Can't get straight answer from insurance company


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Posted by jinglepaws (220 posts)
Aug 20, 2013 11:14 PM

I have to decide whether or not to extend the warranty on the remote and charger next month. I finally contacted my insurance company to see if billing codes L8681/L8689 were covered as suggested by Boston Scientific. Well, after 2 tries, either out of incompetence on the part of the insurance rep or a clumsy but deliberate attempt to be evasive, I can't get a straight answer.

My first email read: "Please confirm whether billing codes L8681 and L8689 would be paid by under my plan." Pretty straightforward question, right? The response to which was: "The service would be based on medical necessity. I would suggest having the provider who is ordering this to submit a predetermination. (a fax # was then provided)"

Interpreting this to mean the rep simply needed further clarification, I then sent a second email. "I do not need service right now. I am trying to determine if needed in the future and deemed medical necessary, would (name of insurance company) cover the cost to service/replace the remote and/or charging unit of my spinal cord stimulator. I ask because I am considering taking out an extended warranty to cover possible out of pocket expenses." to which the following reply came: "Any type of spinal procedures require prior authorization. I am unable to advise if it would be covered or not without review." I clearly stated I had already had a SCS and was speaking to remote and charging unit issues, not a surgical procedure. Surely, if the rep was so uninformed on the issue, she would have done further investigation into the matter before answering. If this was a bad attempt at trying to avoid giving a definite answer, it is a laughable one. Sad thing is, if I call the insurance company, as proven by recent experiences, I will likely get no better or more informed answer to my question. anyone have any suggestions on this? Is Boston Scientific allowed to contact my insurance and do you think they could get an answer?

Update: Called Boston Scientific, talked to a very helpful rep who informed me that the parts covered by the extended warranty are classified as durable medical equipment, not as a procedure code and to point this out to the insurance company. Sent a follow up email to the insurance company and will see if this gets a real answer.

Update #2: Don't know if it's because I mentioned taking out extended warranty (less money out of insurance company's kitty) or insurance's actual policy, but definitive answer of "not covered" came back rather quickly after last email. I would be interested to know just how many out there who have a SCS have an insurance that covers external remote/charger repair replacement?

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Posted by jlboman (33 posts)
Aug 20, 2013 3:54 AM

JP,

Most ins companies are now "dumbing down" so to speak. Hospital settings are using lower quailty equipment, ins companies are notifying providers that specific types of equipment will no longer be covered under certain plans.

This is all due to the poorly legislated "affordable" care act.

I was given a Rx for a bone growth stimulator when I broke my foot. After I was done using it, I asked the rep how to return the unit. The  FDA no longer allows returns of this (I could see not returning the actual contact, but the machine could be sanitized and used again!) and I paid $500 out of pocket to cover my % of the unit.

This is going to happen more and more. Ins will cover less and our costs are going up.

I am sorry that you havent been able to get it covered.

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Posted by jinglepaws (220 posts)
Aug 20, 2013 4:33 AM

Well, it sucks but better to find out before the fact. Now there is no question as to whether I have to pay for the $200 extended coverage policy through BS. I only hope that if I do need repair/replacement, the policy will actually cover expenses incurred and not be filled with loopholes.

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Posted by jlboman (33 posts)
Aug 21, 2013 11:44 PM

JP,

Will they send you the terms of the agreement ahead of time so you may review it and decide if the $200 will be well spent or not?

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Posted by jinglepaws (220 posts)
Aug 21, 2013 1:08 AM

Joanna: Good thought. I just sent email to BS requesting a copy. I am hoping they send a pdf file via email, we'll see. Did you take out the warranty? Have you had to have any repairs/replacements done on your system remote or charger? Anyone else who has the extended service policy and has had to use it feel free to share your experiences.

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Posted by gooneybirds (77 posts)
Sep 03, 2013 3:05 PM

JLB, hang onto your bone growth stimulator as you might need it in the future. I used one a couple of years ago when I had my back surgery, packed it away when the doc said I no longer needed it, and then when my husband had his back surgery we pulled it out, charged it, and he used it. And it still is usable today if either one of us needs it again. We save all the medical device equipment we have received as you never know when they will become necessary. Some duplicates we have donated to either friends or our park.

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Posted by Attheinlet (24 posts)
Sep 06, 2013 4:32 PM

JP, has BS sent you the fine print so you can decide?keep,e posted if you don't mind as I am getting my permanent implant Monday. And iam guessing I will have testament question come up as well .thanks,Kimberly

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Posted by jinglepaws (220 posts)
Sep 07, 2013 4:03 AM

Kim: Not a detailed contract, only a overall description that made it clear that only malfunctions and not loss or accident of either the remote and charger are covered. Being that I've heard on this forum that a remote alone goes for $1500 or more and my insurance has made clear they won't cover anything, I am forced to extend the BS warranty out of pocket. Better $195 than thousands. You are still out of luck if you get, say, in a car wreck (God forbid) or lose your charger or remote. I will be calling BS next week to pay the fee as my 1 year is up on the 19th. I just can't see taking such an expensive risk even if it only covers under specific situations. Hate handing over $195 but what are you gonna do?

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Posted by thunder wheels (51 posts)
Sep 28, 2013 10:20 AM

BS told me at the one year mark, they call you and offer the Extended Warranty! I think it will be a wise investment. The remote sells for $1,000 or more! Yikes! I wonder if each remote is sync'd to that specific IPG. Like if two SCS patients stood next to each other, and used the remote, what would happen? Anything at all?

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Posted by Attheinlet (24 posts)
Sep 28, 2013 1:54 PM

They could be programmed, but I know one remote won't work another right off the bat. The doctor who ran my SCS trial planned for the surgeon doing the operation to take it out. So , the rep took my remote, outside battery pack. Then the surgeon said no way, so the rep gave me a remote. She told me I let it run out of battery, which knew it was fully charged. She put it on gave me the remote. Once in the car to go back up the mountain, I was getting overcharged and the remote said it could not communicate with stimulator. Luckily on the trial, you had the off button on the belt. Used it!

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