ANA Discussion Forum
General Category => Insurance => Topic started by: Nani on September 27, 2009, 07:40:56 pm
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Okay, so I looked up BAHA on my ins website. It covers it as long as I meet the following conditions. I know I meet some of them. The others just aren't quite clicking.
• bone-anchored hearing aids (BAHAs) for patients with ALL of the following:
pure tone average bone conduction threshold of up to 70 dBHL (decibel hearing loss)
speech discrimination score of better than 60%
any of the following conditions:
o documentation of chronic ear infection/inflammation
o congenital or surgically induced ear malformations of the external or middle ear canal
o tumors of the external canal and/or tympanic activity
o conditions that contraindicate an air conduction hearing aid
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Nani -
I'm not a doctor, but I think you meet the requirements.
Which ones aren't you sure of?
Jan
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The first two.
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I'm not certain, but I'd imagine this means the hearing in your "good" ear has to be decent.
If it's greatly compromised, the BAHA on your "bad" side might not work so well.
Although I have a BAHA, I'm not very good with the "how and why it works" aspect. Catherine and Lori are much better at this; I'm sure one of them will chime in.
At this point there are three BAHA processors on the market - all made by Cochlear. The Divino, the Intenso, and the BP100.
I have the Divino because the hearing in my good ear is 100% - if it was much less than 100%, I would have gotten the Intenso (it's more powerful).
The BP100 is basically an upgraded Divino (more bells and whistles; more programmable).
There will be another processor on the market next month; the Ponto by Oticon - competition for the BP100.
Jan
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I had my hearing tested before I was diagnosed. My right ear is still pretty much perfect. Though that might have changed since my son started picking up those ungodly high pitched shrills of excitement that should not even be humanly possible.
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Ooooooo, Nani .....
I can identify with your son's high-pitched squealing. Our 2 1/2 year old granddaughter was bad about doing that when she was upset or wildly excited until we were really firm about "Shhhh, you are hurting Grandma's ear." She really has become very understanding and asks to go outside when she wants to squeal. (as in "That's your outside voice.")
Clarice
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Hmmm... well, I'm think you'd have to have your audiologist do a hearing test on your good ear to determine if you meet the requirements. That's what I had done. I guess it's just to make sure the BAHA will work for you - no point in putting a bolt in your head for nothing! :D
Your surgeon and audiologist should be familiar with what the insurance company wants to see for their predetermination. I would let them worry about that - one less thing for you to worry about. You may have to let them know you want the predetermination done to get the ball rolling, but after that, you should be able to leave it up to them to deal with. With any luck, they'll just call you when they get the approval and set up an appointment for you.
Lori
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Nani,
I agree with what Jan and Lori have said ... and it seems to me that you meet the criteria for getting a BAHA. Have you had a chance to try out a demo BAHA yet? That would be a good place to start. I've worn my BAHA Intenso for almost a year and a half now and find it to be a big help!
Hope it works out for you.
Catherine (JerseyGirl2)
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Thanks for interpreting Nani's insurance company's requirements, Lori and Catherine. Didn't want to lead anyone astray :)
Nani -
Lori has a good point - you should let your doc deal with the insurance company and follow up if necessary. Docs who do BAHA implants are pretty well versed in giving insurance companies the information they need to know to determine coverage.
Catherine also has a good point - you should try the BAHA demo before you schedule the surgery. You don't want to go into this lightly, and while most find the BAHA amazing, there are occasionally some who don't. You need to try before you buy.
Jan
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I was planning on it. I just didn't want to try it, fall in love, then not be able to get it.