ANA Discussion Forum
General Category => Insurance => Topic started by: TimButz2 on September 17, 2009, 04:45:10 pm
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I recently had my fourth surgery on my right ear to remove cholesteatoma. At my last visit to the doctor he stated that my ear look really good and we could start talking about doing the BAHA surgery.
I am covered under United Health Care. What I would like to know is what steps you and your doctor took to get United Health Care to cover the BAHA surgery. If you have any copies of letters or correspondence that you or your doctor sent to get approved would be greatly appreciated.
When my doctor told me about the BAHA surgery and the prospects of being able hear again filled me with excitement. This surgery means so much to me beacause I want to be able to hear everything my sons tell me. I thank you in advance for your help.
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I had United Healthcare. The policy clearly stated that it did not cover any BAHA, Cros or any similar devices. My doctors all sent letters stating that it would greatly improve the quality of my life. It was still denied. I hope you have better luck with them than I did.
Good Luck,
Brenda
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Tim -
I don't have insurance with United Health Care, but I have a BAHA and am enarmored with it ;D
I'd like to suggest you contact the ANA office - contact info on the main page - and ask if they have any suggestions for you. You should also contact Cochlear (www.cochlearamericas.com) - they have district reps that can give you some direction on insurance coverage. Lastly, you might be able to find a doctor in your area who will work with you on the cost of the BAHA if you tell him/her your insurance won't cover it. Some docs will give reduced rates.
The main thing to stress with an insurance request is that the BAHA is not a hearing aid - it is an implant. You should also see if your policy covers Cochlears. If it does, you have an excellent case for coverage of a BAHA. If they cover Cochlears and not BAHAs they are discriminating against you because you are unilterally deaf - not bilaterally deaf.
If you are refused coverage, don't give up. It's worth it to push the issue - I've heard from the ANA that first requests are often turned down, but second requests seem to faire better.
Best of luck,
Jan
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Tim,
I agree with Jan. I tried for a year, but was turned down every step of the way. My doctors all told me any other insurance company would have accepted the request after the second try. Don't give up though. There are a lot of agencies out there willing to step up if you have the time and patience to look. Jan is right, contact the ANA and see what they suggest.
Good luck!
Brenda
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Thank you Brenda and Jan for the advice. I will certainly let you know how I make out.
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Good luck, Tim and don't give up...write to your congressman or woman while you are at it, with the insurance companies denial and your doctor's letters stating that it would greatly enhance your life.
Brenda
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I just wanted to say that I am thankful for you for sharing with us that post about your coverage on the united health care coverage.
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I used to work in an optometrist's office. I hated filing UHC. They are very difficult and have a lot of red tape.
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FWIW, I have UH and have minimal complaints, but I just wanted to point out that not all UH insureds have the same coverage. Most UH plans are designed by the employer that contracts with UH and the employer dictates what coverage they want in the plan they provide and UH prices the plan accordingly to the employer and provides that coverage to the employees. So my UH coverage from my employer is probably different than your UH coverage from your employer (unless we work for the same employer, of course).
Neal
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I so agree with Neal that each employer designs their own plan with UHC. The company my husband worked for, a small company, had to keep changing the coverage each year because the cost went up. We had coverage with UHC for four years and each year it cost more and covered less. Our med copays went from $5-15-30 to $15-35-65 in that amount of time. Healthcare is just not affordable for too many people.
Brenda