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

[Pea-n-Me]

Personally, I could EASILY get by in the world without hair.

Interesting discussion about wigs and hearing aids. Personally, I think hearing aids SHOULD be covered. It's sad to think about all the people who need them but can't afford to buy them.

As for the wig, I might have said the same thing myself - before I actually needed one. I think one thing you may be overlooking is that you may feel you wouldn't need one the way you are right now. It's a very different story when you need one at the same time you're nursing a cancer diagnosis.

When I was diagnosed with breast cancer, it pretty much shattered my world. Looking at the prospect of almost a year's worth of surgery, chemotherapy and radiation was devastating to say the least. But all of it was do-able. If not for the hair part of it.

I can honestly say - after counseling many women (and men) through their illness-related hair loss issues, that it is one of the hardest parts of treatment that anyone has to face. It's almost universal. Because without the hair loss, nobody would necessarily know you were sick. But seeing the glowingly bald head of chemotherapy SCREAMS to the world that you are sick. There's no option there, hence no control over it. And one of the scaries parts of diagnosis and treatment is the feeling of helplessness and complete lack of control over many things related to the illness.

The first day I had to go to look at wigs, I was cool; piece of cake - or so I thought. My lifelong best friend came with me, all the way from out of state. We were joking and laughing in the shop as usual, trying to make light of a difficult situation. I reached for a head covering and tried it on, and in the mirror I simply couldn't believe what I was seeing. Me, myself and I - with cancer. It hit me like a ton of bricks then and there. And then the tears started. I could die from this, leave my children without their mother, you name it. Very difficult feelings to face. All symbolized by the damned hair loss.

At the time I wasn't even aware that the "hair prosthesis" I was about to buy was in fact covered by insurance. Which was great considering that over the coming year, my illness was about to cost me a boatload of money in lost time from work and medical expenses. At that point, I wouldn't have cared what it cost, though - I just wanted a good one. And it pretty much helped normalize somewhat what was a really difficult time to live through.

FWIW, I found the same to be true of the whole concept of losing a breast. Many don't think it's a big deal in the scheme of living or dying, but in fact, once you realize your clothes don't fit right, you sweat your fanny off with a traditional prosthesis, your back can become sore from lack of symmetry, etc, it becomes a whole different realization.

 

[golfgal]

Interesting discussion about wigs and hearing aids. Personally, I think hearing aids SHOULD be covered. It's sad to think about all the people who need them but can't afford to buy them.

As for the wig, I might have said the same thing myself - before I actually needed one. I think one thing you may be overlooking is that you may feel you wouldn't need one the way you are right now. It's a very different story when you need one at the same time you're nursing a cancer diagnosis.

When I was diagnosed with breast cancer, it pretty much shattered my world. Looking at the prospect of almost a year's worth of surgery, chemotherapy and radiation was devastating to say the least. But all of it was do-able. If not for the hair part of it.

I can honestly say - after counseling many women (and men) through their illness-related hair loss issues, that it is one of the hardest parts of treatment that anyone has to face. It's almost universal. Because without the hair loss, nobody would necessarily know you were sick. But seeing the glowingly bald head of chemotherapy SCREAMS to the world that you are sick. There's no option there, hence no control over it. And one of the scaries parts of diagnosis and treatment is the feeling of helplessness and complete lack of control over many things related to the illness.

The first day I had to go to look at wigs, I was cool; piece of cake - or so I thought. My lifelong best friend came with me, all the way from out of state. We were joking and laughing in the shop as usual, trying to make light of a difficult situation. I reached for a head covering and tried it on, and in the mirror I simply couldn't believe what I was seeing. Me, myself and I - with cancer. It hit me like a ton of bricks then and there. And then the tears started. I could die from this, leave my children without their mother, you name it. Very difficult feelings to face. All symbolized by the damned hair loss.

At the time I wasn't even aware that the "hair prosthesis" I was about to buy was in fact covered by insurance. Which was great considering that over the coming year, my illness was about to cost me a boatload of money in lost time from work and medical expenses. At that point, I wouldn't have cared what it cost, though - I just wanted a good one. And it pretty much helped normalize somewhat what was a really difficult time to live through.

FWIW, I found the same to be true of the whole concept of losing a breast. Many don't think it's a big deal in the scheme of living or dying, but in fact, once you realize your clothes don't fit right, you sweat your fanny off with a traditional prosthesis, your back can become sore from lack of symmetry, etc, it becomes a whole different realization.

Hair loss is more of an emotional issue vs a functional issue though. Everyone I know says the same thing you said about the hair loss but they mostly commented on the fact that they had mentally prepared themselves for hair loss on their HEAD but didn't transfer that to hair loss all over their body (eye brows, eye lashes, arm hair, leg hair, etc --although most women I know were thrilled at not having to shave their legs ). Even if you lose your hair, you can still do your job.

I am not discounting the emotional aspects of hair loss in any way, shape or form. How it is seen as more medially necessary then hearing aids is what I don't understand.

 

[daughtersrus]

In MN there is a clause in the health ins contracts that require referrals to specialists that if there isn't a specialist within X miles (I think it is 60) that you don't need a referral AND it is considered "in network" because there is no specialist near by. I would ask your insurance company about this possibility. I am almost positive she could have this done at the Mayo Clinic.

I would also get your Union health ins specialist to help you with this and go higher up in the insurance company. Often the CS people you get a hold of have no authority to look for workarounds like this. When we lived in rural MN we had frequent issues with referrals to "specialist" (asthma dr so nothing like what you need) and I had pretty good luck talking with supervisors as they had more authority.

Part of our problem is that the union is "self-funded". As a result, they do not have to abide by many of the insurance laws (they don't have to cover birth control even though there is a state law that says that BC is to be covered at the same rate as other prescriptions).

When I call, I speak to the union reps. The only way to get around a denial is to appeal the decision to the Board of Directors of the union. I have done this in the past, many times. Some times they decide in our favor (they did once or twice with regard to the prosthesis) and other times, they stick to their guns (they did with the repairs needed to the wheelchair but paid for the new one. )

Honestly, driving from the Chicago are to Mayo would cost us more than paying the out of network rates. She has a wonderful ocularrist near O'Hare that does amazing work. One prosthesis was so good that it fooled a Neurology Fellow at Loyola. She couldn't figure out why the pupil wasn't responding to the light.

 

[golfgal]

Part of our problem is that the union is "self-funded". As a result, they do not have to abide by many of the insurance laws (they don't have to cover birth control even though there is a state law that says that BC is to be covered at the same rate as other prescriptions).

When I call, I speak to the union reps. The only way to get around a denial is to appeal the decision to the Board of Directors of the union. I have done this in the past, many times. Some times they decide in our favor (they did once or twice with regard to the prosthesis) and other times, they stick to their guns (they did with the repairs needed to the wheelchair but paid for the new one. )

Honestly, driving from the Chicago are to Mayo would cost us more than paying the out of network rates. She has a wonderful ocularrist near O'Hare that does amazing work. One prosthesis was so good that it fooled a Neurology Fellow at Loyola. She couldn't figure out why the pupil wasn't responding to the light.

Oh, I misread your other post and thought you couldn't find one in your area. Another avenue to consider is asking the ocularist if they would accept what the insurance company pays as payment in full OR asking if he would apply to your insurance company to be 'in network' (the first is likely, the second is not).

 

[Pea-n-Me]

mostly commented on the fact that they had mentally prepared themselves for hair loss on their HEAD but didn't transfer that to hair loss all over their body (eye brows, eye lashes, arm hair, leg hair, etc --although most women I know were thrilled at not having to shave their legs ).

Um, true. And it was kind of nice while it lasted.

Hair loss is more of an emotional issue vs a functional issue though.

How it is seen as more medially necessary then hearing aids is what I don't understand.

Shoot, I just lost a whole post. Don't have time to write out another, but...

I've enjoyed this thread but what I have to take exception to is the idea that one thing trumps another. When you are the person needing something - whatever it is - it's really important to YOU.

So I'm of the mind that they're ALL important.

 

[Pea-n-Me]

Oh, and I also wanted to thank the posters who gave the perspectives on alopecia, treatment of pulmonary hypertension with Sildenafil, and hearing loss secondary to chemotherapy. Great posts.

 

[OceanAnnie]

Um, true. And it was kind of nice while it lasted.


Shoot, I just lost a whole post. Don't have time to write out another, but...

I've enjoyed this thread but what I have to take exception to is the idea that one thing trumps another. When you are the person needing something - whatever it is - it's really important to YOU.

So I'm of the mind that they're ALL important.

Thank you for sharing your experience and perspective. I understand your point.

I'm sorry for what you have gone through. I hope it is all behind you now.

 

[DisneyBamaFan]

Reading this thread I began to wonder why my insurance company would cover her insulin pump when other companies had, in the past, denied them. Turns out it is about profits. It seems that Type I diabetics who use insulin pumps have fewer medical complications because their blood sugars are stabilized much more effectively by the newer devices.

So again, it would seem, that this choice is really about a profitability gamble. I wonder - if we went to a single payer system, would these things be covered?

 

[Pea-n-Me]

Reading this thread I began to wonder why my insurance company would cover her insulin pump when other companies had, in the past, denied them. Turns out it is about profits. It seems that Type I diabetics who use insulin pumps have fewer medical complications because their blood sugars are stabilized much more effectively by the newer devices.

So again, it would seem, that this choice is really about a profitability gamble. I wonder - if we went to a single payer system, would these things be covered?

You are concluding it's about profits. But that may not be the only reason.

Fact: diabetics with controlled blood sugars have far fewer complications in their bodies (neuropathies, atherosclerosis, peripheral vascular disease, vision loss, etc), heal better, and generally have a better health outlook long term than diabetics who's blood sugars are elevated.

If the pump helps regulate them, then anyone would have a hard time arguing it's not both cost effective AND helps improve quality of life.

 

[DisneyBamaFan]

You are concluding it's about profits. But that may not be the only reason.

Fact: diabetics with controlled blood sugars have far fewer complications in their bodies (neuropathies, atherosclerosis, peripheral vascular disease, vision loss, etc), heal better, and generally have a better health outlook long term than diabetics who's blood sugars are elevated.

If the pump helps regulate them, then anyone would have a hard time arguing it's not both cost effective AND helps improve quality of life.

I agree, but find it hard to believe that my wife's insurance company cares about her quality of life. I really believe this is an attempt to lower those complications.

 

[Pea-n-Me]

Hair loss is more of an emotional issue vs a functional issue though.

One other thought on this I forgot to mention, that even if it is "just" and emotional issue (which I'm not sure I completely buy), emotional issues are real issues to the person having them as well. Emotional ******* leads to depression and also suicide at times, but more insidious is the day to day feelings of sadness and isolation that people experience, not only with cancer, but any type of devastating illness. And as I mentioned with the insulin pump/blood sugar issue, we know as well that illness and recovery are impacted by emotional states as well. Emotional balance and well being enhance healing and recovery, which is why complementary therapies designed to promote these things today are such a great tool that we have as opposed to years ago when we didn't. Medicine does a pretty good job of treating illness today, but doesn't do a great job or treating the emotional aspect of illness. This burden usually falls to the patient himself, and unfortunately, many suffer in silence. So I do think (make that know, since I work with patients and see this regularly), that emotional care is just as important as physical care. They go hand in hand.

I just want to add that I was surprised when I lost my hair how much my head HURT, and there was nothing much that helped it feel better - for months. It is also very COLD to go bald, especially if you have no hair in the winter. Well wear a hat or scarf, you say. Hurts like heck to put anything on your head. I usually couldn't wait to get home to get whatever was on my head OFF it. This doesn't make it more of a functional issue, I suppose, but I think it's important to realize that it's not all about emotions, there are physical aspects as well to hair loss.

 

[Mskanga]

Hair loss is more of an emotional issue vs a functional issue though

I agree to an extent . My daughter lost her hair to chemo and to anyone of any age that is very emotional but to a 14 year old that is traumatic , she felt people knew she was sick and would stare at her , to add more to that she was on a wheelchair so she really couldn't escape the stares.

Why, don't you want to know about that before something happens? The insurance companies are always made out to be the bad guy, and the public is always made out to be the victim. Thats not always the case, we agree to insurance and assume that everything that happens to us will be covered because thats what insurance is for, thats why we pay them, etc. The reality is thats not the case and we don't find that out before something happens.
Look at the research that people do when planning a WDW trip, or buying an LCD TV vs. LED, why shouldn't we do the same research when purchasing our insurance, most people just sign on the dotted line without really knowing what they are agreeing to
I'm guilty of it, but thats my own fault and if something happens and am told this and that isn't covered then I accept that its my fault and my responsibility.

NOBODY in my husband's job has seen the full contract before they signed anything , they have been given a two page memo with a general idea of what is covered but not a break down and YES we did read those 10 years before. How were we to know our daughter was going to get cancer and know what would or would not be covered ? For the heck of it I re-read the book of benefits this morning and in one section the hearing aids are covered under "prosthetics" but they are also listed as an exclusion on their exclusion list. BUT they paid for the second pair....so obviously there's a loophole and THAT is what's wrong , contradicting in my opinion.

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?

I really don't think anyone should make a decission based on assumed prognosis or statistics , everyone responds differently and the 95 year old woman could have lived another 10-15 years for all they know. 75% of the kids we knew with the same cancer my daughter had have passed , so does that mean that based on that the next person should be denied chemo because they are going to die anyway ? Heck no !

It is frightening to think of a numbers cruncher making these decisions as opposed to patients and their doctors.
Sure, on paper it looks great. But wait until it's you (a general you) or your own loved ones needing treatment.

Isn't that the truth, it makes you feel as someone is putting a price on your life.

I can honestly say - after counseling many women (and men) through their illness-related hair loss issues, that it is one of the hardest parts of treatment that anyone has to face. It's almost universal. Because without the hair loss, nobody would necessarily know you were sick. But seeing the glowingly bald head of chemotherapy SCREAMS to the world that you are sick. There's no option there, hence no control over it. And one of the scaries parts of diagnosis and treatment is the feeling of helplessness and complete lack of control over many things related to the illness.

Like I said before the loss of hair for my daughter was traumatic for the reasons you mentioned but the lack of control of many things made her feel like cancer had robbed her of everything , at 14 your social life is critical and that was all taken from her , that was a huge problem for us.

For me personally to have anyone tell me that I should have read the benefits before something happened or before we signed the contract ( which we didn't the employer did ) sounds like someone is telling me I was stupid.
Well , I couldn't anticipate that my daughter would get cancer , I couldn't anticipate all the things she would need arising from her treatment and I could not anticipate that the insurance company would have loopholes. It's easy for those who have not walked in the shoes to say that but I wonder how they would feel if it happened to them with one of their loved ones.

 

[bicker]

You are concluding it's about profits. But that may not be the only reason.

It is always about profits - and that's the way it is supposed to work. These aren't charities. Even those that are not-for-profits are not in operation to channel hand-outs (funded from where?) to policy holders.

Fact: diabetics with controlled blood sugars have far fewer complications in their bodies (neuropathies, atherosclerosis, peripheral vascular disease, vision loss, etc), heal better, and generally have a better health outlook long term than diabetics who's blood sugars are elevated.

Yes, perhaps, but that's a medical decision, not an insurance decision. Insurers describe coverage in terms by which they can use such fact to deny coverage for certain procedures, but in the end the reason why coverage is not "whatever the doctor thinks is medically necessary" is due to profits.

And again, that's the way it is supposed to work.

 

[honugirl]

You are concluding it's about profits. But that may not be the only reason.

Fact: diabetics with controlled blood sugars have far fewer complications in their bodies (neuropathies, atherosclerosis, peripheral vascular disease, vision loss, etc), heal better, and generally have a better health outlook long term than diabetics who's blood sugars are elevated.

If the pump helps regulate them, then anyone would have a hard time arguing it's not both cost effective AND helps improve quality of life.

I wish insurance companies would pay for things that are both cost effective and improves the quality of life, but they don't. I've been fighting hard to get a cortisol pump (insulin pump filled with liquid cortisol) which has been used in Europe with a great degree of success for quite awhile now, but they refuse to cover it over here and I can't afford to pay OOP. I would use less medication and be a more functional, productive person, but to them, it costs too much so I'm SOL.

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......

Most insurances still do not cover self-injectible medication, as far as I know, diabetics are the only ones that are covered other than epi-pens. I have to carry vials of liquid hydrocortisone for emergencies and those are not covered (they would be equvalent to an epi-pen). They told me that to get it covered, I'd have to go to the Dr every time I needed an injection. OK, so you're not going to pay for a $20 vial of medication and the syringes, but you will pay for $150 office visit? I'd be dead by the time I got to the office, so I guess it is more cost effective for them...

 

[whatsup]

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.

this comment was that the insurance doesn't acknowledge the importance of hearing aids in everyday life. What the heck does TV broadcasting have to do with the cost of hearing aids and insurance! Cool down!

 

[suzanna1066@comcast.]

http://humanhairwigs.org/search.aspx?manufacturer=19

Okay--$1000 for a human hair wig...so that they'll feel better about themselves. I'm not saying it isn't needed. But it doesn't restore a function, but yet it is covered all or in part by someone's insurance. It isn't fair to allow someone to lose a function that impacts their life by the reason golfgal's insurance states while covering something--for essentially the same reason she is denied.

Likely it is as Bicker says and is a profit/cost issue.

But nonetheless--it is outrageous in golfgal's circumstance of denial.

Walk a mile in my shoes before you flippantly dismiss it as "feeling good about themselves". You have no idea what you are talking about, trust me.

 

[kaytieeldr]

this comment was that the insurance doesn't acknowledge the importance of hearing aids in everyday life. What the heck does TV broadcasting have to do with the cost of hearing aids and insurance! Cool down!

bicker's actually very cool and rational. He said, in part, "A side issue that demonstrates ..." He was using an example.

 

[Nancy]

In MN there is a clause in the health ins contracts that require referrals to specialists that if there isn't a specialist within X miles (I think it is 60) that you don't need a referral AND it is considered "in network" because there is no specialist near by. I would ask your insurance company about this possibility. I am almost positive she could have this done at the Mayo Clinic.

I would also get your Union health ins specialist to help you with this and go higher up in the insurance company. Often the CS people you get a hold of have no authority to look for workarounds like this. When we lived in rural MN we had frequent issues with referrals to "specialist" (asthma dr so nothing like what you need) and I had pretty good luck talking with supervisors as they had more authority.

Check into gap exceptions, that is what they are called. My company offers gap exceptions if there are no in network providers within a 30 mile radius of your home zip code that can provide the service. Some employer groups do exclude it though so you would need to check if your plan allows it.

 

[bicker]

this comment was that the insurance doesn't acknowledge the importance of hearing aids in everyday life. What the heck does TV broadcasting have to do with the cost of hearing aids and insurance! Cool down!

You missed the point: I was showing how even when society says something is important, it still won't necessarily mean every aspect of society will practice that ethic.

 

[disfan07]

I havent read all of the responses but...

What is medically necessary for one person migh tnot be considered medically necessary by someone else. Basically, if a doctor deems it medically necessary, it should be covered.

For me this is my situation:

I had brain surgery to remove a cyst. Benign and not life threatening but it was causing major headaches and blurry vision. Some people would say that because it was not life threatening and I could still function, it wasnt truly medically encessary. Our insurance company apparently had the same opinoin initially. We had to fight tooth and nail to get it covered. We did and I had the surgery this past june.

I have severe eczema. We have tried everything for it. The only thing that has kept it soemwhat under control is methotrexate. methotrexate is not really used for eczema. It is used for RA and Psoriasis though. Many people dont understadn teh impact that severe eczema can have on quality of life. For 3 years, I was so drugged up on benedryl that I could barely function on a daily basis. Since I started teh methotrexate I am better. Not 100% better but I dont need to take benedryl everyday. It is a qaulity of life. But once again, we had to fight the insurance company for coverage.

BCP should definitley be covered. IMO, it should be free as preventative care. But I get mine to help curb the symptoms of severity of PCOS. We've had issues with this as well.

If a doctor says its necessary, it is necessary and you SHOULD NOT have to fight the insurance company.

Basiclaly, it is the insurance companies. They released the amount that the companies actually SPEND on health care and some companies dont even spend 50% of the premiums paid on health care. I'm all for the new laws that requires the companies to spend 85% of the premiums on care. They shouldnt be pocekting that money to buy themselves second homes and private jets. There is something seriously wrong with the system. It has nothign to do with Americans expecting the companies to cover everything, it has to do with the fact that private insruance companeis are corrupt and do in fact screw over many of their consumers.

On the whole, private insurance companies suck