HEADLINES

Kirklin Clinic Head & Neck Cancer Support Group,  Birmingham, AL

distributed by American Cancer Society

Pat Sanders, Editor

May 2004

 

“WHAT IF….?”           Insurance Answers [Part 3 of 3]

 

WHAT CAN I DO IF my insurance company says the product I want is not covered and turns down my claim?

 

The best thing to do is to try to anticipate and prevent the rejection in the first place by providing very obvious and detailed information with your claim showing that the products are logically covered just as any prosthetic device would be.

 

Insurance policies may be vague about more unusual items like artificial larynges and not mention them by name, but your policy should tell you if it covers prosthetic devices such as artificial limbs. Electronic artificial larynges and TEP prostheses are true prosthetic devices -  replacements for a part of the body that has been lost or that is no longer functioning.  If your insurance would cover an artificial leg for you so that you would not have to go around in a wheelchair for the rest of your life if you lost your own leg, then it should not deny coverage for an artificial larynx or TEP voice prostheses for you so you can speak again and are not left with writing or gesturing to communicate for the rest of your life.

 

Tracheostoma covers, from the little foam patches to the HMEs (Heat/Moisture Exchangers), are really artificial noses.

 

Voice amplifiers enhance the function of the voice production mechanism. They may be harder to get coverage for, but Medicare is covering them now and insurance companies often follow their lead - though Medicare, apparently not understanding voice amplifiers fully, indicated that they are only for people with their larynges in tact, so coverage for them is much more iffy for laryngectomees - but worth a try!

 

A good number of insurance company denials for laryngectomee products are no doubt because the claim does not include sufficient information about the product and the need. Examiners see dozens of claims a day for diabetes, heart problems, etc. But any given examiner may see a claim for laryngectomee products only very occasionally, so the need and the product have to be explained very well. You want the examiner to read it and think, "Yes, that's obviously a prosthetic or medically necessary device and it makes sense that our insurance company would cover that." Otherwise, he/she may turn it down to save the time and hassle of looking into it further. Examiners probably get some sort of efficiency rating on how many claims are handled a day and if they have to spend a lot of time looking up information to figure out the products, they may not bother - may just deny it and figure it is another claim that has been processed that they won’t have to think about anymore.

 

So the important thing in getting coverage is making sure that the insurance company examiners understand that the products you are order are prosthetic devices and/ or fill a valid medical function. When you or the doctor or someone helping you is writing or speaking about it, artificial larynx should not be referred to as a “speaker” or a “talk box” or an “amplifier.”  Always refer to is as a “prosthesis” or “prosthetic device” or an “electronic artificial larynx.” he same applies to TEP prostheses.  It is common and quicker to just write or say TEP, but it should always be “TEP Prosthesis”. Stoma coverings should be referred to as stoma filters or and explained as devices that act as artificial noses in warming, moisturizing and filtering incoming air. On stoma covers/filters/HMEs, hopefully the doctor can give a standing order for the product(s) to be supplied every so often and then you can just send in a copy of that doctor’s order each time you send a claim. Voice amplifiers should always be called “voice amplifiers” and not just amplifiers - and the medical need to assist the voice production mechanism should always be emphasized rather than the social or emotional wish to be able to carry on a conversation easily.

 

Doctors are busy and don't like to write much, but if you, the doctor, the speech pathologist, the respiratory therapist - someone - can supply some reasonable DETAIL about the product and the need, you have a lot better chance of coverage, both initially and then if you do have to appeal. Again, descriptive sheets from suppliers can be a big help.

OK - So what can you do if you the insurance company turns you down? 

 

APPEAL!!!  Any denials on products for laryngectomees should definitely be appealed unless the insurance company can show you in writing that such things are specifically excluded from coverage. The insurance company's own paperwork should tell how to appeal. Look everything over. Figure out what can be improved. Get a better write up from your doctor and/or additional information from your speech pathologist or respiratory therapist.  Get more extensive descriptive material from your supplier. Put it all together and APPEAL - make the insurance company ‘s people take the time to really think about it. Someone’s study showed that if you go to the 2nd or 3rd round of appeal you’re much more likely to be successful, so don’t give up after just one try. Help teach the people who make the decisions about the products you need. The more the examiners from insurance companies, Medicare, Medicaid learn about laryngectomee products, the easier it will be for all laryngectomees to get coverage more routinely without as much hassle.

 

Dorothy Lennox, Luminaud, Inc. 

info@luminaud.com

The following article has absolutely nothing to do with being a laryngectomee, but has to do with being a human who needed to face making decisions in advance in order to have peace of mind.  I wrote it as I lived it and hope I have made a grim subject a little funny.

 

Settling Some Ashes                                    by Pat Sanders

 

I needed to make some plans for my future resting place so that my son would not have to be making decisions based on guesswork at what should be one of the worst times of his life. Losing his mother had BETTER be one of the worst times or being haunted by her might take that priority.  I had made the “cremation” decision a long time ago but where would my ashes go? At one point I had said sprinkle the ashes on the lake where we had a little fishing cabin.  That cabin is long gone and the fish up there will have to wait for someone else to nibble on.

 

I knew that my ex-husband, my son’s father, had a burial of his ashes in a parent’s grave, and my son suggested that I might want something similar.  I wasn’t sure how this was handled by the cemeteries or even what it was called but surely the big cemetery (pardon me, Memorial Park) in Florida, where my parents are buried, would know.

 

I could understand the benefits and simplicity of making arrangements where my parents and a large number of aunts and uncles are buried rather than start over with family in another city or cemetery.  This made good sense as I am an only child and have no close relations anywhere else.

 

Actually, I liked the idea as much as you ever like the idea of dealing with dying, passing on, or just fading away and at least my son would be able to bring just one bouquet for me and his grandparents! This whole thing seemed to be a money saving, practical, idea but I had no idea what to ask for. 

 

So a month after that, I was in Florida visiting my cousin and I suggested we spend the day at the cemetery.  I wanted digital photos of all of the graves and I wanted to stop in the office to find out what they say about this arrangement I would like to make.

 

As soon as I asked the receptionist about arranging for my ashes to be placed, scattered or left at my parents graves, she smiled brightly and I thought I saw a very small $ sign come up in each eyeball as she said, “Oh, you want a Second Right of Inurnment.”  So it had a name. Later, I found there were other Second Rights, such as Interment and Entombment.

 

When the sales lady (excuse me, counselor) appeared, I was about to learn a whole new bunch of words, most of which were acceptable but there were a couple that I already knew, I kept to myself.  They started with looking up the gravesites and getting a map to mark locations, also noting when my parents were buried and when the lots were purchased. The lots had been bought 50 years ago when old rules still applied and I had become the sole owner of the lots, which made things a lot easier for me and I didn’t have to buy any space.  I had the feeling that the Second Right might have been removed from the standard contract during more recent years. Also, being an only child, no one else had any rights.  Siblings would have had to sign for me to be able to plan this Inurnment.

 

Since I live in Alabama and would be cremated in that state, the cremation price was not figured in.  However, Florida has a law that a vault is necessary to be buried in a grave.  It’s called an urn vault (concrete, abt 12” x 12”, $150) and the urn (starting at $195), which holds the ashes is placed inside the vault before burial (opening and closing of the grave, $550). I said, I’ll take one urn vault, one opening and closing, scratch the urn.  I think we can find a cigar box. Found out later there was supposed to be another $50 for installing the vault in the open hole but they forgot to charge me for it. Did they get the extra money when they notified me of this, after I got home?  I had already bought the swamp in Florida and I wasn’t about to pay for the alligator.  I told them my son had a strong back, he could shove the little vault into the hole for $50 and they decided it wasn’t really fair to charge me after the contract was signed.

 

So I called my son and said, “What exactly happened with your dad?”  He said, “We got to the cemetery with Dad’s ashes in a cardboard box.  A guy came out of the office with a shovel, moved some sod, dug a hole, dropped the box in, filled the hole, replaced the sod and left.”  It was $200 or $300 total charge.  OK, in ten plus years, rates go up. From Illinois to Florida, rates go up.  So maybe $700 wasn’t too bad a deal.  Besides, where else was I going to find parents to be buried with?

 

You might think that it would be a lot easier just to scatter the ashes in the breeze.  Maybe, if they don’t catch you!  There is a section called the Scatter Garden where you may let your dear departed join everyone else’s dear departed….for a fee.  Or, perhaps you could drift out to sea in a boat and throw ashes to the wind, being very careful of which way the wind is blowing at the time but you have to rent a boat and probably someone to run it!  Well, my cousin was with me and she had arranged for the burial at sea for her late husband just last year and made arrangements for herself at the same time.  $1,000 each for this sea service and your survivors don’t even get a boat ride!  They don’t allow them to go along.  Talk about being lost at sea! 

 

My cousin said if she had known prior to signing that contract that for $700 each, she could have been placed there with her parents and all of our folks, she would have done that. At least her children and grandchildren would know where to find her. Her husband’s parents are there, too. 

 

With Second Right of Inurnment papers being drawn up, I was to stop back the next day, but there was one more decision I had to make before then.  It is 3AM and I’m awake.  Is this what I want to do? Yes, I am very comfortable with this idea and the amount of money it costs is actually not that bad for the peace of mind and having it all settled. So I rolled over, gave a sigh, and started to drift off.  Wait! I’ve been saying parent’s grave.  That is not the way they look at it.  It is your mother’s grave or your father’s grave and you have to pick one. I have to choose between my parents.  OK, simple, I tell myself, I was a Daddy’s girl so I would have my ashes placed in his grave.  Mom and Dad wouldn’t know, anyway….or would they?  I can’t take that chance.  If they did know, my mother would have her feelings hurt! All right, let’s think about it the other way.  My ashes could go in my mother’s grave.  That’s better.  My dad would understand that….  Peace.  Sleep was on the way.

 

Since I owned the rights to both graves, I had them draw up papers giving the Second Right for the other grave to my son. I could do that since he has no brothers or sisters to sign.  It is really simple when an only child has an only child.  He may or may not need it or choose to use it, but I thought I’d pave the way.  Pave…  Reminds me of the one foot square concrete box for $150!

 

I told the other larys that I visited the next two days about what I had done.  None had heard of it.  None of my friends had heard of it. It is entirely possible that you have a Second Right to existing gravesites and would not have to purchase cemetery lots. Or maybe you can leave a Second Right to a child.  Perhaps spouses may choose to share a gravesite, even if they already own more than one.  They can always be left to your children.

 

If you are interested in this, it is difficult to find answers on the Internet Mostly you have to ask.  I found several cemeteries listed with prices posted that were cheaper than what I paid, and a couple that were more expensive.  For instance, I found one online in a small town in Alabama.

Single Space  $650.00

Right of Second Interment in Any Grave Space $200.00

This is going to become very common and it makes a great deal of sense.
 

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Upcoming Health Insurance for Midlifers           (Notice from Pat Sanders)

 

AARP announced in their last Bulletin that they have launched a new health insurance program for people 50-64.  It is only available in select markets right now, CO, IL, MO, NE and OH, but it is an indication of something that has long been needed and, chances are, they will gradually add other states.  It is underwritten by United Health Care, the same people that handle their Medicare Supplement and it is currently offered in both comprehensive and limited coverage.

 

I know many people in that age bracket who would like to retire, semi-retire, or who are in jobs with no health insurance coverage.  I was in that situation for a period of time after my Cobra expired.  I needed 14 months of some kind of coverage to help me if there should be a catastrophic and costly illness and it was hard to find, high priced, and had huge deductibles.  I would have been delighted to find a company I knew and a choice of plans for just one to carry me through to Medicare. If you are interested and not a member of AARP, this might be a good time to join so you can stay up to date on new offerings. You might also keep a check on their web site   http://www.aarphealthcare.com/personalhealth   or call at 1-800-523-5800