Just in case you all were wondering, your eyes are not part of your body!

[Viper GTS]

I just spent 40 minutes on the phone with a Blue Cross/Blue Shield phone monkey.

I have a degenerative cornea condition called keratoconus. I have to have rigid contact lenses to reshape my corneas, glasses do nothing for me. Without the lenses, I am not legal to drive & cannot identify familiar faces even from 10' away.

In the past, BCBS has paid for my lenses. I have had several sets (fitting processes) paid for at $100+ per individual lens. Then out of nowhere they start refusing them.

Apparently the only vision coverage I have is one routine eye exam per calendar year. No glasses, no contacts, regardless of medical necessity - Never mind the fact that many people I know have had glasses paid for in part by the same plan.

The depressing thing about this is that if it were a degenerative disease of ANY OTHER BODY PART it would be covered fully. But because it's my eyes it falls under the vision category & they don't cover it.

However...

If I wanted to get corneal transplants (the only alternative, used as a last resort) at a cost of $25,000+ per eye they would cover it.

I flat out asked her:

Me: There is an alternative, I could go get cornea transplants. My next claim could be for $25,000. Would you prefer that?
Her: We would cover that
Me: So you would prefer to pay for surgery than pay for contact lenses
Her: Your policy does not provide...

Blah.

Anybody have any tips for dealing with insurance companies? I plan to have Oregon Health Sciences University send BCBS a letter explaining what the lenses are for & that they are medically necessary. With any luck that will fix it. I doubt it will, though.

Insurance companies suck.

Viper GTS

 

[Beau]

Jeez, that sucks. I hate insurance companies, at least dealing with them.

I'd keep calling and talking to different reps. Make a stink about it. Get the university to write a letter explaining what the condition is. If you bug them long enough, you may get them to accept the claim.

 

[Ylen13]

usually a call or a letter from a lawyer sometimes gets them to get their act together.Good luck.

 

[HappyPuppy]

Is there a reason why you don't get the cornea transplants? Just asking because it sounds like that would help your condition.

 

[Imported]

I'm assuming the cornea transplant is quite dangerous.. if it's a last resort.

 

[Tab]

Goto up to the lady and rip her eyes out of her sockets...

Okay, worst case scenario. Kinda funny if they would actually pay surgery... Talking person to person is always better. Let us know how it comes out...

 

[Viper GTS]

Originally posted by: HappyPuppy
Is there a reason why you don't get the cornea transplants? Just asking because it sounds like that would help your condition.

The healing time is a minimum six months of 20/100 or worse vision, potentially 12-24 months. After the transplant I would still need the RGP lenses, since they have yet to master getting the new cornea perfectly shaped due to uneven tensions in the stitches. Not to mention the possibility of tissue rejection, complications, etc.

Basically I'll be wearing these lenses the rest of my life, & although the surgery is a cure for the disease (stops the progression) it does not result in perfect vision without some form of correction.

Originally posted by: Imported
I'm assuming the cornea transplant is quite dangerous.. if it's a last resort.

It's not very dangerous, they've been doing them for 20 years. It's practically outpatient surgery now, you go home the same or next day.

Viper GTS

 

[xSauronx]

Originally posted by: Imported
I'm assuming the cornea transplant is quite dangerous.. if it's a last resort.

yeah, dont think id want someone to swtich parts of my eye out for someone elses cause getting lenses was a hassle, besides, what if it takes a while for the right guy to die so you can get them....man thats depressing

anyway, insurance companies are an evil necesity, like MS Windows, or the US congress

 

[Viper GTS]

Because corneas do not have a blood supply they are a very easy transplant. No matching blood types, they have banks of the things as far as I understand.

The real difficulty is the healing process, & the pretty much guaranteed crap vision during that time.

Viper GTS

 

[Scarpozzi]

BCBS of Tennessee is like a block from here... (Chattanooga offices) You should come pay em a visit...spray pepper sauce in their eyes to show them what it's like not being able to see....those bastards. Then they can pass the message along to the appropriate people to get you taken care of.

 

[LordMaul]

I'm not entirely current on the latest technologies...but are entire eye transplants ala Minority Report availible today in any way, shape or form?

 

[Beau]

Originally posted by: LordMaul
I'm not entirely current on the latest technologies...but are entire eye transplants ala Minority Report availible today in any way, shape or form?

I wish.

 

[andylawcc]

i bet Blue Cross will harass him even further with tons of documentation and paper work if he decide to go with the operation.
its not like they will just give up $25k easily for the transplant.

 

[andylawcc]

Originally posted by: LordMaul
I'm not entirely current on the latest technologies...but are entire eye transplants ala Minority Report availible today in any way, shape or form?

heh, after the operation Viper GTS will be known as Mr. Yoshimoto

 

[XZeroII]

Lawyers. Insurance companies know only one language...and it happens to be the same one lawyers speak. First, tell them you are consulting a lawyer. If they do not give in, then actually see one that specializes in insurance stuff.

 

[vi edit]

Most insurance companies DON'T cover optical, just the same way that that they don't cover dental either. They are usually seperate plans.

Usually flex plans are set up to pay for glasses and contacts.

 

[Viper GTS]

Originally posted by: vi_edit
Most insurance companies DON'T cover optical, just the same way that that they don't cover dental either. They are usually seperate plans.

Usually flex plans are set up to pay for glasses and contacts.

I can understand not paying for glasses and regular contacts.

My contacts are closer to a prosthesis than they are optical devices, their sole purpose is to physically manipulate my corneas thus creating an artificial cornea surface. More importantly, what makes rigid lenses to prevent surgery an optical treatment but the surgery itself is medical?

Up until today I'd been quite pleased, after reading the battle stories that other people have gone through to get the lenses covered I was thrilled that mine had been so painless.

Viper GTS

 

[vi edit]

My contacts are closer to a prosthesis than they are optical devices

Unfortunately, prostetics are kind of an iffy ground with insurance companies as well. Visgf worked in a physical rehab clinic of a hospital with amputation patients who were unable to get prostetics because of lack of insurance coverage.

It's really plan dependent.

 

[rahvin]

Viper, they don't care if you can see, vision coverage is not provided by your plan. If you needed medical attention to prevent losing your vision they would cover it, but not some device to allow you to see.

 

[Brutuskend]

Weird...

But typical.

 

[Bignate603]

Too many nerves in eyes. you could probably put one in and even connect all the muscles and things so it moved but it would not see.

 

[Viper GTS]

Originally posted by: rahvin
Viper, they don't care if you can see, vision coverage is not provided by your plan. If you needed medical attention to prevent losing your vision they would cover it, but not some device to allow you to see.

I am essentially going blind, the contacts are used to prolong the inevitable. They allow me to see for now, and may actually slow/stabilize the progression of the disease due to the constant re-shaping of the cornea.

Again, if it were simply glasses or ordinary contacts I would understand.

Viper GTS

 

[Brutuskend]

Man that sucks.

Sorry to hear about your condition!

 

[rahvin]

Originally posted by: Viper GTS

Originally posted by: rahvin
Viper, they don't care if you can see, vision coverage is not provided by your plan. If you needed medical attention to prevent losing your vision they would cover it, but not some device to allow you to see.

I am essentially going blind, the contacts are used to prolong the inevitable. They allow me to see for now, and may actually slow/stabilize the progression of the disease due to the constant re-shaping of the cornea.

Again, if it were simply glasses or ordinary contacts I would understand.

Viper GTS

I know what you are saying but I doubt you can convince them. In fact I know you can't. You have to get your doctor to convince them. Only your physician has the ability to influence their willingness to pay and he may have to do that by providing your medical information to the insurance company for evaluation. I'm not saying don't fight, but I would assume the worst and plan to pay for them yourself. Do you do a Flex account?

 

[Viper GTS]

Originally posted by: rahvin

Originally posted by: Viper GTS

Originally posted by: rahvin
Viper, they don't care if you can see, vision coverage is not provided by your plan. If you needed medical attention to prevent losing your vision they would cover it, but not some device to allow you to see.

I am essentially going blind, the contacts are used to prolong the inevitable. They allow me to see for now, and may actually slow/stabilize the progression of the disease due to the constant re-shaping of the cornea.

Again, if it were simply glasses or ordinary contacts I would understand.

Viper GTS

I know what you are saying but I doubt you can convince them. In fact I know you can't. You have to get your doctor to convince them. Only your physician has the ability to influence their willingness to pay and he may have to do that by providing your medical information to the insurance company for evaluation. I'm not saying don't fight, but I would assume the worst and plan to pay for them yourself. Do you do a Flex account?

I intend to have my Dr write them a letter, based on the reading I've done that seems to be the most effective way to get coverage.

I do not have a flex account, & have just passed the open enrollment deadline to get one with my employer. It would probably be a good idea though... I don't know much about them, I suppose I should learn.

Viper GTS