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

[clori]

I haven't read all the responses but wanted to reply. I have a dd10 who has had alopecia since 2.5. Alopecia is a autoimmune disease which causes various levels of hair loss. Hair loss ranges from spotty hair loss to full hair loss all over the body. While hair loss isn't necessarily permanent for many people with alopecia it is. Self esteem is a major concern especially for youngsters who have alopecia and get teased/bullied simply for looking different.

Not all insurance companies cover wigs (cranial hair prothesis). Some only cover wigs for cancer related hairloss. Massachusetts does require any insurance company that covers wigs for cancer to cover them for any medical hair loss. When wigs are covered there is typically a money limit per year. The limit often doesn't cover the whole wig. A wig typically lasts a year or so. Pricing decent wigs gives me sticker shock. I always check our wig coverage out when our plan changes. Usually I can pick a wig and get reimbursed up to x amount (currently $350) as long as it is done properly including prescription. My curreny insurance will only allow me to get a wig from 1 specific place in Boston and no internet orders allowed.

Over the summer my dd was diagnosed with mild close to moderate hearing loss in one ear. The cause of hearing loss is unknown nor does the dr know if it is stable hearing loss. DD goes back next week for another check. As of now dd doesn't need a hearing aide since only 1 ear has issues but we don't really know down the road. My 86 year old father lost a lot of hearing from a noisy job before the dangers were fully known. He retired from a federal job that at one point covered hearing aides. I don't think it does now (he has federal blue cross and medicare) and hearing aide batteries used to be covered but no longer are.

My personal view is that hearing aides should be considered medically necessary and covered fully by insurance. However a cranial hair prothesis for medical hair loss is also important to have coverage. I want both wigs and hearing aides to have mandated coverage.

 

[Nancy]

Nancy I do appeal their decissions when I know it's unfair. Like you said the contract was signed by the employer not the employees.
Policies have many loopholes , usually working to their advantage and they deny the claims with the hope that the patients will not fight it , but they are messing with the wrong person with me , I will fight tooth and nail. They tell you many times that they decide if they will pay for something on a case by case basis.....not giving anyone a clear answer.

Good. Now my personal feeling is you shouldn't have to fight tooth and nail but I know that sometimes it has to be done. I may work for the insurance company, but I hate the game playing I see going on sometimes. The best thing that has happened in the last few years is having people become better educated on their insurance and their coverage.

 

[cm8]

I wear hearing aids too, as a result of hearing loss due to chemotherapy drugs. My insurance company wouldn't cover the hearing aids because my hearing loss was "voluntary". What they meant was I "chose" to take chemotherapy drugs that had a chance of me losing hearing in order to save my life. So basically, I could either save my life with chemo and lose part of my hearing, or die from cancer but still have my hearing. Yet, they covered for part of the cost of my wig when I first lost my hair.

What a load of bull!

 

[hambirg]

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

Along with the *other thing* that viagra makes possible.

I bet if more insurance company executives were hard of hearing instead of having ED, it would be the other way around.

I do find the thing about the wigs interesting. I know my Mom who had breast cancer twice gets her prostheses paid for. . .while it's nice, I consider those things to be more cosmetic than hearing aids.

This is kind of in jest. . .BUT apparently the people that make these decisions would rather have erections and see people with flowing hair and falsies instead of having somebody that could hear them. I wonder what the stats are on it being a male dominated decision.

 

[hambirg]

Not even a little. Viagra is relatively inexpensive, in the context of how much offering that coverage draws business to that insurance company.

I think the act of finding such things outrageous to be part of the problem, actually. Looking at the situation rationally, acknowledging the selling and purchasing of insurance as a commercial transaction, there is no basis for such outrage. I think people letting their emotions cloud their judgment leads to confusion, in things like this. In a way it lays a firm foundation for those who would propose that some measure of health care is an entitlement (and therefore owed to people by society -- but not owed to people from private companies... no one who actually thinks the issue through, and does so thinking about things fairly and equitably, ends up with that conclusion).

I agree with you somewhat on this. . .the problem is that based on history we come to understand or at least have an idea about how these decisions are made. To most of us, insurance companies don't cover things that are deemed medically unnecessary. . .cosmetic procedures, etc. Then we are surprised that they deem hearing aids as unnecessary.

However, dental and vision are usually extra coverage. . .we have all come to expect that. So maybe they need to offer an extra "hearing" coverage.

Either way. . .be consistent.

 

[tvguy]

Remember, if this is a work group policy, the insurance company is covering and disallowing coverage based on what your employer specifies.

Also, from a business perspective, far more people are going to request Viagra than Hearing Aids. So the insurance company is making more people happy spending less on Viagra, than more expensive hearing aids.

 

[hambirg]

For the record I am Imabrat's mother and I hope you never have to face this with your child.
I was the one who called the insurance company to ask why the hearing aids were denied and their exact words were " she self inflicted her hearing loss because she willingly took chemotherapy " , in other words she could have opted NOT to take chemotherapy but she chose to do it .
To add insult to the injury I was told if she was in an accident , hit her head and lost her hearing they would pay , but because she "self inflicted it " they would not pay. How would you feel if they told you that with your child ?

And yes I did have to quit my job to care for my daughter , the hearing aids were $3,000 and our deductible is $3,000 with 20% coiinsurance after that. Now try to go down one income , quadruple the amount of bills and pay for all that in addition to everything else , you may think $3,000 is not much .....it's a HUGE amount for us !

Heck yes I expect insurance companies to pay , THAT is the reason why we pay them , this is not cosmetic surgery , we did not plan on my daughter getting cancer and they should cover all the problems rising from her treatment.

I find that such a BS answer (from the insurance company.) They pay for reconstruction after a mastectomy. . .gee. . .that's "self-inflicted" too.

They pay for wound care and eventually prosthetics for people who don't take care of their diabetes. I see that everyday in my job.

 

[hambirg]

I have no idea but voluntary does not mean the same as medically unnecessary, or cosmetic. So to me voluntary means I willingly have a procedure or treatment and yes that does include chemo as well as a nose job, however a nose job would fall under the category of unnecessary, or cosmetic. I couldn't possible know what it said in their contract, but if the insurance company is saying its not covered for that reason, I'm sure its in the terms, and I would hope that imabrats mother (sorry I forget your name) made darn sure it did state that, and if it didn't then fight it.

But voluntary could mean anything. . .if you had a baby then they don't have to cover anything because you chose to get pregnant?

If you had a medically necessary amputation, then they don't have to cover PT or your prosthetic because you chose to have the surgery?

If you had bypass surgery then they don't have to pay for any of your after care. . because you chose that?

That is insane to expect people to decipher any of that!

I do agree. . .if your policy says that they EXCLUDE certain things. . then you can reasonably assume those things aren't covered. I've never had insurance that covers massages or chiropractic, but they are specifically excluded. Now my mom's insurance does cover those things. . .so many per year. I just think that if you lose your hearing due to chemo. . .and I don't know just how common that is, but most people would assume that it is covered, as a complication. . .like most complications ARE covered. If they are NOT going to cover it, then it needs to be a specific exclusion.

I'm just curious. . .how is blindness due to complications of diabetes covered?

 

[Lassie Lynne]

Our insurance that we had a few years ago did not allow for self-injectable medication to be covered. My husband is diabetic. Luckily, we could afford the insulin even though it was a hardship on us. But it just didn't make any sense to deny $200 amount of medicine monthly that would make him have a mostly normal life, if he didn't take it, he could have easily slipped into a diabetic coma. The really weird part was that test trips were covered.........so...you can test your blood sugar (covered) but couldn't get the medcine to correct your blood sugar if insulin dependant (not covered). Arrrggg......

 

[badblackpug]

My child wears Hearing Aids and this annoys me to no end.

I also noticed that Birth Control and Gastric Bypass is covered!

Just a note. Financially it is cheaper to pay for the birth control than it is to cover medical expenses for the life of a child/children so birth control is in the financial interests of the insurance company. Same with gastric bypass. The price of the surgery is cheaper than dealing with the lifelong complications of obesity.

And as others have said, birth control pills and viagra are used for other treatments than contraception and erectile dysfunction.


UGH!

It makes me soooo mad that Hearing Aids are not covered. I guess they go with eyeglasses and thus vision care. But I cannot get Hearing aid insurance like you can get Vision!

And that really goes to the heart of it, doesn't it?

I am peeved that homeopathic remedies can't be purchased with my flex plan anymore. To me, they are extremely needed and VERY helpful (well, probably to all, but most won't give them a chance). But to others, the ones in charge, they aren't deemed necessary. So I'll continue to take them and will almost never go see an MD, so all the money paid towards my premiums will go to other people and I'll just continue on.


In his 20s, hubby had a benign-but-fast-growing brain tumor, the diagnosing MDs "gave him" 6 months to live without radiation. He looked up what the radiation might do to his life, and opted out. Wowie did the stuff hit the fan! He was threatened with commitment because he was obviously trying to kill himself. He had to get an attorney on retainer to protect himself. He then had to pay for EVERYTHING that he did do out of pocket. Insurance won't cover a macrobiotic diet, they won't cover all the supplements he took, nor would they cover the hyperbaric chamber treatments he had. Oh wait, I think they paid for the MRIs he had throughout that year, as the tumor SHRANK and went away entirely, without a bit of radiation. But that's it. Insurance didn't have to pay a million dollars for the MD treatment. So to HIM, organic oranges and carrots and wheatgrass SHOULD BE covered by insurance. But to those in charge, it's MD-treatment only, and everything else is out of pocket. Including the lawyer's fees.

It is because these treatments aren't regulated and haven't been deemed safe or effective. There is no way an insurance company is going to pay for a treatment that may not work, or may actually cause damage. In addition, if these treatments do cause damage, then they would have to pay to correct the damage caused, or pay for longer, or more costly medical treatments for a disease that has progressed because it was not treated with effective therapy. It is the same reason that insurance will not pay for experimental treatments.


It's all based on what you use. What your feelings are. What happens to you. etc. There's no one basic way of looking at what insurance should cover or not.




From what I've read, the main thing to do is working on ways to ignore it. Guess what...that's not paid for by insurance. And the only person doing that work in my area is a state away.




That's just like what I was talking about above. And what someone said to you later. You are glad that your wife's pump is covered. When it's not *necessary*. Helpful, but not vital.

For me, I'm SO glad I finally found an "out there" chiropractor who will also be a preferred provider and bill Aetna. I can finally USE my benefits!

While I *personally* believe that birth control is fairly evil and causes FAR more negatives than positives (doesn't even keep diseases away, but show me a plan that covers condoms!) and the problems won't crop up for years and years...others feel that BC is helpful.

And I'm even on the fence with viagra. I've talked a lot about how hubby *now* has a prolactinoma, a pituitary tumor that causes prolactin to be created (NOT related to the tumor in his 20s according to his endocrinologist, but honestly I think all the kicks to the head from tae kwon do and football caused had something to do with BOTH of them, and so does he). That's the milk hormone, and it will mess up the guy hormones. His endo was astonished by the fact that hubby and I were still able to "try" to have another baby, that's how low his male hormones were.

Thinking back, as hubby takes a pill each week to slooooowly shrink that tumor, to the years before that was diagnosed, thinking back on the problems that were happening, we can SEE, we can know and feel, first hand, how horrible it is when a man has a problem in the realm of viagra.

Those problems are body-problems...and body-problems are generally helped out with insurance paying. That particular drug woudln't have been indicated for hubby, because the hormones were the problem, but it does give a glimpse into the life of someone who needs it.

In our case, the effects of the pituitary tumor caused the need for male hormones. He could have been given just testosterone, but the endocrinologist didn't want to use that, as it would have caused TOTAL infertility during the course of treatment. So he would have FELT better, but he would have had a second diagnosable problem. Instead, he's on HCG. With our insurance, HCG isn't covered normally, but this is the only alternative that wouldn't cover MORE problems, so our insurance agreed.

To someone else...HCG, isn't that the stuff that baseball players take? Why is insurance covering it? Because it's a diagnosable problem, and it's what will help, without causing a bigger problem.

No HCG is human chorionic gonadotropin... or the hormone seen in pregnancy. Professional athletes use HGH or human growth hormone.



Our perception is all based on what is important to the person at the time.

So all we really can do is go with what our insurance says, or switch insurances.

.

 

[hambirg]

There is no way an insurance company is going to pay for a treatment that may not work, or may actually cause damage.

I'm sorry. .but this just made me. . .

 

[badblackpug]

I'm sorry. .but this just made me. . .

Okay your right, especially in the context of the hearing aid question. I meant more in terms of things that were not FDA approved treatments. Just imagine the lawsuits if they were to pay for every new "natural" miracle cure that has come along. Remember laetrile? It was supposed to be a miracle, it proved to be deadly. Some things are just totally ineffective. The insurance company protects itself from liability by only paying for FDA approved therapies. That way if something goes wrong it is the manufacturer that gets sued, not the insurance company.

BTW, my father was hearing impaired and he never had an insurance carrier that covered hearing aides. His last set cost $7500.00. Oddly enough they covered about 10 years of orthodontia for me though, and my mothers incontinence surgery. Neither of these things were "medically necessary" but certainly went towards quality of life. I am not sure why hearing aides are not covered.

 

[bicker]

I agree with you somewhat on this. . .the problem is that based on history we come to understand or at least have an idea about how these decisions are made. To most of us, insurance companies don't cover things that are deemed medically unnecessary. . .cosmetic procedures, etc. Then we are surprised that they deem hearing aids as unnecessary.

However, the problem is that those of you thinking in those terms are thinking in terms of what is "good-ness", from a subjective perspective. While bad decisions are sometimes made, generally coverage decisions are based on predefined standards and conditions. You can't legitimately disagree with these - it's like going into McDonald's and ordering Meal #1 and insisting that it should include an apple pie, even though the specs say just burger, fries and drinks. It is critical to move past one's own preconceived notion of what the insurance they have "should" include, and instead look at the entirety of the terms and conditions and recognize what the insurance actually does include.

So maybe they need to offer an extra "hearing" coverage.

My wife's company offers her the ability to put money into a fund pre-tax and apply it to her hearing aids.

Either way. . .be consistent.

I disagree that consistency is the issue: I think people would express the concerns you're expressing as long as they're not getting what they want, even if what they're getting is indeed consistent with the volumes upon volumes of procedural documentation, internal and external, regarding what a specific insurance policy includes and excludes.

Perhaps the issue is that people want more visibility of the internal documentation, but aren't willing to do the work to make that law: And it must be a law, because it explicitly harms the business of the insurance company. It is irrational to expect businesses to voluntarily put themselves at a substantial disadvantage versus competitors who choose not to disclose their standards and practices. The American insurance-purchaser is not so noble as to truly value disclosure, despite self-satisfying claims that they would. (Walter Mondale learned the hard way that Americans don't value honesty that much, again, despite self-satisfying claims to the contrary.)

When the issue of imposing laws on the health care industry come up, about half the country is opposed. So even for those who are in favor, you have to accept that it isn't a ubiquitous perspective, and therefore you shall not get all of what you want in this regard.

 

[bicker]

I do agree. . .if your policy says that they EXCLUDE certain things. . then you can reasonably assume those things aren't covered.

If your policy doesn't explicitly say that something is included, then you shouldn't make the assumption that it is. Indeed, what we have today is a compromise between what insurers would prefer (coverage for specifically outlined things) and what insureds would prefer (coverage for everything except what's listed). That compromise is really the problem - the source of the lack of consistency referred to earlier. However, the remedy, being switching to one extreme or the other, will be worse for everyone: Coverage for everything except what's listed will skyrocket rates beyond the reach of most people and employers. Coverage for only what's outlined will prompt the industry to greatly reduce coverage offered without reducing price. It's a lose/lose. While the current situation isn't good, it is better than the alternatives.

 

[whatsup]

I have always been amazed that hearing aids were/are never coverd by insurance! So many people can benefit from them yet the insurance industry doesn't acknowledge that!

 

[bicker]

Why do you think that they don't acknowledge that? I think it is very dangerous assuming what other folks think, like that.

A side issue that demonstrates the point: Federal law requires that broadcasters provide closed captioning for the hearing impaired. This is a reflection of our nation's consensus values associated with providing accommodation for people with any one of a specific set of disabilities, hearing loss being among them. As such, accommodation for the hearing impaired is a very explicit national priority.

Television is changing, of course. It's not just antennas, cables and satellite dishes, anymore. Television is now broadcast over the web, from each network's own web sites, from Hulu, Amazon.com, Blockbuster, Netflix, etc. In many cases, these alternatives are more convenient, and/or enable folks to save a lot of money.

But not the hearing impaired.

None of these companies have made the commitment to ensure that practically all of the programming they offer is accessible to the hearing impaired. That is the case with television reception via antenna, cable and satellite dishes, but not via reception via broadband.

To paraphrase what you wrote, about the insurance industry: The broadcast industry seemingly doesn't "acknowledge" that hearing impaire people would benefit from accessibility of programming broadcast via broadband. In reality, they do "acknowledge" it - it just isn't something that they're required to do, and it doesn't drive enough profit to warrant the cost of making such a far-reaching commitment. They're comfortable with the reality, of offering a small fraction of a percent of their programming in an accessible manner, despite "acknowledging" the value that the hearing impaired would derive from them offering accessibility for practically all of their programming.

 

[DisneyBamaFan]

...That's just like what I was talking about above. And what someone said to you later. You are glad that your wife's pump is covered. When it's not *necessary*. Helpful, but not vital.

...So all we really can do is go with what our insurance says, or switch insurances.

Yep - We have had many different insurance companies over the years. When the pump wasn't covered, we paid for it out of pocket. We could not afford it, but we did it. We did not whine that it should have been covered. Why? Because her insurance had already covered so much more. So, so, so much more. IMO, the only people who have a legit claim that they have been taken advantage of by their health insurance companies are those who have paid in their entire lives and not had to file a claim. In reality, those people are subsidizing the care of the rest of us.

My point - I am thankful for what I get. I don't look to complain about what I don't get. Stay positive. It is better for you.

 

[golfgal]

Golfgal, where in your policy does it mention wigs? We have Anthem and I can't find it in exclusions, but I can't find it in covered expenses either.

In our plan documents it is in the contract under "Description of Covered Services" under the "Durable Medical Equipment" clause.

BC should be covered, its not always used just to prevent pregnacy.




I want to start off by saying I am sorry for what your dd and you had and continue to go through. I have been deeply effected by cancer and have lost too many loved ones because of it.

As for the insurance paying for all the problems rising from her treatment, why should they have to? Why do you expect them to take responsibilty for those problems, but you do not have to? If you know the risks involved, and know exactly what your insurance company has agreed to pay for then you should be the one assuming the responsbility of those problems if they arise, that is what you agreed to. I'm not saying they are right in your situation, or the OPs, but when you pay them and sign the contract, you are agreeing to the terms of it.

Then what about my hearing that is lost due do no fault of my own .

Remember, if this is a work group policy, the insurance company is covering and disallowing coverage based on what your employer specifies.

Also, from a business perspective, far more people are going to request Viagra than Hearing Aids. So the insurance company is making more people happy spending less on Viagra, than more expensive hearing aids.

While that is true in most cases, it is not in our case. We have a small group plan that is pre-packaged. There is no plan available for small groups like this that has coverage for hearing aids.

If your policy doesn't explicitly say that something is included, then you shouldn't make the assumption that it is. Indeed, what we have today is a compromise between what insurers would prefer (coverage for specifically outlined things) and what insureds would prefer (coverage for everything except what's listed). That compromise is really the problem - the source of the lack of consistency referred to earlier. However, the remedy, being switching to one extreme or the other, will be worse for everyone: Coverage for everything except what's listed will skyrocket rates beyond the reach of most people and employers. Coverage for only what's outlined will prompt the industry to greatly reduce coverage offered without reducing price. It's a lose/lose. While the current situation isn't good, it is better than the alternatives.

Actually, in the insurance world that is not true. Because of the nature of an insurance contract, unless it is specifically EXCLUDED, you should assume that it IS covered.

 

[bicker]

Actually, in the insurance world that is not true. Because of the nature of an insurance contract, unless it is specifically EXCLUDED, you should assume that it IS covered.

That's the way we consumers wish it was. It is not the reality of the insurance world.

And as we've very clearly seen in this thread, making the assumption you're recommending people make is harmful. People end up being surprised and disappointed, and for no good reason.

 

[DisneyBamaFan]

An insulin pump shouldn't be covered by insurance. Your wife could clearly monitor her insulin levels and give herself injections. An insulin pump is no more a medical necessity than a hearing aid.

I agree 100% and did not whine when I had to buy her first one. We had to take out a loan to do so.