ANA Discussion Forum
General Category => Insurance => Topic started by: Nancy T on April 12, 2007, 11:21:09 pm
-
Anyone have any idea on whether Blue Cross will ever come around to paying for the BAHA? I live in Oregon and my insurance won't pay.
I was told by an audiologist that after Medicare started paying for the BAHA (this was more than a year ago, I think) that BC would probably fall in line eventually, but that's not happening.
I'm hoping I'll be able to change insurance and get a BAHA.
Nancy T.
-
Hi Nancy,
Sorry to hear about your problem. I have Blue Cross and Blue Shield of MS and they paid everything but the out of pocket expense and deductiable. The reason I think mine went so well is I had my BAHA operation at the same time of my AN surgery. It was all included together and they paid.
Ellis
-
I think there is a quality of life thing with insurance companies. If you can get your doctor to wite a letter to the insurance carrier that having the Baha would give you a better quality of life the insurance company will more than likely pay for it. I have been told that most insurance companies deny things like that and things like gastric bypass, plastic surgeries etc. unless the doctors feel that it will enable you to have the quality of life previous to the loss. It is worth a try.
Good luck. You might also check out the trans ear. There are a lot of posts about that.
BrendaO
-
Thanks, Ellis & Brenda! I thought my doctor was going to write a letter to the insurance, but I have no idea whether he ever did. I am seeing him regularly and we discuss the BAHA at every visit--I know he would like to do it, he's a surgeon after all!--but he said something like it would probably take a lawsuit before the insurance company decides to cover it.
I don't think they make exceptions for certain cases--their policy states that they don't cover it unless you have a middle or outer ear problem that prevents you from wearing a hearing aid. Even though I'm just as deaf as someone with an outer or middle ear problem, they won't cover it because my deafness is inner ear! Dumb. It's illogical--just a way for them to cut costs. I suppose their logic is that I could wear a CROS aid, but all the professionals I've seen--audiologists and neurotologists--say I probably wouldn't like it because it would occlude my good ear.
However, I can't complain about BC otherwise--they have covered all my tests and expensive medications that some other insurances don't cover.
Nancy T.
-
What is BAHA?
-
What is BAHA?
Hi Harry and welcome,
Here is a great link re: BAHA (Bone-Anchor Hearing Aid), with pictures of JoeF and his BAHA, as well as a terrific link about BAHA...
http://anausa.org/forum/index.php?topic=2677.0
Also, if you do a "Search" on this website for BAHA, you will find MANY threads re: discussions for BAHA, such as insurance/Medicare coverages, pros and cons of the device and other add'l info.
Hope that helps.
Phyl
-
Aetna denied my BAHA request even at the same time as surgery.
-
can one go swimming with the baha?
-
Nancy, ask your provider if the BAHA can be coded as a necessity of having had your "hearing nerve amputated during tumor excision".
-
Ixta,
One may never swim nor shower with the BAHA unit snapped onto the bone abutment. The bone abutment stays with your skull all of the time. The BAHA unit, (the electronics part) is extremely sensitive to getting wet, bathing and swimming. Check out the BAHA site.
Can't swin with a TransEar either.
On another point though, there is a Cros hearing instrument that works inside a football helmet! ::) How's that for sweat?
-
I had my BAHA imipant on January 3rd 2007. It is just amazing. It justs snaps on so quickly. My Insurance CareFirst BC/BS of Virginia paid the Dr., hospital and imlpant, but did not pay for the device which makes no sense. Why would they approve and pay for the surgery and implant and not the device. The surgery is pointless without the use of the device. I have been appealing this decision and will continue to. I am working with a BC/BS rep in my area and the Audiologist at John's Hopkins medical center. I have a letter fror my Dr. too.
The Insurance says, "we don't pay for hearing aids". As you know this is not just a hearing aid. So I will continue to fight them.
Medicare does pay, but why wait until you are that age and miss out on hearing. The cost for the device was $4200, but worth it.
-
ixta you snap off the hearing device and can swim, dive, shower etc....
Laurie the device itself cost 4200? I know they quoted the overall price around 10-12K....
I'm wondering how much just the headband device is.
-
Hi Boppie, thanks for the advice. However, I never had an AN. I had a sudden hearing loss when I sneezed. No cause was ever found, but my speech discrimination is 25-40 percent (depending) and my hearing loss is in the severe-to-profound range from 750 Hz up. So, I'm essentially deaf in that ear.
Blue Cross in Oregon just reviewed their policy and still won't pay for the BAHA. Actually it never occurred to me that they might pay for the SURGERY but not the aid. I should double-check with my neurotologist, but I know I'm on his BAHA list, so I'm sure they would have let me know if the insurance would pay for it.
Nancy
-
I'm 63, on Blue Cross Blue Shield of Ma. very good insurance but I have been out of work for 1 year due to a knee replacement and a work injury, I have taken over paying my premiums so that I wouldn't lose this ins. I'm a watch and wait right now and looking into all my possibilities.l The doctors advise me to have surgery after three MRI's since Feb. I'm scheduled for another MRI inn Nov. My AN is only 1.2cm x 5.4mm. My question to everyone is if I retire soon and I lose this insurance will Medicare pay for this surgery and all that goes with this AN. Has anyone had this done on Medicare. I hate to have to decide on surgery based on Insurance. MY AN is on the 8th cranial nerve and the 7th is enlarged. I have lost almost all of my hearing on the left ear and have balance and vertrigo issues.
Thank you for all of your great input in helping all of us Newbie's. There is so much to consider and I'm thankful that I have time to completely digest all these options.
Sue/NH
-
Sue, If you wait until you are on Medicare you will get ziltch, zero, nada, for any type of hearing device. I had my surgery at 64 and my TransEar by 64 and 10 months. United Health Care paid for my TransEar based on hearing nerve amputation, not on the code that it was a hearing aid. "Hearing Aid" for Medicare means you pay, no exceptions I was told, not even amputation of nerve.
I am on Medicare now and cannot believe the difference in "what you get". I should not be surprised but I am still young in my mind. ;D The good old days of UHC are gone as primary provider for me.
-
Thanks for your reply, this might make my decision based on insurance, (I Think). Will Medicare pay for the AN surgery or a certain percentage?
Sue/NH
-
Sue,
Are you asking about Medicare coverage for the surgery to remove the tumor, or for the surgery to implant a BAHA device? I'm getting confused... (not too hard to do these days!)
Katie
-
I believe Medicare will cover necessary surgeries and hospital costs. There are deductibles but they are not high. It is just the hearing aids they don't cover at all.
-
Medicare Hospital deductible is $900. per year.(2007) This comes off of the first hospitalization. Additional hospitalizations for the same calender year would fall under the $900. They also have allowed charges for different things., so if you exceed the allowed amount you may be billed more.
It's important that when you go on Medicare that you purchase the part B. This covers the hospital and such that Part A does not cover. You can additionally purchase a Medicare supplement Insurance that will help fill in the gaps that Medicare doesn't pay. A trusted insurance agent can assist you, or check with AARP.
Best to you
raydean
-
I didn't look up the deductibles. That is a chunk out of the pocketbook, isn't it?
-
Thanks all for this info, I'm very concerned about all the cost especially since I'm reaching retirement age. I understand that AARP has the best supplemented insurance.
Has anyone considered these insurances that for a minimal amount per month and also has a NO pre-existing clause would pay you so much while you're in the hospital and if you continue your existing treatment from the hospital to home they also pay so much a day. It's for you to do whatever you want, it would certainly pay for the added out-of -pocket money that we have to dish out for deductibles or hearing aids that insurances don't pay. The reason that I mention this is my daughter who has Cystic Fibrosis we got her some of those insurances and she collects on them everytime she goes in the hospital and it helps her to pay additional expenses. The only drawback is paper work. You have to keep track and submit it to them. But it's worth the hassle for the extra money.
The first time I was asking if Medicare pays for surgery etc......Thanks you for some clarification on that.
Sue/NH
-
Does your insurance company know what a BAHA is? The only reason I ask is that mine had no idea what I was referring to. When it came down to it I asked them if they were familiar with Cochlear implants and if they cover them. It turns out they do and based on that, they tell me that they will cover the BAHA also. I plan on double checking with them prior to my surgery (tentatively scheduled for early 2008) just to make sure they really will cover the entire cost of the BAHA.
-
Great suggestion, Bruce.
Thanks,
Jan
-
Boppie, are you sure Medicare won't pay for BAHA? I thought they did--starting at the beginning of 2006? They changed their policy.
I THINK. I am not sure about that, but whoever's interested might check it out. I do remember an audiologist I spoke with about the BAHA in summer 2005 saying that Medicare was going to start covering it after the first of the year and then I had a better chance that my insurance would, too.
Later I saw that indeed Medicare does pay for it (I THINK)--they changed the policy--but my insurance (Blue Cross) still doesn't.
Nancy T.
-
I'm sure I read somewhere that Medicare covers the BAHA and I think it's the surgery as well as the device. I'm not 100% certain about this, though.
-
You have a good point...The information I got in July 2007 about BAHA came from my audiologist during a discussion on Medicare and hearing aids, but he hasn't seen another AN patient besides me. Specifically, he said Medicare wouldn't cover the BAHA. But the surgery for the post implant is another story I think, as that would be covered by Medicare in any necessary surgery. I'd sure get the BAHA implant at the same time as the surgery. A surgeon sets this up at the same time and surely gives credence to the idea of necessity; so, denial of benefits would be more difficult.
I googled the two words BAHA Medicare and came up with the answer about the device. Check it out. BAHA is not in the same category as a hearing aid, that is the exception. I'd imagine some other aid developers will get into this also, in future.
I think it is too bad that regular hearing aids are not allowed for serious hearing loss. Too many older people lose out on life from poor hearing.