Monthly Archives: November 2008
I doubt this happens to guys very often but ladies, do you ever find yourself in a public bathroom stall and realize someone else in the room is carrying on a conversation with you? Man. For me, that was always the most stressful situation I could imagine. :S I’d be takin’ care of business and all of a sudden I’d realize the person I walked into the bathroom with (because, you know, women usually travel in pairs or flocks to the bathroom!) was talking to me.
So I’m sitting there thinking, “Um…I KNOW they’re talking to me but I have no idea what they’re saying! What do I do?” If it was someone I knew well, like my mom, and I couldn’t follow what she was saying (usually I’d need to be lip reading) I would just tell her to hang on, I can’t understand her. But this used to happen at clubs and parties with people I didn’t know all THAT well, some of whom had no idea I had a hearing loss. What is it that makes people want to start up (or continue) a conversation in that situation?! Sheesh. Usually I’d just stay silent, rather than respond with a totally off-the-wall response that would make it obvious I had no idea what was being said.
Well, today I had a weird little CI moment. I walked into our (private, at home) bathroom and shut the door. As I was turning away from the door, I very distinctly heard Dave say, “Shit!” It sounded like he was right outside. I opened the door and looked around but he wasn’t there, so I walked into the kitchen. He was walking over to the phone, and I said, “Hey, did you just say ‘shit’? What’s going on?” The way he said it wasn’t angry, more like “darn!” so I suspected he wanted to talk to me but realized I was otherwise occupied.
Well, turns out I heard him correctly! He had run upstairs to ask me a question about Thanksgiving because he had my mom on the phone; when he saw the closed bathroom door he realized he couldn’t ask me. But I heard him! Too funny. I guess I might be able to have a conversation behind a closed door now after all!
When I first got my cochlear implants activated at the end of August, I was seeing my audiologist once a week for a mapping. A mapping is basically an adjustment of the software program in each of my implants. In the beginning, I was mainly getting more volume at each mapping. My brain was still getting used to interpreting all this new data being thrown its way, and the more used to it I became, the more volume I could handle.
After a couple of weeks my volume needs stabilized, and then I started getting different software programs to try out. There are different ways to fire the electrodes in my implants, and each way makes things sound different. I needed to decide which software programs worked best for me. Since my cochlear implant sound processors (what I wear on my ears) have three program slots, I can have three different programs available to me. I tried programs that cut out background noise in the car, background noise at parties or restaurants, and programs meant to work with the Direct Connect, which is a special earhook that I can use to connect to battery-powered devices like MP3 players.
After I went for weekly visits for 6 weeks in a row, I got a break from mappings. This past Thursday was my first mapping in 6 weeks, and it was my official 3 month mapping (3 months since I was activated).
We got to the office, I checked in and sat down. I heard footsteps and looked up, thinking it might be my audiologist coming to call us back. Well, it was my original audiologist, Kathy, who had left on maternity leave before my activation date. It was so good to see her! She waved and I got up to talk to her and catch her up. She really is nice and was so supportive when I went for my CI evaluations. She said she’d heard I was doing great and I confirmed that I just absolutely loved my CIs. I told her I was hearing better with them than I did with my hearing aids (before I lost all of my hearing, of course).
I also mentioned that Paige can tell when one of my batteries has gone dead. Sometimes the battery will die when I’m in the middle of something, so I don’t immediately go and change to a new battery. Once when I was talking to Paige she got a quizzical look on her face and said, “Is one of your CIs not working?” I said, “Yeah, my battery died…how can you tell?!” She said my voice gets much lower and it sounds like I have a really bad cold. Even Dave confirmed it – it’s an instantaneous change in the way I talk if one (or both) of the CIs is off.
Anyway, I went to sit back down after I was done talking to Kathy and one of the other patients in the waiting room stood up and approached me. He said, “Excuse me…I heard you talking…do you have an implant?” This is the first time ever that I have been asked about my CIs so I was excited! I told him yes, and he said he was really scared because he’d been losing the hearing in one ear and an implant had been suggested to him, but he had never met anybody with one. Right after we started talking my audiologist called me back, so we only had another minute or so to talk. It really seemed like he was hearing me well so either he was extremely good at lipreading or his other ear was okay. I wasn’t totally sure he meant a cochlear implant or if it was maybe another type of implant, since he mentioned having many surgeries on the ear and they weren’t helping. But in the short space of time that I had, I was able to tell him that I absolutely loved my CIs and didn’t regret getting them even for a second. I’m not sure what his whole story was but it was still nice to get to spread the word about CIs!
Once we got back to the mapping room and I told Krystine that things had been going really well, no volume issues or anything, she decided not to change anything at this appointment. I was a little surprised but not disappointed, since I haven’t felt like I needed more volume or that things have been sounding weird or flat or anything like that. So this visit ended up just being a hearing test, basically. You know how much I love those! Ugh!!
It started with the tones, the usual “press the button when you hear the tone” kind of thing. I started in with the holding my breath again, and really had to force myself to breathe and to calm down. I don’t know what my problem is but these hearing tests just stress me out so much. A lot of times I think I hear a tone but I don’t press the button until I hear it a second time, because I want to be sure I’m really hearing it. I never know if that screws the results up or not.
Again, some of the higher pitched tones would just activate the sound compression in my CI. So I didn’t hear them … I could just tell the sound was shutting down temporarily. That happened just once or twice…I’m not sure if they just stop testing me in those frequencies when that starts happening or if it’s not happening with as many of the high pitched tones as it used to.
These tests take FOREVER because they test me first with both CIs, then one ear, then the other. Then they moved on to the sentences. For the first time they tested each ear individually. Last time they had me keep both CIs on and they tested me in quiet and again in noise. So I listened to a recording of a man saying sentences. It was pretty soft and at first I thought “Oh no, I’m not going to get any of them!” But the sentences in quiet, with both CIs on, went pretty well. Then they did the sentences in quiet, each ear by itself. That was drastically worse, and I pretty much expected that because it’s what happens when I try to hear on the phone. I’m only using one ear on the phone and I can catch a word every now and then, but not enough to feel comfortable actually having a conversation. With the sentences it was the same way…I could catch a word or two. My left ear did much better than my right ear in the individual tests.
When they did the sentences in noise it was horrible…I could barely catch anything. Not even enough to make a guess – I just sat there, not saying anything most of the time. I did do a lot better with both CIs on though…I’m not sure I caught any of the sentences in noise with just one ear at a time. So for me, anyway, having two CIs makes a huge, huge difference in my comprehension!
When the hell of the hearing test was over, I thought the results would be worse than last time (six weeks ago). However, after Krystine did the comparison it turned out that I went from 96% sentence comprehension in quiet to 98%, and in noise it went from 53% to 58%. What a surprise! (That’s with both CIs, by the way — she didn’t mention the results with one CI at a time.)
She didn’t mention my audiogram with the tones at all and I didn’t ask, so I have no idea how I’m doing with that. I’ll have to make sure to ask her when I go back for my 6 month appointment in February.
And that was pretty much it! I had forgotten to bring my backup processors with me to my last appointment, so they had an old program on them. I brought them this time though, so she put my current program on them and I was good to go. I don’t go back again now until February 6, next year! (Obviously though, if I have any problems I can make an earlier appointment for a mapping.)
So this wasn’t really a mapping at all…just a hearing test, basically. I keep trying to put a positive spin on the hearing tests (“At least I can hear something now, versus the tests where I just sat there because I heard nothing!”) but man, I still hate them. I guess I always will!
Well, the insurance issue still isn’t officially resolved yet but I’m feeling hopeful that it will all turn out in my favor. That’s the short update. I thought I’d go ahead and write a more detailed, coherent explanation of insurance and how it applies to me, since we all have such different insurance experiences in the USA.
When I last worked outside the home, through 2001, I was covered by Blue Cross/Blue Shield in a PPO plan. I was an Administrative Assistant to the Human Resources Manager, and one of my duties was dealing with insurance. I was the person who signed people up, handled the yearly enrollment meetings, removed people when they left the company, etc. I explained the coverage to the new employees, helped people understand their EOBs (Explanation of Benefits forms, which are sent after the insurance company finalizes a claim) and would advise them when they had insurance woes. Many times I would call the insurance company for them and try to work out payment issues. We offered a few different plans – the HMO and PPO options of BC/BS (with HMO being the cheaper option), and a cheaper HMO option from Rush Prudential. I saw firsthand how many people got tripped up with the HMO rules – seeing a specialist without a referral, etc. Because of that I usually try to pick a PPO plan if I can afford it. With those, you can see whatever doctor you wish but if your doctor happens to be a “Preferred Provider”, the insurance company pays more on your claim.
So! I knew a fair amount about insurance, and I’m comfortable with the terms, paperwork, how claims are paid, etc. When I was laid off from my job in 2001, I kept my insurance through COBRA. It was horribly expensive compared to the small monthly premium I paid as an employee, but it was important to me to stay insured. Once that ran out (I think it lasted for 18 months, or maybe it was 12 months) I had to look for individual insurance. At this point I was working for myself so I had no group coverage to benefit from. I used ehealthinsurance.com to compare rates and decide what coverage to go with.
Originally I applied for a plan through Blue Cross/Blue Shield since they were the ones who most recently covered me. Imagine my surprise when they denied my application – I was considered ‘high risk’ because I took medication for my blood pressure. Keep in mind, I never had any medical issues due to high blood pressure; it was something discovered during my most recent pregnancy and it just never went away after I had Paige. I lost a lot of weight and ate right, and nothing affected my blood pressure, but it’s something that runs in my family (along with high cholesterol) so the doctor put me on medication to keep it down. So I take my medicine, never have any problems…and I was still denied insurance.
The way it worked when I worked outside the home and needed insurance through my employer was pretty simple. You fill out a basic form – name, address, birthday, social security number, etc. I can’t remember for sure but I believe they ask if you smoke, and maybe ask your height and weight but I think even those small details are left off the form. You just give them basic information, mark off which coverage you want, and whether you have dependents. You’re automatically enrolled, no questions asked. Once a year there’s an enrollment period (usually in October) when you can switch plans, again with no questions asked.
As an individual, paying WAY more in a monthly premium, things are different when you apply for insurance. You’re asked to list every doctor visit you’ve had in the past 10 years, all hospitalizations, all medications taken (plus when they were prescribed, what for, etc.). Your whole medical history is scrutinized before an insurance company will insure you.
So when I applied for another plan, I’ll admit I was tempted to leave off this incriminating information just so they would cover me. I couldn’t do it though – it just scared me too much to omit information. So I was honest again, this time applying with Unicare, and figured I wouldn’t be accepted by them either.
Happily though, they accepted me and things were just fine. So from about 2002 or so up until December 2007, I was covered by Unicare’s PPO plan. Things went as usual – I almost never see the doctor except my once a year “womanly” checkup and my annual visit to my doctor to check blood pressure and cholesterol. I take cholesterol medication now as well, and all of my numbers look really good.
Every year my premium went up, quite a lot. I would switch plans within Unicare so that I had a higher deductible, to make my monthly premium more affordable. When you do that, though, you can’t switch back to a plan with a lower deductible without going through the whole application/underwriting process all over again. So it was a big decision to keep increasing my deductible, knowing I would be stuck with it from then on in.
In December I got a letter that my monthly premium was going up to around $220 a month. This was for a PPO plan with a $5,000 annual deductible (the highest they offered), and a separate $500 deductible for prescriptions. The plan I was on would let me see my doctor 3 times a year, with a $30 co-pay each time. If I saw the doctor more than that, then I paid full price and it was applied to my deductible. I would need to spend $5,000 of my own money before any claims were paid, and frankly, that sucked. Plus, they didn’t cover my annual physical with a co-pay. All the lab tests, mammogram, etc. went to my deductible and I paid the “negotiated rate” that the insurance company had with the health provider. I was paying a lot of money for peace of mind and not getting a real lot back.
So although I didn’t have much time to research a new plan, just about two weeks to research, apply and hope I was accepted, in December 2007 I decided to look for cheaper insurance with better coverage. Most plans look good until you see how they cover prescriptions – they either don’t cover them at all, or they charge a huge separate deductible for prescriptions. Finally though, I settled on Aetna. They seemed to really promote preventative care, with great coverage for mammograms and annual physicals, and since that’s really all I ever used insurance for (besides my monthly prescriptions for blood pressure and cholesterol), I crossed my fingers and applied.
Well, they too were cautious when they saw my medications listed, and I had to give lots of extra information to the Underwriting department before they accepted me. I had to give the results of my most recent cholesterol test and all kinds of other details. They did accept me but with a higher monthly premium than I was originally quoted. I have a $5,000 annual deductible and $500 separate deductible for prescriptions, but my premium (even at the higher rate) was MUCH more affordable and my preventative care would be covered either with a co-pay or at 100%, so I was thrilled.
When I applied, there was a question asking if I’d seen a doctor for “any of these issues” within the past 10 years, and hearing loss was listed. I answered “No” because my last hearing loss-related visit was 15 years earlier. I hadn’t even had an audiogram in the past 10 or 15 years – my hearing loss was just not a medical issue at all.
That’s what had me SO freaked out about this letter I just got from Aetna. I was afraid they thought I was trying to hide my hearing impairment from them, even though I answered truthfully. Plus, I’ve heard so many times about people having their insurance coverage canceled because they left off one innocuous doctor visit on the application, so the insurance provider says they lied or omitted information and cancels their coverage retroactively. Sadly, it happens to many people and is legal.
I got that letter, with the vague questions which sounded like the insurance company was trying to trap me into lying to them or leaving information out, and I completely lost it. It wasn’t even possible to answer the questions they asked, since there were no time frames given and none of the questions were specific. The only one that I could answer was “What is your current height and weight?”
Here’s how my mind works in a situation like this: Oh my God, they’re going to cancel my coverage because I answered “no” to that question. I am going to owe over $300,000 for all the money they paid out this year. I don’t have that kind of money, so we will have to declare bankruptcy. We’ll lose the house. I won’t be able to get any insurance coverage now because it will look like I committed insurance fraud. I’m so stressed out over this that I’m going to have a heart attack. (I couldn’t sleep – all I did was lay in bed and worry.) And if I have a heart attack, what hospital will take me if I have no insurance? How will I pay the bills afterward?
On and on.
Of course, I had to wait until Monday to even begin to figure out what was going on, and I got the letter on Saturday. It was the worst weekend I’ve had in many, many years.
On top of all this, the letter from Aetna said they couldn’t pay any of my claims until this was resolved. I was panicked about that too because I just had my annual checkup, so I had claims in for my doctor’s visit, mammogram, lab work, etc. I also needed to renew my cholesterol medication this week, and it costs about $95 a month if I have to pay in full (it’s $25/month with a co-pay through insurance, after I meet the $500 deductible). So I was afraid to renew my medication and figured they would reject all my recent doctor bills. Ugh!!
Dave was able to get through to the Aetna underwriter on Monday of this week. She apologized more than once for the vagueness of the questions – I guess it’s kind of a form letter that they use. She said mainly what they are looking at is the date of my recent hearing loss – they want to confirm that it wasn’t before I applied in December. I can see how it looks so suspicious – I apply for new insurance in December which goes into effect in January, and then four months later I go completely deaf … and get surgery for cochlear implants in July. Anyway, she said based on the records she had so far she didn’t think it was going to be a problem, so I started to relax just a little bit.
The next day, election day, we got a phone call from the company in charge of going over my medical records. They wondered if they could fax the medical release forms to me, so Dave gave them our fax number. We got the forms, filled them out and faxed them back that afternoon. There was a form for my regular doctor and a form for my ENT/surgeon who did my cochlear implant surgery. Both asked for my medical records for the past two years.
That was a BIG relief because I haven’t seen my ENT at all in the past two years other than once I went deaf this year. My first visit to him in 2 years was in mid-April 2008 when I lost my hearing. My regular doctor has seen me once each year for my annual checkup, and those visits were reported on my insurance application.
Dave faxed a letter to the Aetna underwriter on Tuesday as well, with the medical release papers, asking if she needed any more information from me. All the vague questions they asked in their form letter are answered in my medical records, so I didn’t specifically answer the questions (which would have been kind of impossible anyway). We haven’t heard from her, but the medical records company called and left another message today. Dave called them back and get this…they were calling to ask about the medical release forms and if they could fax them to me. Dave said we already did that, they put him on hold and then came back and said, “Oh, sorry, it looks like we got them on Tuesday.” What the hell?! I feel like incompetent people hold this huge decision in their hands. It’s not very reassuring!
I am cautiously optimistic though – I did bite the bullet and submitted my prescription renewal today and it went through, covered by insurance. I checked my claims page on Aetna and they paid my mammogram yesterday. So maybe things are okay? Either that or it was just an empty threat about them not paying my claims until this is resolved.
I figure, if they really try to push this I have a legal leg to stand on and I would definitely take them to court. The underwriter did tell Dave, though, that this was not a case of recission; however, my monthly premium will probably go up about 25%. So right now I’m just generally tense, not hysterical. I won’t completely relax until I receive a letter from Aetna saying the issue is resolved and I’m not canceled.
Finally, I had my 3 month mapping session today. I almost cancelled it, because it’s $275 an hour if I have to pay full price, and I didn’t think my insurance would cover it. We decided, though, that we would just pay if we had to because it’s too important to ignore. I will save that for another post though…as always, I talked too much. But hey, insurance issues apply to many of us so I thought it might be helpful for someone out there. Or just give all of you with good insurance a reason to breath a sigh of relief and think, “Thank goodness that’s not me!” LOL
THANK YOU many many times over to everyone who left encouraging comments, sent nice emails and sent good thoughts my way. It means so much, I can’t even begin to say. You all are great!!
I’m too upset to go into much detail here, but I just got a letter from Aetna threatening to cancel my policy retroactively. They suddenly decided that I either lied or omitted information on my application when I first applied for insurance in Dec. 2007. They requested all my medical records and asked me 8 questions, 7 of which are so vague, I can’t answer any of them. I have to reply within 10 business days.
Of course, we get this on a Saturday so there’s no answer at the phone number given. Even so, they probably won’t talk to Dave and I can’t hear on the telephone. There’s no TTY number given.
I have NO IDEA what to do. I have heard horror stories about policies being cancelled for totally minor, unrelated things the insurance company decided were omitted from an application. My surgery, all the doctor appointments, tests, etc. involved cost around $300,000 in total. If my insurance is cancelled retroactively, I can’t pay those bills back. As it is, I have over $10,000 out of pocket that I’m paying right now and that is killing us.
All I can say is…if they didn’t want to pay for my CI surgery, why did they approve it? Yes, it’s horrible timing that I switched to Aetna in January and went suddenly deaf in April, but it wasn’t a pre-existing condition and I had no idea I was going to lose my hearing! I wish they would’ve just denied the surgery rather than paying and now making me go through this hell. The questions they are asking are so vague that there’s no way to properly answer them…and I’m sure they do it that way so they can say I lied or omitted information when I respond.
This is a nightmare. That’s about all I can say.