Landon has been doing great with his N5 processors. We just thought he talked a lot before---now he's never quiet. The only thing we can figure is he has to be hearing better with the new ears. Even his AVT made the comment he is more talkative during his therapy. They stay on a lot better too. He has started to get more independent with his hearing--asking for his ears in the morning and asking to keep them on later at night. He has also been wanting to help with changing the batteries in them. Today he came to me holding his left ear open--apparently the batteries had died so he pulled the cover off, threw the old batteries in the garbage, and came to ask me for some new batteries. I gave him the 2 batteries, he put them in the right way, put the cover back on and turned it on. We've been using the old mic loc tubing off the freedoms to hold it on so I had to put that back on but it was definitely a sign he is growing up and taking charge of his hearing.
We got an EOB on the processors from his insurance and got quite a shock---it said our portion was $25,000. Needless to say I sent a quick email to our case manager to check in to this. She replied back that it was processed incorrectly. The insurance company processed it as DME (durable medical equipment) which has a cap of $2,500. She said it should have been processed as prosthetics because that is what they consider his ears and there is no cap on that. So we will end up paying our deductible and then our max out of pocket for his upgrades--which is not bad considering insurance was billed almost $28,000-and this was after the trade-in allowance for his freedoms. He is definitely hearing better-talking more-and they are staying on better--so it's worth every penny.
Monday, May 3, 2010
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3 comments:
Did you need to submit any additional paperwork for your insurance company to cover the N5 processors as prosthetics? Mine has informed me that they are considered "Durable Medical Equipment". Please feel free to email me at flower24816@gmail.com . Thanks!
Kait
Yay Landon! What a big boy changing his own batteries! I find it interesting that they think he may be hearing better with them!
I'm so glad I read this too. I think my insurance company billed us for "durable medical equipment" too instead of covering it under prosthetics. Hmmmm. I'm placing a call today because we're still paying on Aiden's surgery (just because of the "equipment" - everything else was covered 100% outside of our copay).
I had no idea that was how they were being covered. We have a case manager at our insurance that helps us with all of his claims so when I asked about the upgrades, I asked her what our portion was going to be and she told me our deductible and our max out of pocket. When I got the EOB showing our portion was going to be that much, I emailed her to see what the problem was. She just said that is how they classify them-as prosthetics-and she would get it resubmitted. If there is anything on the new EOB showing it, I'll scan it and post it on here when I get it. Maybe it will help if your insurance company sees that is how another company classifies it. I don't know if it will help but it's worth a shot.
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