ANA Discussion Forum
Archive => Archives => Topic started by: rheab on March 17, 2005, 08:49:02 pm
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I know that there are thousands of people who have had BAHA's implanted. My ins co refuses to pay for the external device. They pd for the implantation surgery. Seems that they consider the hearing device as a simple hearing aid. Like I really wanted two screws in my skull for looks! Has anybody else had a problem w/their ins co rejecting the device? Please respond. My doctor and I are trying to figure this out. I was his second BAHA case. His first one was pd for by the same ins co that I have! He's done about 100 of these since I had my implant 11 months ago. If this ins co rejects mine, it will reject the majority of his other patients, too, as it is the majority ins carrier for this state. I love the device. It has made a world of difference in my life. If I have to pay for it, I will of course. This is not a simple hearing aid. I tried several types and none of them worked. This thing is remarkable. Don't mean to keep going on. Looking for help. I'm almost 4 years post op. Doing great. Had the subocciptal approach. No facial paralysis, no dry eyes, etc. Experiencing fullness in deaf ear and some imbalance. Doc says it's muscular, so he prescribed muscle relaxer, which relieves the symptoms. Anyway, I'd like to hear from others who've had the BAHA and have had issues with their ins carrier. Thanks. God speed.
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By the way- do you know how much the Baha might cost you if you can't get insurance to pay?
This is something I may consider in the future. It scares me though. Can you sleep on the side of your head with the screws?
Sorry to not answer your questions except with questions of my own.
Thank you for any reply.
Alisa Andree
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What I am looking at is a balance due of $2500.00 for the external device. My ins co pd for the procedure to have the screws put in, but not the external device. Makes no sense to me. Anyway, I don't even realize the screws are there unless I happen to brush my hair and hear it scrape. It does not interfere w/sleeping, showering, blow drying and setting my hair, etc.I have to warn hairdressers, tho. It will freak them out to scrape the thing! The device is wonderful. I cried when I first tried it at my doc's office. It took 3 months for the screws to heal. That's normal from what I understand, but my doc has tried new procedures for putting the screws in and he says that those people have a much quicker recovery than I had. Then I cried when they put the thing on my screw the first time. (There are two screws-one above the skin and one below in case the one above the skin gets knocked out-ughh) It is amazing. My doc says that if ins hadn't pd for the surgery, I would have been looking at about $10,000.00. Hope this info helps. My doc is looking to Entific to give him some direction on getting pd for this. He may be out a lot of money if ins doesn't pay for all that he's "installed." I wish you luck. I highly recommend this thing, even if my ins ends up not paying for it!
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The answer to your question depends on the health insurance policy. Plans differ within the same company so one patient may have coverage while the next one may not. In my research I've found that the external portion of the BAHA is considered a "hearing aid". Unless a person has coverage for hearing aids (usually an additional rider to the policy) hearing aids are not covered. Medicare also refuses to cover hearing aids. In talking to our doctor we've found that the surgery would also be covered, but not the external hearing device. The doctor was up front about this possibility. I'm surprised that this issue didn't come up during the pre authorization stage.
I know that BAHA people are working on getting this changed, but for right now most of the time hearing aids aren't covered.
I hope this helps to answer your question. Please look at your health insurance policy or talk to your agent, but it's my guess that there's a hearing aid exclusion to the policy.
Best to All
Raydean
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I've had my BAHA 1 1/2 weeks now. I have noticed an improvement, not as drymatic as I had hoped, but it is better than before and people have noticed I'm hearing them better and have made positive comments.ÂÂ
As for insurance, I had no problems, my insurance paid for the implant and hearing device. I'm told that companies that pay for the hearing device are looking at BAHA's as a prothetic device. If that's the case it wouldn't make sense to pay to fit a limb to accept a protehtic device, but then not pay of the device. They that approach with your insurance company.ÂÂ
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Call the Entific people yourself. I talked to a woman in their claims dept. She said to call her if I needed help.
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I am planning on having a BAHA placed a couple of months from now. I am already prepared for denial from my Ins. company. My doctor says to keep appealing and keep appealing until you get to the medical director of the ins. keep fighting. get letters of necessity from you doctors and send them in.
I was told it would cost about $12,000 for the whole thing, surgery and hardware.
jennifer