you can't understand the conversations in the first place.

Going out is just no fun either. Think of the loudest concert you have ever been to and how you can't hear the person next to you, that is how it is for someone that wears hearing aids anytime there is a crowd-like in a restaurant, etc.

But a wig is medically necessary because that wig will help you hear the ambulance coming down the road when you are driving .

 

[DisneyBamaFan]

Better than any other state in the union as a matter of fact. Look back at any post here about health care premiums/coverage and you will find that MN has the lowest premiums with the best coverages around. Most of what other states will be seeing in the new health care reform, MN has had for decades. Someone on another thread posted that he and his 3 kids were on a plan in Oregon similar to one we had in MN, the plan for the 4 of them cost $900/month, ours was $577/month for 5 people-with better overall coverage. When a company can make decisions in the best interest of their policy holders vs their shareholders, it makes a world of difference. The highest paid CEO in MN (and one of the highest in the nation) heads up one of the major health coverage systems in the state too.

And it still isn't good enough?

 

[DisneyBamaFan]

...I just don't get it.

Because you want insurance to cover EVERYTHING that you deem important. This is exactly the same mentality that is destroying our country's economy. We all have expectations - way too many of them. We all want someone else to provide x, y, z. The only thing that changes is what that x, y, z might be for them.

 

[OceanAnnie]

What's interesting is what is being decided. A wig is more important than hearing?

 

[daughtersrus]

I'm sitting in the office with my DD right now waiting for her ENT to come in. This is something that we've been dealing with since she was diagnosed with hearing loss at age 1. They told us that they're considered a 'patient convenience'.

 

[DisneyBamaFan]

What's interesting is what is being decided. A wig is more important than hearing?

I agree - I can't help but wonder why. The perfect example is Viagra. No way should Viagra be covered by insurance.

 

[golfgal]

And it still isn't good enough?

Again, it is WHAT is considered medically necessary and what is not. I have no complaints overall with our insurance/coverage (except for the hearing aids)/costs. Over the years we have had to spend very little out of pocket, after premiums, for our health insurance, except for hearing aids. Again, Viagra is necessary but hearing aids are not? A wig is necessary but hearing aids are not?

 

[teacherforhi]

And just to add to the mystery...most insurances will cover the cost of a cochlear implant and the surgery. How is a cochlear any more medically necessary than hearing aids?

 

[golfgal]

And just to add to the mystery...most insurances will cover the cost of a cochlear implant and the surgery. How is a cochlear any more medically necessary than hearing aids?

I know, crazy isn't it?? I know people have asked why I don't do that but I have enough hearing that I don't really 'qualify' for them but if I did they sever ALL hearing and the cochlear implants don't always work.

 

[Carly_Roach]

OP is right: it is unbelievable that a temporary fix like a wig is covered whereas a permanent prosthetic such as a hearing aid isn't covered. However, I suspect these types of challenges will be reduced in the future when the insurance company has to come up with ways of meeting the 85% requirement that starts next year.

http://www.insuranceheadlines.com/Health-Insurance/7061.html

Health insurance companies will have to spend a minimum of 80 to 85% of premiums on direct patient care, the HHS (US Department of Health and Human Services) announced. HHS Secretary Kathleen Sebelius said new medical loss ratio regulations will make the insurance marketplace more transparent.

An 80 to 85% minimum, which HHS says is thanks to the Affordable Care Act, will make sure policyholders get more value for their premium dollars. This minimum will start in 2011. Companies that do not do this will have to give consumers a rebate the following year.

I thank the current Administration for this. So can you.

 

[golfgal]

OP is right: it is unbelievable that a temporary fix like a wig is covered whereas a permanent prosthetic such as a hearing aid isn't covered. However, I suspect these types of challenges will be reduced in the future when the insurance company has to come up with ways of meeting the 85% requirement that starts next year.

http://www.insuranceheadlines.com/Health-Insurance/7061.html



I thank the current Administration for this. So can you.

I don't hold out hope that this will happen, like I said earlier, MN already HAS this and they still don't cover hearing aids, 95% of money made has to go to patient care here already. I just don't see it happening.

 

[DisneyBamaFan]

I don't hold out hope that this will happen, like I said earlier, MN already HAS this and they still don't cover hearing aids, 95% of money made has to go to patient care here already. I just don't see it happening.

Alabama's is the same way, also non-profit. My insurance is from the state of IL. It is very expensive, but with a wife who is a Type I diabetic, worth every cent. She just got a new insulin pump. Cost of the device - $10k. Our cost - $500.

So, even though I pay, out of pocket, over $20k each year for medical care, and another $7500 each year in premiums, I am still thankful. Without medical insurance, we would be living in poverty.

 

[MushyMushy]

GG, what kind of hearing aids are you getting that cost so much? We're dealing with this with my dad right now. His hearing is unbelievably bad and has the ear canal type of hearing aids. They need to be replaced and we're trying to talk him into buying something better. Now his insurance will cover about the cost of one, so he's at least lucky in that regard.

This whole thing is so much more than "quality of life." He's miserable right now. Can't see well, can't hear at all. Even if we try to write him notes to communicate with him, he has a hard time reading the note.

 

[Carly_Roach]

I don't hold out hope that this will happen, like I said earlier, MN already HAS this and they still don't cover hearing aids, 95% of money made has to go to patient care here already. I just don't see it happening.

That's OK. I see it happening and that's enough for me. Best of luck with your insurance issues!

 

[browneyes106]

I had never heard of insurance companies covering the cost of wigs. A couple of years back a friend of mine had to have brain surgery and I purchased a wig for her. I think some insurance companies won't. I agree with the OP hearing aids should be considered for necessary than wigs.

I have known people who have hearing loss/impairments and have had trouble getting hearing aids. My cousin has a son who lost part of his hearing to menigitis when he was 2. When he was 9 or 10 he lost one of his hearing aids during a school trip and the insurance company refused to pay for it. I can't remember the cost but my cousin contacted an organization that help her pay for part of it because the insurance company didn't want to replace it.

 

[golfgal]

Alabama's is the same way, also non-profit. My insurance is from the state of IL. It is very expensive, but with a wife who is a Type I diabetic, worth every cent. She just got a new insulin pump. Cost of the device - $10k. Our cost - $500.

So, even though I pay, out of pocket, over $20k each year for medical care, and another $7500 each year in premiums, I am still thankful. Without medical insurance, we would be living in poverty.

On our plan an insulin pump would cost nothing if bought through a participating provider, which 90% of the providers are here. My out of pocket medical costs last year, $60. This year, they will be over $6000 . Overall, we have wonderful medical coverage-just scratching my head why a wig is covered but hearing aids are not. Our premiums (60/40 split with DH's company) are $6760/year for a family of 5.

GG, what kind of hearing aids are you getting that cost so much? We're dealing with this with my dad right now. His hearing is unbelievably bad and has the ear canal type of hearing aids. They need to be replaced and we're trying to talk him into buying something better. Now his insurance will cover about the cost of one, so he's at least lucky in that regard.

This whole thing is so much more than "quality of life." He's miserable right now. Can't see well, can't hear at all. Even if we try to write him notes to communicate with him, he has a hard time reading the note.

My current aids are the in the ear ones (not the super small ones but not the ones that fill up your entire ear either). I am getting the newer ones that sit behind the ear with a clear plastic receiver that goes in my ear. I have about 70% loss in both ears and the in the ear ones just are not powerful enough for my loss any more. I am getting Starkey's (brand) through my ENT. They are the IQ9's (I think that is what they are-I have to look that up again to be positive).

 

[browneyes106]

Hearing aids last about 5-7 years or so. The ones I am replacing I think are about 8 years old or so (I can't remember exactly when I got them). Kids usually need them more often because they grow and their ears grow so they don't fit. Most kids I know have the behind the ear kind so they just get new ear molds done as needed. Our state has some programs to help kids that need hearing aids as well so if a child needs a hearing aid, between insurance and the state programs, you don't usually have to pay anything for a child.

This is why many older people do no wear hearing aides-it isn't vanity like they say, the simply can't afford them.



I didn't have cancer. My hearing loss is from unknown causes-I pretty much woke up one morning and couldn't hear-well I have some hearing. I didn't realize what had happened really until I went to the dr several months later thinking I had an ear infection though.

I was 29 years old when my hearing went. It happens.

For those that don't think it is "medically necessary", go buy some foam ear plugs and wear them for a day. Try to talk on the phone, listen to your children, go through your day without your hearing and then come back and tell me that it is a "quality of life" issue. Even with my hearing aids in I have no hearing in the upper registers so I can't hear a phone ring, a smoke alarm go off, my car's warning that I left my lights on, etc. I had to retire from my old job because I could no longer hear on the phone but it still wasn't enough to qualify for disability coverage because with hearing aids my loss wasn't "enough"-but nevermind that you can't use your hearing aids while on the phone or they squeal through the whole conversation .

I no longer watch tv because I can't understand what people are saying-yes, I can turn up the volume but then everything gets distorted because of how loud it is-never mind that you also turn up the background music which is a lot of why you can't understand the conversations in the first place.

Going out is just no fun either. Think of the loudest concert you have ever been to and how you can't hear the person next to you, that is how it is for someone that wears hearing aids anytime there is a crowd-like in a restaurant, etc.

But a wig is medically necessary because that wig will help you hear the ambulance coming down the road when you are driving .

Golfgal I know someone who lost their hearing in a similar way and the doctors could never determine it either. This person was a family friend's ex-husband. He was in his early 30's and over a few weeks one year he would notice decreases in hearing, he visited various doctors and nothing could be determined. He started wearing hearing aids and he had to make modifications at his job to deal with his disability.

Your situation with disability benefits and the insurance company is unfair.

 

[DisneyBamaFan]

On our plan an insulin pump would cost nothing if bought through a participating provider, which 90% of the providers are here. My out of pocket medical costs last year, $60. This year, they will be over $6000 . Overall, we have wonderful medical coverage-just scratching my head why a wig is covered but hearing aids are not. Our premiums (60/40 split with DH's company) are $6760/year for a family of 5..

Tell you what, I'll pay for your hearing aids if you pay for my PPO deductibles and uncovered expenses in 2011.

 

[tvguy]

Actually, in MN, no insurance companies are NOT allowed to make a profit-by law they are not-for-profit entities. That doesn't mean they don't make MONEY, but they have to not show a profit by the end of the fiscal year (which means their employees are paid very well).

This post caught my attention, so I googled Minnesota health care.
With all due respect, since Minnesota HMO's are reporting record profits in 2010, I don't think "for profit" health care insurers are banned in Minnesota.

http://www.allanbaumgarten.com/index.cfm?fuseaction=dsp_report&state=mn