Kirklin Clinic Head & Neck Cancer Support Group, Birmingham, AL
distributed by American Cancer Society
Pat Sanders, Editor
“WHAT IF….?” Insurance Answers [Part 1 of 3]
What can I do if the supplier I want to get a product from will not bill my insurance company? Even though the insurance company sent them an authorization??
Background: Insurance company authorizations, unfortunately, usually have fine print that indicates they are not promises to pay. If the supplier provides the product and submits a claim, then the insurance company will consider paying IF all the factors are right. But it is very hard for a supplier, especially one who sells all around the country by mail order, to determine the coverage and current eligibility for all of its customers with insurance, especially considering that there are thousands of insurance companies, each with its own rules. Many of the suppliers serving laryngectomees have had great losses in unpaid bills and in phone, letter and fax time and in employee wages trying to collect from insurance companies. Some have regretfully decided that continuing to bill insurance companies would force them to either raise prices for everyone or go out of business.
So what can you do? Here are 3 possibilities:
1) You can pay for the product yourself and then try to get reimbursement from your insurance company. When you place your order, ask your supplier to include more than one copy of the “paid” invoice and also to include descriptive information on the product. Get a claim form from your insurance company, fill it out, and send it to the address the insurance company specifies, along with a copy of your invoice, a copy of information describing the product, and a physician's explanation of your need for the product. If the product is covered by the insurance company, then you should get some amount of reimbursement. If the product is something you will be ordering regularly, get several copies of the claim form and make copies of the descriptive material, along with the physician’s statement so you can easily send them along each time you send a claim.
2) You can find out if your supplier and insurance company will work with proforma (as a matter of form) invoices - this is an invoice with all the particulars filled in except the serial number (if there is one) and the shipping date. The supplier sends the invoice to the insurance company, and if the company pays the bill, THEN the supplier sends the merchandise. Often the insurance company will accept the invoice by FAX. Sometimes this works out very well and very quickly. Sometimes it drags on and you have to contact both sides to make sure they’re doing their part but when it does work it can be very helpful, especially in the purchase of a more expensive item that you cannot afford to pay for up front.
If the proforma invoice option is acceptable to both the insurance company and the supplier, you or the insurance company would need to provide the supplier with the insurance company name, address, phone number, fax number, name of a specific contact person - and also with all of your own information - name, address, phone number, insurance policy and ID#, Social Security number, date of birth - any such information the insurance company would require to be put on the paperwork. Because of the extra time, phone calls and paperwork involved, your supplier may be willing to use this method for the sale of several hundred dollars in merchandise but perhaps not for $15 worth of stoma covers. The more information you have ready and the easier you make it for the supplier, the more likely they will be to be willing to do proforma invoices for you. (Note: Insurance companies often have dozens or hundreds of representative with dozens of fax machines. Make sure you get rep names and phone and fax numbers that will get you and your supplier to the right people or department each time - not just the general insurance company number.)
3) You can find a local medical equipment provider who works with your insurance company and see if they can and will act as a middleman, buying the product(s) you need from the supplier and billing them to the insurance company for you. Your insurance company should be able to give you a list of the local medical providers that they deal with. (The provider list may already be in the information your insurance company gives you when it renews your policy, along with the list of doctors that work with your insurance company.) Then ask your supplier if s/he is willing to sell the equipment you want to a local provider.
Of course, the local provider may say they don’t carry the product you want and don’t know anything about the product you want - but if you are prepared and show them the product description and give them the contact information for the supplier - and give the supplier the name and telephone number of the local provider - then you may be able to get the two companies together and make the needed arrangements. Do everything you can to make it as easy as possible for them by having descriptions, contact information, insurance information and doctor’s prescription or orders ready. The less phoning/faxing or paperwork that has to be done on either side, the more willing they may be to handle the transaction for you.
[More answers in Part 2, next month]
Dorothy Lennox, Luminaud, Inc.
Larynx Cancer – almost 50 Years ago! by Frances Stack, MA, CCC ret.
I have been asked to share some of my knowledge and experience in developing alaryngeal voice. Notice I use the term “voice”, speech is produced using the mouth, the lips, tongue, teeth and pharynx or back of the throat. Voice is the sound produced by the larynx when air pressure from the lungs travels up to the larynx and pharynx and voice or sound is produced.
As I read the many WW members experiences sharing their pain and travails, I remember my own, those many years ago. I was diagnosed with cancer at age 24. Finished beauty school and was facing treatment. Had maximum radiation then a right hemi-laryngectomy but to no avail. I underwent a total laryngectomy one month before my 27th birthday. I bought a beauty salon ten months earlier, believing that I was cured. I was one angry person!!! How could this be happening to me?
Before I left the hospital, the Speech Pathologist, William Waldrop (God bless this man) came to my room and got me to "burp". He was elated; I wasn't. He asked me to come to class at the hospital and when I did, I was horrified. A room of old men with stomas uncovered trying to belch! I ran out of the room crying. Mr. Waldrop ran after me but I wanted no part of it. At that time, women laryngectomees were rare, especially young ones.
Six weeks after surgery I was back at work because I had to work. I whispered and would get angry when I wasn't understood. Fortunately, the understanding woman who came to work for me kept me sane.
About that time, my surgeon and speech pathologist decided that if I wouldn't come to class, Mr. Waldrop would stop by on his way to work and try to get me to attempt to learn to talk. I didn't want him to come, but he came by anyway. For six weeks, he climbed three flights of stairs and would talk to me and try to get me to produce voice. I wouldn't. I would serve him coffee and sweet rolls but wouldn't respond but I guess subconsciously, I was listening and learning. I would drive the back roads of my area when I would get angry and try to talk to myself. About three months later, I surprised myself by being able to say one, then two, then three words.
When I went in to see the surgeon for the next checkup, I stopped to see Mr. Waldrop. He almost fell out of the chair when I walked in and said, "Hi, how are you?". He immediately asked me to come to class but I refused. Then he asked, "Frances, would you help me with this one patient?" How could I say no? I couldn’t and, after that, I volunteered in the speech clinic for about thirteen years. Being a volunteer also helped me learn. It is said that in teaching, you learn as much as you teach!
What I really want to say is that I have always used esophageal voice but I worked hard to get it the way I wanted it. Because I was in direct contact with my salon patrons, I practiced in front of a mirror so I didn't develop any distracting movements. I used a tape recorder to hear how I sounded. I worked very hard to be as normal as possible. I practiced singing "You are my Sunshine" every day. I use deep breathing to control the power of my lungs. After all, opera singers aren't born, they practice. I'm no opera singer but I can project my voice quite a distance. Along with voice goes diction and rate. Speaking clearly and a little slower makes a big difference in how you are perceived as a speaker. Today young people speak so fast it's hard to follow them.
After thirteen years, I was encouraged to go back to school and matriculate for a Bachelor's degree in Speech Pathology. I was short three hours in abnormal psychology for a double major. Unfortunately, the rules were changed before I graduated. I would need a Master's degree to practice Speech Pathology.
My Master's degree is from the University of Illinois. I worked like a dog for eleven months for it. The three hundred hours of practicum I didn't do at St. Xavier's, I had to do at the U. of Ill. I wouldn't trade a minute of it! I put time in at a nursing home, a sheltered workshop, a public grade school and loved every minute of it. I proved I could do it without a larynx. At the end, my supervisor congratulated me saying, "We purposely threw the book at you to see if you would sink or swim. You swam!"
After I returned home, I was called back with a job offer from the Department of Rehabilitation Services for one year to fulfill my internship requirements. I had to travel the state of Illinois, giving speeches, lectures, and doing whatever was appropriate to inform others of what was possible for laryngectomees. I traveled the four corners of my state with my male Lhasa Apso who took his job very seriously. No one could come near my
car or person. He was with me during the eleven months of graduate school also. When the internship period was finished, I came home wondering what was in store for me next. Hairdressing was out since I sold my salon before I started school. Besides, who would hire a speech pathologist who was also a laryngectomee?
I heard of a Home Health Agency who needed a clinician. I called and told the Director that I would understand if she didn't think I could do the job but if she thought I could, I'd be glad to come in and discuss it. She hired me before we finished talking! I worked with mostly stroke patients in their homes. Imagine, a laryngectomee working with aphasic
patients. I would try music therapy for some (where that part of the brain was unaffected), again singing "You are my Sunshine". We would laugh together and I'd tell them if I could do it, they could at least give it a try.
In a memory that stands out, one of my laryngectomized patients lived in a very bad neighborhood. I told her that I was a little apprehensive about coming there. She pointed to two older men who always sat on her porch and told me "Anyone who touches you or your car has to answer to them and me." With that said, she went to a cabinet and pulled out a revolver and said "Don't be scared, honey, you're safe here."
The clinician who preceded me in that job contacted me. She had laryngectomees in her case load and was teaching them SIGN language because she had no idea of how to work with them. I offered to help her and she got me into the hospital where I worked on a part time basis. In time she left and I became the department manager. I managed three Departments: Speech, Audiology (I started that department) and Ophthalmology. When I protested about Ophthalmology being given me, my boss told me not to worry, he felt I was a good manager and could do the job.
I share all of this with you because as Churchill said, "Never, never, never, give up!” For every door that was closed to me, another opened where I least expected it to. My deep faith has sustained me in the darkest hours and there was always light at the end of the road.
SO WHAT IF IT’S NOT NEW YEARS by Pat Sanders
Resolutions don’t have to be once a year. We don’t have to wait for the end of a year to change something we are doing or start living a different kind of life. Little changes made regularly can make big differences.
Most of the changes made at New Years are about diet, weight, drinking or smoking and, often they last a few days or maybe a few weeks and the new ways are broken before they can get to be good habits. Funny, how we figure once broken, might as well give up and wait till next year. Maybe we should make new resolutions or renew the old ones once a month or maybe every Monday. That would allow for some slack weekends and a lot of starting fresh starts on Mondays!
Let’s think about something simple that we can do to improve ourselves. We have had cancer so we have a need to be vigilant about staying strong and healthy. Are you eating foods that are good for you as well as ones that taste good? You need protein. If you have bread and jelly, add some peanut butter and use whole grain bread. How about dairy products? Cheese, cottage cheese, yogurt, milk (maybe low fat?) are all good products. If you eat meats, find some that you enjoy and eat a meat dish every day. Eat lots of vegetables with a good variety. Add seasonings to foods without much taste and try some new dishes. Eat right with good fresh foods and you will feel better.
If you have trouble eating enough of the foods that are good for you, then consider taking some vitamins. You can get chewables, powdered ones to mix into a drink or some of them come in liquid form. You don’t have to load up on dozens of bottles of things, just start out to supplement your diet in a simple way and do the best you can to get your nutrients naturally.
One week at a time. Make a resolution each Monday morning to do something that is good for you…just for a week. Maybe this is the week to try yogurt!