Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
It's not Medicare that's saying no. It's the surgeon she is seeing who is reporting that diagnosis code. Get a freaking second opinion!
In regard to hearing aids, one word: Costco. DH has experienced FAR better results and care with their staff and products than he ever received from a private audiologist. At about half the price.
Completely agree with Costco for hearing aids.
There is no reason to pay $5000 for hearing aids. That is essentially getting scammed by an audiologist who is earning very high profit.
My father saw an ENT doc before he got his hearing aids, and this doctor told him to avoid the Audiology clinic in his own University Hospital Department and go straight to Costco. My Dad's hearing aids at Costco were "only" $1700 with an excellent return/warranty policy and all visits to the hearing aid techs for adjustments, small repairs/cleanings etc.. are free and easy to schedule.
Yes, Medicare decided many years ago that for cost-containment, they would not reimburse some health related expenses. This includes dental and hearing aids, and there are many more treatments/devices that have these arbitrary exclusions even though they are medical necessary. Hopefully, most of you will be lucky and will never discover what these exclusions are, due to your good health (and good luck....).
Right now my father is facing such a Medicare exclusion for a medical supply he urgently needs every month. Pretty much every private insurance company, VA insurance, and many state Medicaid programs will cover this supply. But Medicare does not. Sometimes these Medicare decisions are not only medically dangerous, but cost ineffective and irrational. In my father's case, if he cannot get this medical supply, he will ultimately have to have a very invasive, potentially life threatening surgery that will leave him with a severe deformity and will ultimately cost many tens of thousands of dollars with ongoing costs for the rest of his life. But Medicare doesn't care. They would rather pay thousands and thousands of dollars more than consider what is right and best for an unfortunate person. It is really crazy.
There is no reason to pay $5000 for hearing aids. That is essentially getting scammed by an audiologist who is earning very high profit.
My father saw an ENT doc before he got his hearing aids, and this doctor told him to avoid the Audiology clinic in his own University Hospital Department and go straight to Costco. My Dad's hearing aids at Costco were "only" $1700 with an excellent return/warranty policy and all visits to the hearing aid techs for adjustments, small repairs/cleanings etc.. are free and easy to schedule.
Yes, Medicare decided many years ago that for cost-containment, they would not reimburse some health related expenses. This includes dental and hearing aids, and there are many more treatments/devices that have these arbitrary exclusions even though they are medical necessary. Hopefully, most of you will be lucky and will never discover what these exclusions are, due to your good health (and good luck....).
Right now my father is facing such a Medicare exclusion for a medical supply he urgently needs every month. Pretty much every private insurance company, VA insurance, and many state Medicaid programs will cover this supply. But Medicare does not. Sometimes these Medicare decisions are not only medically dangerous, but cost ineffective and irrational. In my father's case, if he cannot get this medical supply, he will ultimately have to have a very invasive, potentially life threatening surgery that will leave him with a severe deformity and will ultimately cost many tens of thousands of dollars with ongoing costs for the rest of his life. But Medicare doesn't care. They would rather pay thousands and thousands of dollars more than consider what is right and best for an unfortunate person. It is really crazy.
You can't fight with Medicare.
That's why...to my opinion...that when people say our medical system is broken I have to agree.
As far as whether someone can or should get a tooth implant, $4000 was just over their budget due to Cancer last year for her, a kidney removed, and he being in the hospital for 5 weeks due to a back surgery that went bad, then he got a staph infection in hospital...it was nip and tuck for awhile but he is fine now except for all of his other chronic conditions.
There comes a time that a dental implant just might put your income over the edge.
When I am 80, god help me, I would not get an implant unless it was a frontal tooth. I do not want to be a snagglled tooth old lady,'d otherwise, nah! I'd rather save my money for a cancer diagnosis or new knees.
And I completely agree with COSTCO being the go to for hearing aids...however, my friend does not agree, she may have to now, though....that pension only goes so far and she is not done paying for the first one and they want to try her on a new one. JEEZ!
Oh, I checked on AARP/Walgreens and in my state of Indiana the supp is about $26. I got the quote from AARP.
I only have one implant to replace two back molars. It is obvious not for cosmetic reason. The implant is very solid, feel like a real tooth and allow me to chew from both sides.
I would expect implants to replace front teeth would function as good as real ones for biting. My mother has dentures and always removes them when she eats. Of course, she could only eat soft food.
I think for sole cosmetic purpose, dentures would work fine. IMO, the main benefit of implant is excellent tooth replacement for food enjoyment. If implants look better than dentures, it is just added benefit.
We have always chosen the most comprehensive dental insurance plans (our current plan is Metlife at ~$50/month) because we think good dental care is essential for our life. As we get older, it is harder and harder to maintain good gum and teeth. There are more and more evidence shows a strong association between gum disease and heart disease, stroke, diabetes etc. and it can also shorten life. I strongly believe that you can not be healthy without having healthy gum and teeth.
Well, I quite agree, however, our health system does not so there you go. I also think eye glasses are a must but our health system does not so there you go again.
Note that elective does not mean cosmetic. Eyeglasses and hearing aids are considered elective because you don't *have* to have them to live. I'm a counselor, and there are diagnoses that insurance companies and Medicare won't pay for because treatment is not considered medically necessary. If a couple comes in for marital counseling, their insurance company will require that one of them has a formal diagnosis that's deemed medically necessary.
There are limits to health care in Canada, too, that are similar to the limits in the U.S. system:
Note that elective does not mean cosmetic. Eyeglasses and hearing aids are considered elective because you don't *have* to have them to live. I'm a counselor, and there are diagnoses that insurance companies and Medicare won't pay for because treatment is not considered medically necessary. If a couple comes in for marital counseling, their insurance company will require that one of them has a formal diagnosis that's deemed medically necessary.
There are limits to health care in Canada, too, that are similar to the limits in the U.S. system:
I hear you Vasily, I think that the difference between elective and cosmetic sometimes is just splitting hairs.
Kinda like mental health care, as you note, that one or the other has to already have a formal diagnosis that is deemed medically necessary for marital counselling.
So if one beats the crap out of the other, does the other have to get a diagnosis of such like a personality disorder to get marital counselling paid for. Sounds like a chicken and the egg concept. But then again, if the other thinks marital counseling is going to do much good for their marriage, since the one thinks marital compromise means beating the crap out of the other to get their way.....well.
So how does the one actually get a diagnosis if the other chooses not to be medically diagnosed.
Ok, here is what I have learned...you get what you pay for.
DH and I spent a few years with Advantage plans. This is free, but it is like selling your soul to the devil. I went for physical therapy once and was told it was only by mistake that they accepted my plan, " because they weren't getting paid anything."
My advise is to pay for Medicare supplements, D and F. If you don't get it now, you may not be eligible later. Just because you are healthy now, does not mean you will be later. If you try to get a supplement after you have a chronic or expensive illness, you can be rejected.
Yes it is ridiculous that dental and vision and hearing aids are not included in insurance.
Why do you think insurance is obligated to pay for vision and hearing? There are two schools of thought on this - medical insurance should be more like car insurance which does not pay for car maintenance, or, insurance should pay for everything in which case it is not insurance at all but free medical care.
Personally I think people should bear some responsibility for health care. Otherwise they tend to pig out and pigging out is one major reason why healthcare expense is out of control in the USA. I don't have a problem with vision and hearing being a personal responsibility. Neither one is going to be a financial catastrophe for anyone.
Why do you think insurance is obligated to pay for vision and hearing? There are two schools of thought on this - medical insurance should be more like car insurance which does not pay for car maintenance, or, insurance should pay for everything in which case it is not insurance at all but free medical care.
Personally I think people should bear some responsibility for health care. Otherwise they tend to pig out and pigging out is one major reason why healthcare expense is out of control in the USA. I don't have a problem with vision and hearing being a personal responsibility. Neither one is going to be a financial catastrophe for anyone.
So we go back to the question....are we responsible for our brother?
So, we all will be "our brother" at some time. No matter who has what, no matter what we pay for insurance, those with the means will expect and have more care, food, shelter, but a soft bed does not mean your end game will be any more than then someone down the hall.
Pigging Out. Could you give more information what you think is pigging out?
So we go back to the question....are we responsible for our brother?
So, we all will be "our brother" at some time. No matter who has what, no matter what we pay for insurance, those with the means will expect and have more care, food, shelter, but a soft bed does not mean your end game will be any more than then someone down the hall.
Pigging Out. Could you give more information what you think is pigging out?
Yes, we are responsible for our brother. I have no problem with Obamacare or single payer. But the fact is people have shown a tendency to overuse health care services when it is free. Like getting a cold - you can do what everyone has done for 100s if not 1000s of years - be patient, read a book, blow your nose and it'll be gone in a few days. But with all-you-can eat insurance, people run to the doctor who prescribes useless antibiotics. That is pigging out.
This is not my idea, this comes from analysts who have looked at why US health care costs so much. It is why Obamacare had built-in copays and co-insurance, so people would feel some financial responsibility for the choices they make. If people are allowed to consume as much as they want for free, they will. And someone has to pay for that and that ends up being all of us.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
