ANA Discussion Forum
General Category => Insurance => Topic started by: conniefields on August 29, 2013, 07:41:48 am
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I need to know if anyone who has been rejected by insurance for BAHA. has appealed and gotten approved and what you did to help the process. I have SSD from my AN and insurance won't approve my BAHA.
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I received denial of coverage for the BiCROS and BAHA. I am appealing and probably won't know the response for a while. The company I have retiree coverage with is self insured but Humana administers the claims. Humana denied coverage. I sent an appeal to my former employer's plan administrator in the HR dept. First I was told they were opening up a plan administrator review. Yesterday I received an email saying my doctor requested authorization which was denied but that isn't the same as being denied. HR threw the ball back in Humana's court and if Humana denies it again THEN the company will open up a plan administrator review. Personally, I think they are trying to wear me out with all their BS...
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My appeal letter includes information I found online that Medicare covers the BAHA and what the Medicare definition of a BAHA states. I also stressed the fact that my hearing loss is a result of a covered medical condition.
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**see my postings
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Realize this post is a few months old, but haven't been on the Forum in ages.
At the time I got my BAHA (almost 5 years ago) I was told by the folks @ the ANA that most insurance companies deny coverage of the BAHA the first time you ask. However, they also told me, if you keep asking odds are good that they will eventually agree to coverage.
No insurance company wants to pay a claim - especially an expensive one (and BAHA surgery and processors aren't cheap). Most people take no for an answer and drop your request. Be persistent; don't take no for an answer. Find out why they are denying coverage. Also, get your doctor's office and the manufacturer of the BAHA you want to go with (Cochlear or Oticon) involved.
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My coworker had the BAHA procedure done a few years back and I wrote her appeal letter and got it covered. Now two years later, I had to have surgery for an acoustic neuroma and got the bicros hearing aid covered for myself. Of course I had to write a letter of appeal on mine also. I work in the Medical field and write appeal letters and audit medical charts for a living so that helped. Please let me know if I can help you. :)
Crista Kelley