We have had BlueCross’s Advantage plan now for the past five years and I really have no complaints about them. They are as good a medical carrier as I have ever had. As a Medicare advantage plan, they have been excellent — maybe better than excellent. Often really great. They cut costs whenever they can. They approve medications quickly. Pretty much every hospital and most doctors work with them.
This year, UMass came up with their own plan. I wrote about this earlier: CHANGING MEDICAL PLANS – MASSADVANTAGE. I chose MassAdvantage because they agreed to treat Garry’s hearing devices as prosthetic hardware which is like a wheelchair or an arm or leg. They pay 80%. We pay 20% in (hopefully) easy payments. Even split up, it is still a lot of money. We’re not talking hundreds of dollars. It’s thousands of dollars and the sky is the limit on pricing.
When I called Advanced Bionics and Garry’s audiologist about it, I was told that Garry’s hearing devices were not covered by Medicare. I pointed out to get the cochlear implants, they removed all the “hearing parts” of his ear. Without that device, Garry has zero hearing in his right ear and close to none in the other.
That the customer service reps didn’t understand what I was trying to explain is understandable, But Advanced Bionics is on BlueCross’s active provider list. They know it’s covered by insurance. It’s part of their business model.
I did my best to explain this and I’m a pretty good explainer. I got forty years of practice explaining complicated things. These are prosthetic devices that replace the normal functions ears. He can’t just go to the nearest hearing aid location and get a set of aids. These are specialized devices and would cost a fortune out of pocket.
The woman called me back and said no, they didn’t pay for them. At all. I had the same conversation with the MassAdvantage rep. But after she talked to her superiors she said not only would they cover them, but it’s in the Medicare directive that these devices are covered as prosthetic devices — which is logical because they are prosthetic devices. Thus they are covered 80% by insurance and the remainder is a slow payout which is presumably set up so we can manage it.
Today, when I called BlueCross to explain why I was leaving them — other than that MassAdvantage costs less — is they will cover his hearing devices. Moreover, Medicare says are covered. If Medicare covers them, Advantage plan insurers are legally obligated to cover them too. When I pointed this out to the BlueCross woman. She said that I must have been given the wrong information. That couldn’t be right. I agreed. That answer couldn’t be right. It felt wrong.
MassAdvantage agreed to cover them and when I heard that, I said: “You are the winner!” I signed up. Not much of a winner. We’re old. We need medical care.
Mind you, even with 80% insurance coverage, these device are a huge expense for people living on a tight budget. Our income has stayed the same for 20 years which is as long as Garry has been retired. Every month prices go up. I’m always amused by young people who think Medicare is “free insurance.” It’s not free. Not even close to free. And it’s missing a few pieces. What is more, we PAID for Medicare through all the years we worked. it was the biggest piece coming out of our paychecks.
The rest of the world may get raises (I hear the economy is improving), but we don’t. People surviving on Social Security get the same amount forever or until death do you part. I’d find this terrifying if I thought about it, but I try not to think about it. The past five years have been terrifying enough. I don’t need to make it worse.
I’m going to try to make sure everyone understands a cochlear implant is a surgical reconstruction of a individual’s hearing equipment. A necessary prosthetic is required and mandatory.
Not only is it time they start paying for Garry’s prosthetic hearing devices, but I’m waiting for them to begin covering the rest of us — like eyes, teeth, and insulin, AIDs medications and other expensive long-term medications that we need to keep on living. Meanwhile, they always remind us to have our eyes, hearing, and teeth checked but won’t pay to help us get them fixed. I don’t understand the point of telling us we get tests when the result is to leave us hanging in the wind if we need assistance.
I already feel like I have accomplished something if BlueCross recognizes this. Legally, they are required to recognize it. It would make a lot of people’s’ lives easier and better. Something to feel good about.