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

[LovableGluttons]

Viagra is one of the only medications used to treat pulmonary hypertension. Without treatment. Without that treatment, you die. Since it continues to be one of the only FDA approved treatments, the insurance companies really have no choice about covering it.

Try chemo at thirty grand a dose on a 95 year old who still passes away two months after diagnosis.

We need better education on why some things should not be selected because the rate of cure is just too small.

 

[crashbb]

How is VIAGRA, lifesaving? Explain that one!

Hearing aids are pricy...but there would be a reason. Unless you know how to make them using scraps from inside your home.

Just using this because it was easiest.

However, Sildenafil citrate (aka Viagra) actually has many life saving uses. It is used for pulmonary hypertension and heart disease, for example. I have Secondary Raynaud's and it is an option for me to take during the winter to help prevent episodes.

I have no idea if this is the case with the insurances your are discussing, but I know that my insurance will cover some drugs only if they are prescribed for reason A and B, but if not they are prescribed for reason C. In other words, they'd cover Viagra to treat heart disease, but not ED. This of course, doesn't stop doctors from prescribing the drug for false reasons.

 

[golfgal]

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

Yes, they are. All of those companies listed, BC/BS, Health Partners, etc. are not-for profit. Again, that doesn't mean they don't make money but they ARE, by law, not-for-profit. Look up all of the companies listed, http://www.google.com/search?hl=&q=...avclient-ff&rlz=1B3GGLL_enUS390US391&ie=UTF-8

they are all not for profit.

 

[golfgal]

Viagra is one of the only medications used to treat pulmonary hypertension. Without treatment. Without that treatment, you die. Since it continues to be one of the only FDA approved treatments, the insurance companies really have no choice about covering it.

Try chemo at thirty grand a dose on a 95 year old who still passes away two months after diagnosis.

We need better education on why some things should not be selected because the rate of cure is just too small.

If this is what it is prescribed for, fine, but the coverage I am talking about specifically states that 6 pills/month are covered for erectile dysfunction.

 

[Lisa loves Pooh]

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 referring to the person whom was quoted that lost theirs due to chemotherapy.

As far as I'm concerned, hearing loss is up there with any other ailment that insurance covers. If they are going to cover us when other things fail to work properly, they should cover the hearing and not write it off. So I totally agree with you!

I hope to learn ASL if I lose my hearing--I am suspecting that might occur. I have wild tinitus and I have woken up with an ear feeling clogged and could not hear. No cold or anything and eventually hearing was restored.

However, even with ASL, while you can communicate in person with someone who knows it, or read closed captioning--like you said, you can't HEAR things.

Thanks for the explanation on how hearing aids work in terms of replacement. I just didn't know.

 

[Lisa loves Pooh]

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.

I didn't say anything of the sort. Nor did I imply it. You must have me confused with someone else. I don't object to co-pays and deductibles. I do object to an insurance company deciding that a wig for vanity is medically necessary, but an aid to restore function of one of the 5 main senses to not be. Nor do I get that you find it okay for an insurer to cover (assuming in part!) chemo for an illness that could kill, but not the hearing aid to cover (again...in part!) the hearing loss because patient volunteered to have chemo.

That boggles my mind.

 

[bicker]

Why aren't you guys upset at the price of hearing aids?

For what they do, Hearing Aids are a good value. They are as medically-necessary as many of the other items mentioned, and therefore there is some basis for expecting them to be covered.

However, note that coverage is what you pay for. If something that is medically necessary is also shockingly expensive to cover, then you can expect it to have a shocking impact on your premium. The money to pay for the coverage isn't going to just magically come into existence from Fairyland. So it is not surprising to see very expensive treatments that are somewhat commonly necessary (hearing loss is widespread) sometimes covered and sometimes not. Covering such things all the time may be best for the hearing impaired, but it is specifically not ideal for those who have no need of such coverage, since covering hearing aids substantially increases the premiums for everyone on that health plan.

So companies that make hearing aids are allowed to make a profit, but not insurance companies?

They both are. No one is owed anything, in this regard, from a private company, except that which is explicitly promised, and there is no rational basis on which to expect something (like hearing aid coverage) to be promised by a private company unless doing so is profitable.

 

[bicker]

I don't think anyone has an issue with them making a profit, but to cover Viagra but not hearing aids seems a little outrageous.

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).

 

[bicker]

I gotta agree with this. Insurance companies are always painted as the bad guy, but what about the companies that are charging obnoxious amounts for stuff in the first place?

Most people work in a job, or is related to someone who works in a job, that provides products or services that someone else will claim are priced exceedingly high. How many people would willingly take a 50% pay cut to cut the prices that their customers pay? Not many, I suspect.

I get what the OP and others are saying... but some of the blame lies outside of the insurance companies.

And often there is no blame whatsoever... and blame only comes up because people are frustrated and need to lash out, regardless. It's human nature. We all do it at times.

 

[bicker]

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).

However, many of the things that make an insurance company profitable are the same things that make it break-even. Indeed, one is just a special case of the other. So it boils down to the same thing: The reality is that an insurance company breaks-even best when it has a lot of subscribers (economies of scale; buying power for Rx; etc.), and lots of subscribers comes from offering a lot of the coverages that many people care about, and few of the coverages (especially few of the expensive coverages) that not many people care about.

 

[Octoberbride03]

The American health-care system is horribly broken. I just don't see hearing aids as "health-care" any more than Viagra. They should both be taken off the "list", IMO.

One of the huge problems with the cost of our health-care system is the expectation that it cover EVERYTHING. Private companies don't work that way. They have to make a profit to exist.

Well by that logic, then my cochlear implant doesn't qualify as health care either and yet is covered by my insurance. This costs far more than hearing aids do.

The hearing aids cost far less, and come in a range of prices depending on what kind you need. I have a vision care plan which covers most of the eyeglasses cost, but no hearing plan even though the exams are covered and the cochlear implants. I think if you get to the point where you need a hearing aid, you may rethink your position.

As a former hearing aid user I think they should be covered.

 

[Anne MN]

here is a different tact-
have you looked at part of your insurance that is Durable medical equipment?

I know that somethings are covered as a Rx, and others are durable medical equipment.

I know that when we lived in MN, some of DD's things were Rx and others were DME.
just a thought-
and DME is seperate in a lot of cases- I knew that something was going to be DME and called the "regular" CS # they denied it, found the # for DME and they said when do you need it?

 

[honugirl]

Under my health insurance, a type 1 diabetic can have ALL their medications and necessary stuff covered, but as someone living with no adrenals who must have hydrocortisone and fludrocortisone to live, I am subject to their cap. I will go over it next year and end up paying over $1000 OOP for my meds that I need to LIVE. Literally, I die without them and fast, like within a day or 2.

My inusrance will pay for breast reconstruction for a breast cancer person, but a Cushing's Disease patient cannot have their excess skin removed (google Cushing's Disease pics and you'll see why it's vital to many of us). It's not a cosmetic reason for us, it's a matter of being able to move and function.

I'm also not allowed to have a permanent sterilization procedure even though carrying a baby to term would be dangerous (it's not impossible, but would be considered high risk, not a risk I'm willing to take for me or the child) and the child would have an increased risk of inheriting Cushing's, but I'm not allowed to prevent that either (which would cause them an increase in premiums by having another Cushing's patient to deal with).

I can go on and on about how I'm getting screwed and don't give me the line of bull that I"m going to get more for less with reform. THAT IS COMPLETE AND UTTER BULL! I'm already seeing how much LESS my insurance is paying for my essential meds for my larger copay and premium. One of them went up $70 in 3 months. I'm going to have to ration that one. I could spit blood when it comes to this crap.

 

[suzanna1066@comcast.]

Alopecia is a real medical condition and is more widespread than you think. Insurance coverage for wigs is not outrageous at all. Wigs intended for every day use are necessary, very expensive and different from "cosmetic" wigs.

I won't get into a debate over insurance covering this or that but just because you don't need does not mean someone else does not.

 

[imabrat]

Just to be clear, the insurance company paid a fortune - far more than you will ever pay in premiums - for drugs and therapies that saved your life, and the thing that sticks with you is that they didn't pay a few thousand dollars for your hearing aids?

Why aren't you guys upset at the price of hearing aids?

I'm not sure that you understand just how financially tolling having a member of your family battle cancer is. I was 14, I'm 17 now - it's not like I could've gone out and get a job to help pay for treatment. My mom had to quit her job to take care of me, so my dad was never home for my siblings, he was always at work trying to pay for bills. Lowering costs was not an option, if we had chosen a closer, cheaper medical center I would be dead. I know that I worth well over a million dollars medically between chemotherapy, joint replacements due to the cancer, etc. but I do not understand how they can label hearing aids "not medically necessary".

Heck, I would be willing to pay half the price of the hearing aids if the insurance company covered the other half. I don't understand why they don't cover them. This was a decision of saving my life over saving part of my hearing, and I guarantee you anyone here or anyone working for that insurance company would choose the same thing.

 

[golfgal]

I was referring to the person whom was quoted that lost theirs due to chemotherapy.

As far as I'm concerned, hearing loss is up there with any other ailment that insurance covers. If they are going to cover us when other things fail to work properly, they should cover the hearing and not write it off. So I totally agree with you!

I hope to learn ASL if I lose my hearing--I am suspecting that might occur. I have wild tinitus and I have woken up with an ear feeling clogged and could not hear. No cold or anything and eventually hearing was restored.

However, even with ASL, while you can communicate in person with someone who knows it, or read closed captioning--like you said, you can't HEAR things.

Thanks for the explanation on how hearing aids work in terms of replacement. I just didn't know.

You probably already have some hearing loss. The tinitus is usually a sign of hearing loss. I have it constantly, not fun.

here is a different tact-
have you looked at part of your insurance that is Durable medical equipment?

I know that somethings are covered as a Rx, and others are durable medical equipment.

I know that when we lived in MN, some of DD's things were Rx and others were DME.
just a thought-
and DME is seperate in a lot of cases- I knew that something was going to be DME and called the "regular" CS # they denied it, found the # for DME and they said when do you need it?

Yes, I looked. It specifically says in our plan documents that hearing aids for those over 18 are not covered. I was hoping to find a change in this with the new plan but no luck.

 

[sparklynails23]

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.

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.

 

[indimom]

However, many of the things that make an insurance company profitable are the same things that make it break-even. Indeed, one is just a special case of the other. So it boils down to the same thing: The reality is that an insurance company breaks-even best when it has a lot of subscribers (economies of scale; buying power for Rx; etc.), and lots of subscribers comes from offering a lot of the coverages that many people care about, and few of the coverages (especially few of the expensive coverages) that not many people care about.[/QUOTE]

Agreed. And there are plenty of those rare but expensive treatments out there. Our daughter has a rare eye condition which is treated with a chemotherapy drug that costs $3,000 a shot, which insurance will not cover. Some patients require the shot in six week cycles. We're praying she won't be one of them because it will come down to a choice between vision vs. living expenses.

 

[Lisa loves Pooh]

You probably already have some hearing loss. The tinitus is usually a sign of hearing loss. I have it constantly, not fun.



Yes, I looked. It specifically says in our plan documents that hearing aids for those over 18 are not covered. I was hoping to find a change in this with the new plan but no luck.

It doesn't go away when the hearing does????
How fair is that???? Grrr...wish there was a way to fix THAT. I feel like I'm listening to the tv emergency broadcast signal (old one) 24/7.

I'll have to check our insurance coverage. Likely it isn't covering hearing aids. But
I will check later, just to see. ETA: Cochlear implants covered, nothing else is. So it seems that complete and total loss...they will help (perhaps), but partial loss, not at all. Oh well..another medical issue for DH to grumble about when it occurs. Yay me!

 

[Lisa loves Pooh]

Alopecia is a real medical condition and is more widespread than you think. Insurance coverage for wigs is not outrageous at all. Wigs intended for every day use are necessary, very expensive and different from "cosmetic" wigs.

I won't get into a debate over insurance covering this or that but just because you don't need does not mean someone else does not.

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.