This is an extremely slippery slope. Most will agree with you because Grandma's 95. But what happens when someone's 42? Should they be denied coverage of chemo because their projected life expectancy is "only" two months? Is this the "education" of which you speak?
This is an extremely slippery slope. Most will agree with you because Grandma's 95. But what happens when someone's 42? Should they be denied coverage of chemo because their projected life expectancy is "only" two months? Is this the "education" of which you speak?
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?
Then what about my hearing that is lost due do no fault of my own
This is an extremely slippery slope. Most will agree with you because Grandma's 95. But what happens when someone's 42? Should they be denied coverage of chemo because their projected life expectancy is "only" two months? Is this the "education" of which you speak?
) - depending on the company that we were using at the time.
Chemo is not always curative. Many times it's palliative.
Some of the best lawyers in the world write the contracts for insurance companies. I assure you, if it is excluded, it is named so in the contract (though it may not be named specifically in a "list" that you would recognize). The problem - most of us don't read those contracts carefully before we sign them - or, with medical insurance, many of us only have one affordable option through work and have to accept what is offered.
To use my wife's example - the insulin pumps have been excluded in cloudy language, excluded in very clear language, and included in very clear language (never included in cloudy language, it was always very clear when it was included
If you read the contracts, you'll see that what I said is true: The contracts outline what is covered first, sometimes in broader strokes, and in those cases you'll also see exclusions. Sort of like saying "including New York, Pennsylvania and Maryland, excluding Baltimore and Annapolis".
she was instrumental in getting insurance companies in Massachusetts to cover prosthetic devices.They are remarkably sophisticated devices. In addition, most properly (due to how sophisticated they are, and the nature of differences in hearing from one hearing impaired person to another), they require a lot of maintenance and support, which is generally included in the price.
Yes, and that's really an issue you could latch onto if you wish. My wife could hear with the hearing aids she wore 20 years ago. She simply hears substantially better with newer devices. Still not as good as if she wasn't hearing impaired, but she won't die from being hit by a bus she didn't hear coming, with old hearing aids. (Shock value, deliberate.) So the question could be how much quality of life should health care afford people? I have degenerative disc disease. Why not just let my condition put me in a wheelchair. It won't kill me... it'll just make me less mobile.
Yes. It isn't the materials, necessarily, but the workmanship.
I think the simple answer is that the American public will be more understanding of an insurance company denying claims for $4000 devices rather than $30 to $500 that (artificial hair) wigs cost, especially since a hearing impaired person (presented on the news, for example) looks like nothing is wrong, while a chemo patient with no hair would carry much more shock value.
First hand report: "Don't underestimate hearing." She would prefer to have lost her hair than lost her hearing.
I think the bigger question here is, why the H are hearing aids so expensive????? Does the technology change so frequently? Are the materials so costly? I'm aware they're small, but is the labor so specialized and intensive to justify a price upwards of $4,000????????????
Aside from that, opinion only: Why are wigs covered but hearing aids not? Well, there are alternatives to compensate for hearing loss. Sometimes, with total loss, cochlear implants work. There's lip-reading, ASL/SEE, there's (as pointed out above) closed-captioning, there's pencil and paper, there's patience, there's adapting... all if one can't or won't use hearing aids.
Sure, there are alternatives to medically-related hair loss: hats/scarves, or the currently more socially acceptable bald woman. Think, though (and I realize there are a few men on this thread) how important your hair is to you - how much time you spend on it, styling, maybe coloring, keeping it looking good... what a huge effect it has on your overall appearance and, frankly, opinion you have of yourself and how you feel others consider you. Think how you judge other women when they're having a bad hair day, or simply don't have a lot of hair (those women, by the way, the ones with thinning hair, don't get wigs covered by insurance).
NOT defending insurance coverage, simply trying to explain why one specific item is covered while another isn't.
By the way, NOT to make this political, but, well, go ahead and try that route. My state representative claims
I think the bigger question here is, why the H are hearing aids so expensive????? Does the technology change so frequently? Are the materials so costly? I'm aware they're small, but is the labor so specialized and intensive to justify a price upwards of $4,000????????????
Aside from that, opinion only: Why are wigs covered but hearing aids not? Well, there are alternatives to compensate for hearing loss. Sometimes, with total loss, cochlear implants work. There's lip-reading, ASL/SEE, there's (as pointed out above) closed-captioning, there's pencil and paper, there's patience, there's adapting... all if one can't or won't use hearing aids.
Sure, there are alternatives to medically-related hair loss: hats/scarves, or the currently more socially acceptable bald woman. Think, though (and I realize there are a few men on this thread) how important your hair is to you - how much time you spend on it, styling, maybe coloring, keeping it looking good... what a huge effect it has on your overall appearance and, frankly, opinion you have of yourself and how you feel others consider you. Think how you judge other women when they're having a bad hair day, or simply don't have a lot of hair (those women, by the way, the ones with thinning hair, don't get wigs covered by insurance).
NOT defending insurance coverage, simply trying to explain why one specific item is covered while another isn't.
By the way, NOT to make this political, but, well, go ahead and try that route. My state representative claims
That isn't always the case. I'll give you an example. My DD is disabled. She has had a wheelchair since she was about 3 1/2 years old (we carried her prior to that). Because of the disease that she has, she isn't growing at a typical rate. Custom wheelchairs have "growth" built into them. In other words, pieces can be moved to adjust as the child grows. Some parts may need to be replaced due to medical issues along the way (foam-in-place back cushion) and other parts may need to be replaced because they wear out (tires, handlebars ).
DD's chair had plenty of growth left in it but needed some parts replaced. The insurance company refused to replace the parts because they weren't "medical" but without me saying anything, they looked at how old the chair was and offered to pay for a new chair. I explained to them that it really wasn't necessary to get a new chair and could they just cover the repairs.
Nope. Instead of paying a few hundred for the pieces that we needed, they paid close to $10,000 for a new chair. Keep in mind that our insurance is with the union that DH is part of and they are "self-funded". The very next week after getting DD's new chair, a form letter goes out to all members talking about the fund balance being low and how we should try and reduce our claims.
We also get a runaround when DD needs to have anything done with the scleral shell for her eye. Prosthesis are covered but a prosthetic eye can not be ordered from a durable medical equipment supplier. It has to be hand made by a ocularist. The problem is that there are no ocularists that participate in the BC/BS PPO anywhere in the state of IL, MI, IN, WI or IA.
Our insurance will cover it at a reduced rate because they say that we're "choosing" to go out of network. I've told them many times that I will go to anyone in network if they will please give me the name to call. Their response is that there is no one in network and if we choose to go out of network, it will be at the reduced rate. Keep in mind that the shell is not just cosmetic but also medical. If she doesn't wear the shell, the bones in her face around her eye will not grow correctly require cranio-facial surgery. When this was explained to them both by the ocularist and the surgeon, their response was that they understand and when the time comes, they would be willing to pay for the surgery.
