Medically Necessary but not covered???

[beachman]

Has anyone run into this one?  The director of the insurance company BC/BS said the BAHA is medically necessary for my husband due to underlying issues but because of the wording of the contract that my company has it is not covered? 

[leapyrtwins]

The wording of the contract may say that the policy doesn't cover hearing aids; most insurance policies don't.

The BAHA isn't a hearing aid though - it's a prothesis or an implant. 

Cochlear will help patients "fight" their insurance companies for coverage http://anausa.org/forum/index.php?topic=11751.msg135380#msg135380

You can also contact Cochlear directly - look for the information on their website www.cochlearamericas.com

Good luck,

Jan

[Ellenmn]

I am having the same issue with BCBS of IL. The people at OMS said they will file the appeal  but when I talked to her she didn't sound very positive. I hope the appeal works.

[leapyrtwins]

Ellen -

have you asked Dr. Battista for help?  He and his staff usually know what they need to do to get insurance coverage.

Also, check out this thread http://anausa.org/forum/index.php?topic=11751.0  It contains a link from Cochlear Americas that helps BAHA candidates get insurance coverage.

In addition, I have a contact @ Cochlear who might be able to help you.  I met her at the ANA Symposium in Chicago this past August.  If you'd like her information, please PM me.

Good luck!

Jan