ANA Discussion Forum
Treatment Options => Microsurgical Options => Topic started by: kixit on April 01, 2012, 12:01:07 pm
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I'm new to this forum and just figured out how to post, so I really am a newbie. I have been diagnosed with acoustic nueroma, 9mm--rather tiny but casing symptoms. I woke up Feb 17th deaf in my left ear. I thought nothing of it since I was battling a cold all week and thought it was just sinus related. I woke up the next morning with my world spinning, still deaf. I went to urgent care for the spinning and nausua. I followed up with my PCP on Monday. She prescribed Z-Pac for sinus infection as well as Prednisone for sinus swelling. I asked her if I would be better by the weekend so I could go back to work, she said sure. By Wed. the ear was still deaf so I requested an ENT. After my visit with him he ordered an MRI which showed the lil bugger in my left inner ear. I wasn't so concerned with the tumor as I was the deafness. Needless to say all through this I've been walking like a drunk person.
I had an appointment with ear surgeon (1 PM) and neurosurgeon (3 PM) at UVA in Charlottesville, Va. Dr Kesser (ear surgeon) explained everything. We discussed treatment. I said if my balance will not get any better without surgery then it has to go. So we decided on the translab approach and I'm also attempting to get the BAHA. I'm wondering if my Anthem insurance will pay for that. My policy states no hearing aids and they consider bone anchored ones just that.
My balance is a lot better (I was told it would improve because the right side compensates.
My surgery will be on May 24th and I won't need the neurosurgeon : ).
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Hi Kixit, welcome to our little community. I'm sorry you had to find us, but I am glad you did.
I can't tell you specifically if Anthem will cover your BAHA. However, I can tell you that as a state employee on Anthem in Virginia, Anthem covered all my surgeries (at MCV/VCU), including the BAHA implant and device without a squawk. Hopefully your experience will be similar.
I would be remiss in asking, even though you have made decisions, whether or not you considered radiation therapy, such as CyberKnife, GammaKnife, or other? Some find that a preferable approach to a small tumor.
Best of luck to you,
Tod
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Thank you for the warm welcome! ;D I told the surgeon straight out no gamma knife. I don't want radiation in my head. He agreed wholeheartedly because of my age, the SSD and research has only been recent (approx 15 years) about future results of tumors turning malignant. I also tols him that radiation can leave scarring and that if sugery was required in the future it would be difficult to remove the tumor. He seemed impressed with my knowledge on the subject. I told him I had been off of work for a month and I'm in "research overload", lol.
I am a local government worker for the police dept. ( a proud animal control officer, lol) and that's why I am concerned about insurance paying for the BAHA. As you can imagine my hearing is pretty much my job. My insurance is Anthem of Va and the policy states:
"Your coverage does not include benefits for hearing care except as defined on page 33 of this booklet.
Your coverage also does not include benefits for implantable or removable hearing aids, with the
exception of cochlear implants"
So that has me nervous if the insuance is going to pay. If I get a denial. does anyone know how long an appeal takes? I have 7 weeks until translab surgery along with BAHA (fingers crossed).
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Thank you for the warm welcome! ;D I told the surgeon straight out no gamma knife. I don't want radiation in my head. He agreed wholeheartedly because of my age, the SSD and research has only been recent (approx 15 years) about future results of tumors turning malignant. I also tols him that radiation can leave scarring and that if sugery was required in the future it would be difficult to remove the tumor. He seemed impressed with my knowledge on the subject. I told him I had been off of work for a month and I'm in "research overload", lol.
I am a local government worker for the police dept. ( a proud animal control officer, lol) and that's why I am concerned about insurance paying for the BAHA. As you can imagine my hearing is pretty much my job. My insurance is Anthem of Va and the policy states:
"Your coverage does not include benefits for hearing care except as defined on page 33 of this booklet.
Your coverage also does not include benefits for implantable or removable hearing aids, with the
exception of cochlear implants"
So that has me nervous if the insuance is going to pay. If I get a denial. does anyone know how long an appeal takes? I have 7 weeks until translab surgery along with BAHA (fingers crossed).
Just wanted to comment on the surgery after radiation I have read that is definitely possible but of course only with trained hands..As far as the insurance there is always an exception that the doctors can write to a Supervisor, Manager or their Medical Board and do a strong letter on your behalf and 99% of the time they will allow it. It is time consuming and a game that is played but can achieve good results.
Best Wishes,
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BAHAs aren't conventional hearing aids and shouldn't be coded as such for insurance purposes. Technically a BAHA is a prosthesis or an implant.
Your best bet is to contact the company that will be manufacturing your processor (Cochlear for the BP100, BP110 or Oticon for the Ponto series) and ask them to fight your insurance battle for you. Both these companies have insurance divisions that will help you and they know what insurance companies generally need to grant coverage.
If you don't know which company to contact, ask your doc(s).
Good luck,
Jan
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I've been reading where there are different styles of Baha's depending on your degree of hearing loss. I am SSD thanks to AN with 70dB (last hearing test was 3/14/12). On one site it showed a BAHA with an attatchment to be worn on the body for my degree of hearing loss. I don't want that style. Any suggestions? Also, this may be a dumb question-do I wait for a response from the insurance company to see if they are going to pay or should I contact the facility (UVA) that is going to do the surgeries to see if they have submitted the procedures yet?
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Hi kixit and welcome .....
As a Ponto Pro wearer, I am a little confused by what site you are looking at with a BAHA that has an attachment to be worn on the body. To my admittedly limited knowledge, it is my understanding that all bone anchored hearing devices have a processor that attaches to the abutment implanted in the skull. The processor is what receives the sound to conduct it through the abutment and your skull to your remaining good auditory nerve on the opposite side from your AN. See: http://www.oticonmedical.com/
Translab surgery removes all hearing apparatus from the AN side, along with the tumor, so you will be totally deaf or essentially have a "dead ear" on what will then be your former AN side.
Maybe you have also read about CROS hearing aids, which is an entirely different way of conducting sound to your "hearing" ear.
I, too, had no difficulty with insurance coverage for my Ponto. Previously, I had to pay 100% on my hearing aids, but insurance picked up 100% on my bone anchored device.
Clarice
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Hello, I just wanted to add my welcome to this rather exclusive club! It sounds like you are pretty well informed...I think a majority of the people who find this forum, myself included, seem to handle things better because of all this information! This was pretty evident as when I had my surgery done at House Ear Institute, and I was staying at Seton Hall and there were a few people coming in who had absolutely NO clue what was coming are what to expect... and you could tell they were definitely worried about the whole process. Jan gave very good advice about the BAHA insurance...the hearing loss is medically induced, not caused by too loud of music or whatever, so it should be treated as a medical procedure. Good luck to you and keep us updated!!
Jay
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Hi Kixit and welcome,
We just had a support group meeting and had rep from BAHA there.. VERY informative. There is a device that you wear like a necklace for some people. I did not pay much attention to that as it was not for me. But one lady has untreated AN on one side and bad hearing on other and he demonstrated it for her. But he also demonstrated the "typical" behind the ear device on everyone of us and it is amazing how well it works. . of course there was a lot of static noise and was not as clear as one implanted, but you could get the idea of help it would give. So just wanted to add to other posts, that yes there is a device worn in front like necklace,, but evidently not used by many.
It was also mentioned that most insurances will pay,,, "eventually",,, after some appeal as these are not actually considered "just ' hearing aids,, but prothesis hearing aids,,, definintely go through BAHA co. insurance/customer serv, dept, for help.. I have not begun the process yet, as I plan on recovering before moving forward with all of that.. maybe soon.. good luck,, Jane
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I called my insurance carrier today (Anthem of Va) to check to see if my surgeries were approved. My translab was, no question. They had not gotten a request from my doctor for the BAHA!! After speaking with the insurance nurse-she said they do pay for the BAHA if the criteria is met and it sounds like I meet it. All she needs is the request from the doctor-so don't think as soon as I hung from her I called UVA right away!! It was probably an oversight on his part. He added it to my permission for treatment form after I signed it.
It definately is a good idea to double check behind your medical provider. They do get busy and have more patients than just you/me. The nurse said a lot of people don't check and then they are faced with charges that weren't pre-approved and can't be approved after the fact.
The countdown is on-- 6 weeks (May 24th) till Translab and BAHA. Then 3 months until I can hear on BOTH sides again. 8)
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P.S. As I went through the "people tree" with Anthem, I found it humorous that I knew more about the BAHA than they did (except the nurse). Both phone techs had no idea what a BAHA was and what it is for.
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kixit -
the device you saw with the "body attachment" isn't a BAHA, it's called a Cordelle and it's not for those of us who are SSD. Cordelle's aren't widely worn these days.
Lots of medical people have no clue what a BAHA is - including my kid's pediatricians and my ENT (gasp!). I had my implant at a hospital (outpatient) where my doc usually doesn't do BAHAs; in fact I was the hospital's "first". My doc and I were only 2 of 3 people who knew what the BAHA was. One of the nurses had seen the schedule the day before and researched BAHAs on the internet; pretty impressive.
Jan
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I was denied coverage for the BAHA. There is an exclusion in my policy for them but there is coverage for cochlear implants. I immediately called insurance company, got the run around about coding and unanswered questions. I sent Cochlear an email for help. I plan to write my appeal letter sometime today (Imworking). When I got the denial email from my surgeon I felt like I had been punched in the stomach.
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I was denied coverage for the BAHA. There is an exclusion in my policy for them but there is coverage for cochlear implants. I immediately called insurance company, got the run around about coding and unanswered questions. I sent Cochlear an email for help. I plan to write my appeal letter sometime today (Imworking). When I got the denial email from my surgeon I felt like I had been punched in the stomach.
Don't give up keep appealing 99% of the time persistence pays off...Now the denial letter from your doctor did they fight for you and lost or this is only the first time and they sent just a normal letter..The key to winning with insurance companies is a strong letter from the doctors and yourself I have not heard of any BAHA denials usually these are covered and hearing aids are definitely never covered, but do not give up that is what they want and how they win if someone keeps up with it they will soon win...Hoping you will be one of them..
Best Wishes,
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I talked with Cochlear today. They sent me the appeal paperwork. The consultant wanted to know if my insurance was self-funded. She said if it was the I may have a better chance of winning the appeal because the employer can overturn the denial. I put a call in to HR. Also, I called Anthem requesting the denial letter. I was told they didn't have one because it's straightforward BAHA is not covered but they could "create" a letter. I mentioned Cochlear helping with the appeal 8) A few hours later......Anthem calls to say they are putting a hold on the letter for further investigation into my case. I said you told me its straightforward "no coverage". She said she has put a call in to Dr Kesser for further information. So......you deny my coverage for the exclusion in my policy then tell me hold up I'm investigating further. Should I be confused? I am cautiously excited that I may not have to fight for my hearing!
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Kixit ~
From my experience with insurance companies, I would venture to guess that you now have a reasonable chance of getting your appeal granted. :)
Jim
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I certainly hope so Jim. UVA e-mailed me an estimated price---- $20,113.00 (give or take). They need an approval or money in hand by noon May 11th. That's if I want it done with my Translab on May 24th.
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kixit -
if your insurance policy covers CIs (cochlear implants) they have to cover BAHAs or they are discriminating against you, which is illegal.
CIs are for those who are bilaterally (double-sided) deaf, while BAHAs are for those who are unilaterally (single-sided deaf). Your insurance company can't use the tactic that you aren't "deaf enough" for them to pay for the type of hearing implant that you need.
Call your insurance company, insist on talking to someone in charge - like a supervisor - and mention "discrimination". Include the word "lawsuit" in your conversation and see where you go from there. They need to know that you are serious about this request - and they need to know that they are in violation of the law.
Good luck,
Jan
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Jan,
I called Anthem on Fri., straight out I was told because I have an exclusion in my company policy they won't cover. Well I mentioned descrimination, Cochlear helping with the appeal and the state commission. Anthem was going to create me a denial letter since there wasn't one already because of the exclusion. At 3 PM, Anthem called said they were putting the letter on hold because they were going to investigate my case further. My response was but you said....she said maam we are going to talk with your doctor and so on. I also left a message for human resources about being self-funded insurance (per Cochlear) and I mentioned discrimination as well ;D. I'm fighting this like no other. My job depends on it!
I get a lot of information from this site. The people here are so informative and supportive!!
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Jan,
I called Anthem on Fri., straight out I was told because I have an exclusion in my company policy they won't cover. Well I mentioned descrimination, Cochlear helping with the appeal and the state commission. Anthem was going to create me a denial letter since there wasn't one already because of the exclusion. At 3 PM, Anthem called said they were putting the letter on hold because they were going to investigate my case further. My response was but you said....she said maam we are going to talk with your doctor and so on. I also left a message for human resources about being self-funded insurance (per Cochlear) and I mentioned discrimination as well ;D. I'm fighting this like no other. My job depends on it!
I get a lot of information from this site. The people here are so informative and supportive!!
That is the game or the insurance companies wishful thinking that people do not fight it and you cannot imagine how many give up but the few that will not take no for answer will get results the insurance has a certain amount allotted for out of network cases or medically necessary and will approve it I forgot thought not sure if the Cochlear is considered a hearing aid or like the BAHA which is almost always covered. I know hearing aids are not covered at all with all insurance companies I have yet to hear of one that does .. .. Do not give up be persistent and hoping it will be covered for you. It is sad with doctors high malpractice insurance and shady doctors and the insurance companies game as to limited coverage that is has come to managed care and difficulty having to get approvals but with both it is the bottom line and that is money and the patients are the ones suffering because of it !
Best Wishes,
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kixit -
if your insurance policy covers CIs (cochlear implants) they have to cover BAHAs or they are discriminating against you, which is illegal.
CIs are for those who are bilaterally (double-sided) deaf, while BAHAs are for those who are unilaterally (single-sided deaf). Your insurance company can't use the tactic that you aren't "deaf enough" for them to pay for the type of hearing implant that you need.
Call your insurance company, insist on talking to someone in charge - like a supervisor - and mention "discrimination". Include the word "lawsuit" in your conversation and see where you go from there. They need to know that you are serious about this request - and they need to know that they are in violation of the law.
Good luck,
Jan
I think I wrote earlier about hearing aid so both of these should be covered by the insurance I forgot what the Cochlear was hate the brain freeze.
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Anthem called. Denial letter is in the mail. However, human resources is checking with their group administrator and is waiting to hear back from them. The insurance book that I got my information from (as I was informed) is outdated (2009)but nonetheless descriminatory. And I mentioned that to human resources. They didn't comment, lol. I have an update fee for the BAHA surgery ($20,113) and processor w/headband-I won't need the headband, ($5100) for a total of $25,213. All to be paid on or before May 11th at noon.
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What type of discrimination are you talking about? Just curious.
James
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Anthem of Va is my insurance carrier. In my employers policy there is an exclusion for bone anchored implants but it covers cochlear implants (used for bilateral hearing loss) but doesn't have any coverage for unilateral hearing loss. That is descrimintaion in my eyes..errr..ears..lol
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This is definitely discrimination - my insurance broker confirmed that when I first approached him about whether my insurance company would cover the BAHA. He said "if they cover Cochlear Implants, they HAVE to cover BAHAs".
There was a case here in Illinois about a year ago where BCBS-IL was denying a young girl who clearly needed a BAHA insurance coverage. The media made such a huge case of it (it was all over the evening news) that BCBS-IL couldn't change their opinion fast enough.
Sometimes you just have to rock the boat.
Good luck, kixit.
Keep us posted.
Jan
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kixit;
I had thought by state law that brain surgeries required the attendance of a Neurosurgeon? Seems this is how Dr. Shahinian ( Minimally Invasive Endoscopic Neurosurgery ) at Cedars Sianii, got in trouble and involved in court hearings years ago.
Re, BAHA; Of course most are candidates, but not all. An Audiologist must determine the pts. "air bone gap". Some do indeed hear better with a Cros Hearing aid. Some loudness levels are just better with a Cros HA.
Not sure I'd want to call that last person a "Numbskull" :) or not. I can't run so fast anymore.
Best wishes!
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I had a consultation with both ear surgeon and neurosurgeon. I won't need the neurosurgeon since the AN is still in the IAC (but he will be on standby).
I contacted HR again. She said that she has still not heard from the policy administrator and will wait till Friday to call them (it takes time to research is what I was told). I told her that I all I was waiting on is the denial letter and sending my paperwork in to Cochlear for the appeal. I want them to know I am fighting it with the company.
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Kixit,
I find this odd that you wouldn't need a neurosurgeon, unless you are talking about just for the BAHA. My AN is still in the IAC, but I will have both doctors. Just my thoughts...
Lisa
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Lisa .....
I thought the same thing. The second time (when it was translab) my AN regrowth was all in the IAC. The otolaryngologist (Dr. Friedman) did the opening and removal of the middle ear parts, then the neurosurgeon (Dr. Schwartz) did the actual tumor removal, then Dr. Friedman returned to implant the Ponto BAHA abutment. The IAC is well within the skull so it puzzles me that a neurosurgeon would not be needed.
Clarice
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The problem with insurance policies is we never read them until we want to make a claim. I live on a river in central Texas, and flooding is not covered in my home owners policy, so I bought flood insurance from FEMA. If your policy had not purposefully discriminated against bone anchored devices, then you might be able to argue your case, but in a legal sense, they wiped their hands clean ahead of time, and you probably don't have a legal right to argue the case, because it is specifically denied in the policy...just like flood insurance.
Do you have a copy of the policy? Have you actually read the paragraph that denies bone anchored devices? The reason I ask, sometimes we can get into a personality dispute with the person on the other end of the line, and they can make it their business to make sure you have a bad day...deny your claim..."by the way a denial letter is in the mail."
Get your hands on the policy that your employer has, the one that covers you. Post the paragraph here and let's see what it says. Sometimes there is an answer written between the lines, and I am pretty good at reading what is not printed. Maybe we can find an answer. Just claiming "discrimination" is a hollow argument and will get put on permanent hold. Get the policy, and let's have a look.
James
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My Anthem insurance policy states the following:
"Your coverage does not include benefits for hearing care except as defined on page 33 of this booklet.
Your coverage also does not include benefits for implantable or removable hearing aids, with the
exception of cochlear implants".
There is nothing on page 33 about hearing coverage---nothing!
When speaking with Human Resources earlier she said this was a gray area ( I had asked her about my chances of getting an approval) and that it is a case by case basis. She had not heard back from the policy administrator yet. Hopefully they will say YESSS give her the BAHA!!
UVA said a peer-to-peer with my surgeon is probably not necessary because it's not a medical necessity issue it's a non-coverage one.
I am sending Cochlear all my paperwork for the appeal. I got the "denial" letter today. Don't get me wrong-I'm not angry at anyone, just annoyed that there is coverage for bilateral hearing loss but not unilateral hearing loss.
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Are you reading the 2009 policy or is it a current policy? If you have the old policy, your page 33 is probably different than their page 33. Try to get the current policy so you know what their page 33 says.
I might throw this in. My insurance company lists my BAHA as a PROSTHETIC, not a hearing aid. The abutment, the little screw that gets drilled into your skull, is not an implant...it becomes part of you...it does not come off...your skull grows into screw. The BAHA is a sound processor, not a hearing aid. The key word here is PROSTHETIC. It is not a removable hearing aid. The processor is removable for maintenance and it cannot get wet. The abutment is not removable.
So this is the problem. You have an old policy, they have a new policy. Your page 33 is different than their page 33. You are thinking prosthetic, and they are thinking hearing aid. Ask about their prosthetic policy.
James