ANA Discussion Forum
General Category => Insurance => Topic started by: cherry on September 25, 2008, 05:05:09 pm
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Hi Tamara,
Do you happen to know the codes for getting insurance to pay for a transear due to balance problems? I had an AN removed 12-12-06 and left with SSD. I can't afford $4500 for a transear which is what they are asking in my area. My audiologist said she would help me if she knew what codes to use.
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Cherry -
I will check but it may take a few days. My understanding from this forum is that the transear is not covered. But I will look. I just got the BAHA installed yesterday, and that one IS covered by most insurances. Any reason you don't want to go that route??
Tammy
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Tamara -
I think the reason the BAHA is covered is because it's technically an "implant", while the Transear is a hearing aid. The majority of insurance plans don't cover hearing aids.
Strangely enough I've sometimes heard other forumites say that their insurance covered their BAHA surgery, but denied the processor since it's a hearing aid. Doesn't make a lot of sense to me, because what's the implant without the processor ??? But insurance companies sometimes aren't logical.
Jan
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Tamara,
Thanks for checking for me. I would not be a good candidate for the BAHA because of location of my scar and titanium mesh also used. Anyway not really wanting to undergo another surgery either.
Cherry :)
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Cherry and Tammy-
I am also curious about this transear. I seem to recall reading here somewhere that some people have had it covered (maybe Boppie). I am on the hunt right now for an audiologist who wants to "learn" on me and have also been in touch with Rick at TransEar. There is a new transear in Beta that sounds terrific. As for BAHA, as great as it sounds, I just can't even think about another surgery of any kind on my head. Even though it would be really, really cool to have a nob to hang things on... ;D
Debbi, huh?
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Debbi,
What's the new Transear in Beta? What are the upgrades? I can give you the audiologist who did my Transear. You need a custom mold and he got it right the first time. You will have to PM me because I can't list his phone number here.
Eve
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I would not be a good candidate for the BAHA because of location of my scar and titanium mesh also used. Anyway not really wanting to undergo another surgery either.
Cherry :)
Cherry -
did a doctor who performs BAHA surgery tell you this? I'm just curious since I've never heard of this. I have titanium mesh and a scar from my retrosigmoid surgery, but neither was a factor in my BAHA surgery. My doc (neurotologist) has performed lots and lots of BAHA surgeries, and I can't believe that all his patients had retrosigmoid surgery like me.
I also just wanted to assure you and Debbi that the BAHA surgery is absolutely nothing like AN surgery. It's not nearly as long or nearly as invasive, plus the recovery time is very quick. Although no one likes to have surgery, I'd hate to see that used as the deciding factor.
Jan
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For those interested in the latest and greatest TransEar, here's an excerpt from an email from Rick:
Not yet announced, but incredibly exciting ;D is our new model TransEar380 HF. It is a substantial improvement even over the current TransEar, and this is likely to be the model you will get once you are evaluated. Beta users report huge increases in word recognition, gain, and understanding speech in general, and I think you will really like it. It is a true industry first, a real break-through in technology!
Eve, I'll PM you - I am hoping to get this done close to home, but willing travel if necessary!
Debbi
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Jan,
It was a doctor that does BAHA surgeries that told me he would not advise me to get one. He said it was the location of my scar not just the fact that I have one. Anyway I have teeth issues that are bothering me now too. Since my AN I have had two root canals on the AN side and still am having problems. I have a small mouth and very large teeth with even larger roots. I wonder if they are putting pressure on the facial nerve in any way? Anyone else have any theories about this?
Cherry
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For anyone still waiting, I have been unable to locate Transear insurance codes. I'm betting that Rick can help with that - Debbie, are you in touch with him??
Truly, the BAHA surgery was a piece of cake. I was in surgery at 7:30, released by 11:30 and enjoying a lunch with my husband by 12:30. Was driving my kids around by the afternoon. How easy is that?? Also, I'm LOVING the BAHA so far. It's so fun to play with the abutment and HEAR it in my good ear. Okay, maybe I need to get a life... ;D
Tammy
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Tammy -
you don't need to get a life :D
I was enarmored with my BAHA - still am - and as you say the surgery was a piece of cake.
I'm thankful every day I went through with this decision.
Jan
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A few curious questions about BAHA. How about washing your hair, using creme rinse, hair spray, does your hair every get tangled around it? How about blowing your hair dry?
Cherry
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Cherry -
Obviously you wouldn't want to do any of these things with the processor (tiny hearing aid) attached to your head - you'd fry the battery and ruin it.
However, shampooing - and using cream rinse - with a BAHA implant is no big deal Hair spray and other hair products, gel, etc., aren't an issue either. I think I was told that you just have to clean off the abutment with a baby wipe or something similar before you attach the processor. Or you could put the cap on the abutment, to keep it clean, until you're done styling your hair. You get one that matches the color of the processor.
I don't use hair products, nor do I blow dry my hair, but I'm sure someone else who does can tell you about that.
My hair hasn't ever gotten tangled around my abutment, but someone (I think it was Sam Rush) cautioned me about letting curly hair get wrapped around it. I guess that's not a wise idea.
Jan
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Hi, Cherry,
I have my hair colored and highlighted (started back about a month after my implant surgery), and have had absolutely no problems with my BAHA abutment as a result. I also use a blow dryer and generally try to keep it on low when I'm near the abutment; I also keep the dryer moving fairly quickly over that area as well. I've certainly had it on high heat in the abutment area from time to time, but have had no problem. My BAHA is the Intenso model (a bit larger and more powerful than the Divino), but once it's in place I usually forget it's there. I've gotten into the routine of always feeling my head with my hand just before I get in the shower to guarantee that I've taken it off! I'm pleased at how absolutely normal it feels to have it on. As an aside to other BAHA wearers who may read this: I've also gotten into the routine of replacing my battery once a week ... even though it's probably good for about two weeks of power. Guess this isn't being very "green."
Best wishes as you make your decision -- I am really happy with mine.
Catherine (JerseyGirl2)
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Catherine -
being "green" aside, I also find that replacing my battery once a week helps the sound. Great point!
And I have to echo what you say about the BAHA feeling normal when you have it on. I, too, have to reach up during the day - and especially before showering - just to assure myself it's either on or off my head, whichever the case might be. It's been a pleasant surprise to find I'm not really aware of it when it's on my head.
Thanks for the info on blow drying. I'm thinking of growing my hair a little longer and with the cold weather coming, it's good to know I can dry my hair if I choose to without an issue.
Jan
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Hi all, I've split off these discussions re: hearing devices (ie: BAHA, Transear) and insurance converage and moved to their own topic... great discussions... let's keep this one going here, ok? Thanks! Phyl
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I have my insurance broker helping me appeal with Blue Cross Illinois. Here is an excerpt from the letter so I think this is the code you are looking for.
The CPT code, V5040 was on the original predetermination letter drafted by the Ear Institute of Chicago. This same CPT is on the medical policy written by Blue Cross Blue Shield of Illinois.
Sorry for the slow answer but I haven't been on the board much lately.
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Ellen -
good luck with the insurance coverage issue. Ask your broker if your policy covers Cochlears. My broker told me that if it does, by law, it has to cover BAHAs.
BAHAs and Cochlears are basically the same thing - it's just that Cochlears are for those who are bilaterally deaf and BAHAs are for those was are unilaterally deaf (SSD).
Who's going to do your implant surgery? Wiet or Battista?
Battista did mine back in March - and I truly love it ;D
Jan
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Jan
That code is for the Transear. I'm am going to try to get the transear covered, if not I'll do the BAHA.
If I have the BAHA Battista will do it.
I'm a bit tired of surgery right now. I had the AN surgery 6-28-07, a complete hysterectomy including ovaries 7-25-08, and facial nerve surgery on 12-23-08.
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Ellen -
sorry, my mistake. I didn't read this thread back to page one :P If I had I'd have realized you were talking about the TransEar :-[
I didn't know that insurance companies covered the TransEar; I figured it was classified as a hearing aid (not an implant, like the BAHA).
I'm sorry to hear about all your surgeries; I hope 2009 is a better year for you :)
Take care,
Jan
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Just an aside, I read in my "Schedule of Coverage" for my insurance that my insurance pays a maximum of $1,000 per 36 months, 90% after deductible for hearing services INCLUDING HEARING AIDS. I guess depending on how it's coded, a BAHA might be an implant for insurance purposes and therefore not restricted to the $1,000/3yrs, but TransEar will be covered under that restriction.
How much do these things run? Nobody at TransEar is emailing me back with a list of providers in my area so that I could go talk to them directly about it..
Regards,
Brian
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Brian- Just FYI, I had better luck just calling TransEar - their customer service people were incredibly helpful and spent probably 30 minutes on the phone with me looking up doctors in New York, NJ and PA within certain area codes. Now, I am going to re-look at my medical insurance to see what they say about hearing aids. I really want to get a TransEar.
Debbi, getting a little tired of spinning in circles when the bell chimes....
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Hi!
In frustration because the secretary never replied about sending my Dr. Monfared letter to Pre Certification at United Healthcare, I called TransEar and they sent me to the inventor of the TransEar. I have read that so many of you have had fitting problems and that going to the inventor in the same town in Tennessee would probably the best place to go with the exception of Jersey Girl 2 who said she had a nice fitting. I sent the United healthcare all my audiograms and a request for Trans Ear as well as Soundbite and see what they come up with. The secretary at the inventor's office quoted me a price of about $2300 and then corrected herself to something like 3200 and I didn't have a pencil but was too excited to be in touch with them. I told her I wouldn't come to Tennessee until the TransEar were precertified and she understood that and said she would work with me and email me the forms and I emailed her all my audio grams. So we are on the road. I've copied down the CPT code and hope it works.
Take care all,
Mei Mei
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In frustration because the secretary never replied about sending my Dr. Monfared letter to Pre Certification at United Healthcare, I called TransEar and they sent me to the inventor of the TransEar. I have read that so many of you have had fitting problems and that going to the inventor in the same town in Tennessee would probably the best place to go with the exception of Jersey Girl 2 who said she had a nice fitting.
Hi, Mei Mei,
oops, wrong Jersey Girl!
I'm Jersey Girl 2, and you'll notice from my signature that I had a BAHA implant at the same time as my acoustic neuroma surgery in January 2008 at House in Los Angeles.
Eve (Jersey Girl) is the NJ resident with Transear. I've met her at a couple of the NY / NJ acoustic neuroma functions and I believe that she is quite satisfied with her Transear. She certainly seemed to be doing fine with it.
Catherine (JerseyGirl 2)
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Thanks...I write to her. I know Monmouth County well. We were in Lincroft and my parents were in Holmdel.
Mei Mei
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They called in for the precertification of the TransEar and I called in for the SoundBite. United Healthcare said they considered them Hearing aides and that my insurance with them would only cover hearing aides for my minor children. I am the only one on the policy that I now as a retiree on disability am paying $400 a month for.
Will pursue.
Mei Mei
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They wrote to me and said there is no hearing aid allowed on our policy with the School System but invited me to appeal this denial as often times they approve denials. It was strange to encourage me to submit additional information so I printed out the article on balance, asked for a letter from my nurse practitioner and neurologist with my cover letter included in the Priority Mail folder pre paid. They will send it off. Then I received a separate letter from my Otologist and they said they wouldn't read these separately. I also had my primary care send his letter to the Precertification number as well. I should have had them send the letters all to me. There is no way for them to collate what comes in separately and put them in a folder. I sent them a link to my doctor's letter saved in google Docs and still haven't heard from them although they said they get back to you in two days.
I tried to attach the letter because it was so beautifully written about the medical necessity for a TransEar.
Well if anyone is successful at an appeal, please let me know. Also please let me know what CPT Code is.
Sincerely,
Mei Mei
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Hi Mei Mei,
CPT codes are numbers assigned to specific medical procedures or services. These numbers are then used by insurance companies to determine reimbursement. You may have seen adds for medical coding courses. The same codes are used by all docs to help make the reimbursement process consistent. My sister got her medical coding certification not too long ago. Feel free to PM me if you have specific questions that I can relay to her. Good luck with your transear quest.
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The United Healthcare denial of appeal for the TransEar came on Saturday. I was expecting it but was very hopeful in that Georgetown and Johns Hopkins wrote very convincing letters that I am trying to attach here. Georgetown's letter said that I've developed Cervical Dystonia which I am getting Botox injections for tomorrow and have been approved for every 2 months.
:-[ Mei Mei
Clicked attachments and didn't get anywhere.
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I called the local audiologist that Angie's List rates very well and he gave the CPT Code at V 5040 which means digital hearing aide and doesn't mention bone conduction. I have to gather up my energy and send a cover letter to two more doctors (a friend that is an insurance agent said to include letters to two more doctors on the second appeal). She also said that United Healthcare is particularly difficult. Once I gather the papers and cover letters, I will ask them to write the letters and forward them to me so that I can put my appeal letter in the envelope along with all previous appeal documentation.
Persist we must!
Mei Mei
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I have BC of Miss & Tenn. They would not cover BAHA or Transear. I opted for Transear a year ago. I have been happy with it. About $2700.00. I had to go for two fittings but no big deal.
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That's a nice price. I'm getting $3200 up here. I'll try one more appeal and then give in.
Mei Mei
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I have BC of Miss & Tenn. They would not cover BAHA or Transear.
Glad you are happy with your TransEar ;D
Just wanted to note that BC is famous for denying insurance coverage of the BAHA - but they have been challenged several times by their insureds and they have lost. One case was here in Illinois not too long ago. They were denying coverage for a young girl who desperately needed a BAHA. After lots of media attention, they decided to pay for everything.
From what I know, most insurance companies deny coverage of the BAHA on the first request. But if you are persistent and keep requesting, you generally can get coverage. Both Cochlear and Oticon help BAHA candidates with insurance coverage issues these days.
Jan
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This was an interesting thread. Went for my one-year follow-up and audiologist had me try the BAHA device. Wow! Never realized how much I missed hearing out my left ear. Now to talk to insurance company (United Healthcare-ugh). Maddening to have to jump through hoops when Medicare will pay...but I have 3 more years before that will kick in and I want to hear now!
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I also have United Healthcare and got denied about two months ago. I talked with a friend an insurance agent and she said they are very difficult. I included several beautiful letters especially from Dr. Niparko's office. The nurse practitioner at Georgetown said that not hearing was causing me to get Cervical Dystonia because I was always turning and straining my head to the right to hear all day long. Now I have to appeal again. The denial letter said I could appeal again with more information. The big problem is that the Montgomery County Public Schools policy does not allow any kind of hearing device. Good luck with your application.
Mei Mei
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This was an interesting thread. Went for my one-year follow-up and audiologist had me try the BAHA device. Wow! Never realized how much I missed hearing out my left ear. Now to talk to insurance company (United Healthcare-ugh).
BAHAs are fabulous; glad you're considering one.
As for the insurance question. You don't have to go it alone. Cochlear and Oticon both have insurance divisions that help BAHA candidates approach their insurance companies about coverage. Use them; that's what they're there for.
Good luck,
Jan
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I met with a audiologist yesterday and asked the insurance coverage question because of concerns that I have read about on the forum. She told me that she has never seen a claim denied for a BAHA. As Jan said it may take several attempts but the audiologist and manufacturer should do the hard work.
Tim