Playing the Insurance Game

I have talked to my health insurance company four times since yesterday to try to figure out this rechargeable battery issue. I have talked to the audiologist twice (once by email and once in person). First I was told the doctor's office would need to get this all precertified and check a website...this was after I PROVIDED the insurance code for the batteries! After several more phone calls, and being transferred over to the pharmacy department when one of the customer service reps didn't listen very well, I think I know what to do. The audiologist will write a letter of medical necessity  for Elijah to get the batteries. I will fax it to the claims department of the health insurance company. I will then receive a letter stating if the batteries are covered. If they are covered, then I will order the batteries and file a claim...keeping the letter of approval from them in a VERY SAFE PLACE! I have played this game before and had to wait six months to get $600 back from the insurance company, but it is worth it in the end.

Elijah has $300 left before reaching his deductible, but if he goes to the pulmonologist before I order them (he goes on July 14th) then that will put another $200 towards his deductible. His pulmonologist is considered out of network, but we didn't want to switch doctors. My "insurance year" starts on September 1st, so I want to get this all done and ordered before that date! Hopefully, I will get around $400-$500 to go towards the $800 total for four rechargeable batteries!

Visit to the Audiologist

Elijah went in to see the audiologist today for his yearly "check up" If he is not having issues, we go in once a year to just his map and see how things are going. Elijah did well and participated in the mapping session. He has not always been cooperative in the past. However, I did have to promise a "treat" on the way home (edible treat) in order to get him to cooperate. It does drive me a little crazy that I have to bribe a 16 year old.

Even with a bribe in the past, he has been known to complain and still not participate so it was nice to NOT have that happen today. The audiologist showed him his map and played a tone three times and asked him if it was too quiet, too loud or just right. He answered for each one and some of his answers were that it was TOO loud or TOO soft or NOT right, so he was trying. This is really huge for him. He did this for both the comfort level and threshold level for EACH ear. The comfort level is the loudest sound he can hear without it being TOO loud. The threshold level is the quietest sound he can hear, but not so quiet he can't hear it.

$160 for THIS battery rack

While we were there the audiologist checked his processor on his right ear, because it would not connect to the computer. There was some "residue" on the connector part of his processor piece. She cleaned it and got it working. When we put the battery cage back on it, we could not get it to turn back on. After some trouble shooting we determined that the battery cage was defective for some reason. She gave us one to borrow and I came home to order a new one ($160 OUCH). I will mail the other one back to her when our new one comes in. You can see the picture of it on the right.....this is just the rack, I have the cover that goes over it already...OUCH again.

The audiologist also told me that it is better to use rechargeable batteries, because when the air circulates through the disposable battery rack cage (not sure of the official name) it can cause issues with moisture and the processors. This may be why she had to clean the connector piece on his processor. For those who don't know what I am talking about the processor is actually two pieces. The top part is the processor and is the "computer" part of his "ear". The bottom part holds the batteries. These two pieces can be twisted apart, so you have two pieces. When we use the rechargeable batteries, that battery twists onto the processor.

Nucleus 6 processor
 

I called our insurance company and got some information on how to determine if they are covered. The gentleman in customer service was actually very nice and LISTENED. He finally understood what I was talking about and I provided him with an insurance code. They are considered durable medical equipment (DME) and he gave me the info for the doctor's office to get me a letter or assistance with pre-certification. We also have to meet a deductible, but he is actually CLOSE on his personal deductible. This is not my first rodeo, so I will see what I can do. I do prefer the rechargeable batteries to the disposable ones!

Rechargeable vs. Disposable Batteries

Disposable batteries

Elijah has been using rechargeable batteries since he was upgraded to his Nucleus 6 processors. He had rechargeable batteries with his Freedoms, but his FM system had a separate battery rack so we didn't use the rechargeable batteries much until he started using the MyLink FM system. He has had the Nucleus 6 processors for 18 months now and one of his rechargeable batteries is starting to not hold a battery all day. I started doing some research on disposable batteries and found that I can get a box of 60 batteries for $18.25. After doing the math, I would need about 600 batteries, or 10 boxes for one year. That is $182.50. The cost of one rechargeable battery is $199. The only reason to go with the rechargeable battery is for swimming with the Aqua+ kit.

rechargeable battery

I still have some disposable batteries that we can use until I decide what I want to do. One advantage of the rechargeable batteries is they do last all day and we just switch them out at night (he has four batteries for two processors, so one set charges while he wears the other two). The disposable batteries will last for 2-3 days, but can die at any time and then you have to stop and change them. Elijah doesn't like it when his batteries die, so I would have to have a chat with his case manager so she understands that he may not react well if they die at school. He knows how to change the batteries, so that is good. The disadvantage of the rechargeable batteries is they only last about a year, so if we switch them out every other day then they should last 2 years, but you never know. For me to buy four new rechargeable batteries would cost $800 for 2 years. The disposable batteries would cost about $360 for 2 years. I could try to get insurance to cover the batteries, but that is a hassle that I am not sure I want to deal with right now.

I am curious to find out what others prefer! Please leave a comment.

Nucleus 6 with disposable batteries

Elijah's N6's Have Been Ordered

I got the email today that Elijah's N6's have been approved at the in-network rate! He and I sat and looked at the order form and he decided he wanted the color Maize(beige). He also picked out two different processor covers(one for each ear). We are both very excited that he will be upgrading to the N6 from his Freedoms. I was told it will take 5-7 days for them to ship to us, and hopefully someone will be home to sign for them. If not, I will make the 20 minute drive to the FedEx office the next day and pick them up! I can also send his Freedoms back to be cleaned once his N6's are programmed. I made an appointment for him on June 25th to get them programmed. Even with insurance coverage these processors are still expensive, but I am happy that Elijah will get this upgrade!

 

Here you can see the size difference between the Freedom, which Elijah is wearing now, and the N6 he will be wearing soon!

 

Good News!

A few months ago, I wrote about buying Elijah's rechargeable CI Freedom batteries and how the insurance company did not cover them. I did call and ask for it to be reviewed, and TODAY I got a phone call that I they are going to reimburse me 80% of the cost! I AM SO EXCITED. Finally, something that has gone my way. Of course, the money will go straight to the credit card to pay off what is left of the batteries, but I am so glad that it worked out. It was worth the phone call back in August. I really didn't expect to get the money back!

What a Weekend!

Elijah and I left on Friday around lunch time to drive to Austin to participate in the Family Weekend Retreat at the Texas School for the Deaf(TSD). Jacob had to work over the weekend so he stayed with my partner, who also had to work! We arrived around 4:00 and got checked in. We went to our dorm room and settled in. Dinner was at 5:30, so we left a little early to walk down to the cafeteria. I have learned from past experience, it is good to get to the cafeteria early when attending something like this!

We had about ten minutes to wait and there was another family there waiting also. Elijah and their daughter played and ran around a bit. The mother and grandmother chatted with me. I then hear a scream and someone crying.  I look over and Elijah is getting up and holding his nose. He had fallen while running up the stairs. He comes running to me and when he moves his hand all I see is BLOOD. The other mom handed me tissues and when I wiped away the blood, I saw this huge gash! It was deep. I knew it needed stitches.

He and I started our walk back to the check in area, because our car was there and I needed to find out where the closest hospital was. I was a nervous wreck. This would be my second trip to an ER in two weeks and this was in another town! The nurse looked at Elijah's nose and agreed it needed stitches. Someone offered to drive us, because by this time I was in tears and my hands were shaking. Elijah was crying and all I wanted to do was take care of him.

We arrived at the ER and they got us back pretty quick. The woman who took us waited in the waiting area. She was the first of many angels that night. They took X-Rays and he had also broken his nose. He got five stitches. Elijah was not very happy about stitches and threw a fit. I told him they would have to give him medicine to calm him and he would get sleepy. There would be no ice cream social at TSD if he was sleepy. He calmed down and after two huge shots he got his five stitches. We then got his prescription for antibiotics and left. It was now around 7:45. We found a CVS and arrived right around 8:00. The pharmacist then tells me they closed at 8:00. I explained the situation and she filled the prescription. Our second angel of the night.

We arrived back at TSD and they had saved us dinner. TSD is a huge campus. It reminds me of a small junior college and there are lots of stairs! Another staff member then drove us over to the ice cream social in a golf cart, because the walk was SO long. This was Elijah's favorite part!!! We ate our dinner, had our ice cream and Elijah got to play with other kids. He was a real trooper!

The rest of the weekend was awesome. I went to workshops on Saturday and Elijah went to a day care where he got to play with other kids. He swam, but did not submerge his head due to the stitches. He had an awesome time and he behaved! I arrived back and we hung at the dorm until our group got to eat dinner. We then went and watched them shoot off rockets at the football field and then hung out with some other families. Let's just say we crashed hard that night and were in bed by 9:30.

Sunday morning was our last to be there. Elijah went to day care after breakfast and I went to two more presentations. We left around 11:15 and met my sister and nephew for lunch. We are now at their house!

Once we get home, I will post some pictures that I took. I really enjoy connecting with other families at this retreat. This is also a time when Elijah gets to be around other deaf kids his age. There was a good mix of families there with kids who signed, talked or did both! If you live in Texas, I encourage you to take your family if you have a deaf child. It is only $75 for the weekend. You stay in the dorms and they feed you while you are there! You can't beat this deal. Just be careful on those stairs, or you will spend some time in the ER. OH and I am ever so glad to have that accident insurance, WHO knew I would need it again so soon!

Accident Insurance

While we were sitting at the ER with Jacob's broken finger, I remember that I had accident insurance on me and the boys. I called them the Monday morning after he broke it and got them to send me the claim forms I needed. I faxed it to them on that Monday and then faxed them the bill from the orthopedic visit after that visit. Quick update on that...the doctor said he could remove the splint after a week and he didn't need a follow up visit. There was no joint or tendon involvement.

I called the accident insurance company yesterday and they said they had just sent me a check for $250. This will cover the $150 copay for the ER visit and the $30 copay for the orthopedic doctor. The extra amount is because he broke a bone. I will take it and probably put it towards his car insurance.

I am very glad to have this insurance. The only other time we have used it was when my then husband was in a car wreck several years ago. Accidents are unplanned and usually expensive. I am glad that this money will cover his co-pays. I hope we don't need to use it again for any of us!

Ordering Cochlear Implant Supplies

I like to use rechargeable batteries in Elijah's Freedom CI processors in the summer. First of all, it saves him from using disposable batteries and he needs the rechargeable Lithium batteries to swim with his processor. We put his processor in an aLoksak bag and he wears a swim cap. The disposable batteries won't work because the need air to work and the bag seals them off from that.

I called Blue Cross Blue Shield and was told I needed a pre-determination letter. Ok, I can do that. I called his audiologist's insurance department and spoke to someone there. She got back to me and they no longer order supplies for patients, and told me to call Cochlear and they will handle it. She said if Cochlear needs the letter they will contact the audiologist for one. I then call Cochlear and they tell me they will only order if Elijah has Medicaid, which he doesn't. He suggests I call BCBS back and see the best way to handle it. He said I could order the batteries and then file it on my insurance. I then call BCBS back and they NEED that letter to authorize payment. If they approve it they will send a letter to the audiologist and one to me. She said I can still order the batteries and then file a claim. I then called the audiologist and spoke to the same woman in the insurance department there and she said they could do the letter. I had her email, so I emailed her what I needed.

MY OH MY, what an ordeal. Thankfully, we have over 300 disposable batteries, so I won't need to order those. I can just see BCBS telling me later that they won't pay for disposable batteries, because they just paid for the Lithium rechargeable batteries. ARGH. I am considering letting Elijah wear them to school IF insurance does pay for two new ones.

I am very thankful to have good insurance, but it can be a real beat down sometimes trying to figure out HOW to get things paid for.

Jacob Broke his Finger

We arrived home from the grocery store yesterday and as Jacob was getting out of the car, he managed to slam his finger in the door. He reacted as would be expected and we managed to get in the house to take a look at it. His index finger on his left hand was pretty banged up. We bandaged it up and put ice on it. After about two hours, the bleeding would not stop. I left Elijah home with my honey and took Jacob to the local ER. This was my first time to take Jacob to the ER for something that had happened to him. Elijah has been MANY time!

An x-ray revealed that he had broken the tip of his finger. He also had a hematoma under his fingernail. The doctor numbed his finger and then relieved the pressure by putting a hole in his fingernail. He sure did squeeze my hand pretty tight, when she did that. The nurse then put a splint on it and we came home.

He did fine at school today and slept good after having some pain meds last night. I called the pediatrician and got the name of an orthopedist. I am taking him on Thursday to see that doctor. I need to stop and pick up his x-ray from the hospital before we go! I also called the Accident Insurance people and I do have a policy on Jacob! That will help with some of the co-pays! I am glad to have good health insurance but copays add up quickly!

We took the bandage of and cleaned his finger this evening. It looked a lot better, but still pretty bruised. It is still pretty sensitive. He will be in the splint for at least six weeks. I am curious to see what the orthopedist says on Thursday. I'll keep y'all posted!

September 11, 2001

It has been a day of remembrance for me. I was a teacher at the high school in the district I work in, when a teacher in the hallway told me about the World Trade Center. I then heard a bit later that another plane hit the other tower. One of the interpreters had a radio and she pulled it out so we could listen to it. I called my husband who was just as afraid as I was. I knew my mother was traveling that day from somewhere in the north east, but wasn't sure where. I finally got a hold of someone at her company who called her so she could call me. Someone finally brought in a video from home and everyone int he school watched in horror.

It was very difficult for all of us and I remember trying to explain it to my students using sign language. I videoed the news coverage at home for the next week or so bringing it in for my students to watch. They would work and then ask me to explain what was happening in the video. Much of the coverage was not captioned so they had no idea what was going on.

There was one shining moment on that day. I got a call from the caseworker handling Elijah's cochlear implant surgery. It had been approved and the doctor's office should be calling to set up his surgery. He was 17 months old at the time and we had been awaiting this moment for several weeks. He had his surgery on Sept. 26, 2001.

It was a day of mixed emotions for me. I was elated about Elijah's surgery but devastated by the events of the day. I also remember how patriotic my deaf young men were in my class. They were determined to join the military and help. They knew they couldn't be on the front line, but they could drive a truck or be a mechanic. It broke my heart to tell them that they would not be allowed to join, but that I was so proud of them for wanting too.

New Ears!!!

Today Elijah and I drove down to the audiologist's office and pick up his new silver Freedom Cochlear Implant processors. It was like gettin an early Christmas! The secretary handed me two brown boxes full of equipment. We got everything that you get with a new kit. Each processor came with an extra controller(we didn't get that when we upgraded in 2006), two coils,two rechargeable batteries and charger, as well as a case for each processor and some other odds and ends.



I let Elijah choose his color this time and he chose the silver. The other choices were black, beige, brown, pink and blue. I was really surprised he didn't get the blue ones! I decided I would keep the eargear on his beige processors, that are now his backup processors, to use for soccer and also for when we go down to the beach for our vacation. I'll take all four processors and use the beige ones for the beach and pool, but he still won't wear them in the water. I need to order two snugfits and might even get him some different colored mic covers and also stickers to decorate them with.

He was very cute when we were in the office. I put one of them on and he liked it. I then assembled the second one. The audiologist had programmed them for, but had not put the whole processor together. I didn't make an appointment to pick them up because she just loaded the MAPs and let me pick them up. She knew we didn't want to wait to get them. I put the second processor on him and he looked at me and said, "Mom, we going to take these home, right?" I told him, "OH yes!"

We got home around 4:15 and I went through everything. I basically cleaned out one box and loaded up his body worn processors in them. I found the return paperwork and I decided to run them to the local office supply place which fedex picks up from so I could get them on their way! I came home and went through all of the body worn processor cords and such to get rid of them. I then organized all of the new equipment and put the beige processor equipment in one area. I am OCD that way!

Tomorrow is the last day of school and Elijah will get to wear his new EARS! I like the sliver, it goes good with his red hair!

Cochlear Implants Processors--Health Insurance

This is the Freedom cochlear implant processor which Elijah wears now.



Elijah was implanted back in 2001 with the N24 Cochlear brand implant. When he was first implanted he had a body worn processor(BWP). Which is pictured here below.



He later got a second implant(turn on January 2005) in his other ear and again wore the BWP. There were some advantages....it had a computer screen which made for easy troubleshooting and the microphone on his ear(looked like a small hearing aid) was very small and light. It was easy for him to wear, but it was bulky. He wore a harnass under his clothes that someone made for us. He loved his "ears" though and wore them daily.

In October of 2006 we were able to upgrade Elijah to the Freedom processor pictured at the top of the page. It was the newest implant available. He did not have the internal part of the Freedom, but the Cochlear comopany makes the processors backwards compatable. Elijah did well with the transition and we liked having the smaller processor. It took a bit to get used too, but overall it was a good move.
This is what the internal part of the cochlear implant looks like.


Cochlear has now come out with the Nucleus5 processor which is compatable with the freedom internal device. Elijah cannot get it yet, but the company is also making his BWPs obsolete, so I called to inquire about trading those in. We are going to trade those in with a $2500 credit towards each Freedom processor. He will then wear those new Freedoms as his primary processors(comes with a 3 year warranty) and have his Freedoms he wears now as his backup processor. I spoke to the insurance company today and they did approve payment on these processors. WOOHOO!! We will have to pay 20% but that is better than paying 100%. We are also getting a $2500 certificate for each processor towards a Nucleus5 processor. It is good for five years and we have to wait for compatability right now anyway. Hopefully within five years we can trade in for those Nucleus5 processors.

This seems like a lot, I know, just to have a child hear but it is worth it. Elijah will now have backup processors which are behind the ear and not body worn processors. We are happy with the freedom processors and would only upgrade because of the size(the new one is a lot slimmer and a little shorter). I am just glad my child can HEAR with his processors. It is such a gift. I wear a bracelet that Cochlear put out that says "Hear Now and Always" and I truly do believe in that. I am thankful for the technology and for the health insurance I have. Is there really any price one can put on being able to hear?