Anthem Insurance Denied Appeal for BAHA...HELP!!

[pwurtz]

I've been reading lots of previous posts, but most say that the initial request was denied, but that the appeal went through.  I've already appealed with help from the OMS insurance support, but it was again denied.  We live in Indiana and we have Anthem insurance.  The insurance was excellent for my original acoustic neuroma surgery, so I'm surprised by this. 

I find SSD difficult.  I had my surgery five years ago, so I've tried to learn to live with it.  I am trying to get back into teaching (I quit 12 years ago when I became a mom), and noisy classrooms don't work well with SSD.  It's so frustrating when someone calls out my name and I can't tell where the sound is coming from.  I know BAHA may not help this, but it seems many people find that it does.  I also can't stand restaurants or even the teacher lounge when people all around me are talking.  I'm currently working as an instructional assistant, but I can't help but worry that my SSD will affect my chances of getting a job.  I've never been secretive about it and everyone knows about my brain tumor, as I also have facial nerve damage. 

Any suggestions??? 

[leapyrtwins]

pw -

if at first you don't succeed, try try again.  Seriously.  Lots of first requests for the BAHA are turned down, but subsequent requests are granted.  Don't know why that is.

Did your insurance company give you a reason why they denied the BAHA?  I found when I requested coverage for mine, that no one at my insurance company knew what a BAHA was or why one would need it.  Your doctor's office can be instrumental here.  Make sure they explain to your insurance company what a BAHA is - including that it is NOT a conventional hearing aid - and why you need it.

When they request coverage, they need to stress the fact that a BAHA is an implant or a prothesis (not sure I spelled that right).  Also, find out if your insurance company pays for Cochlear implants.  You don't need one, but if they cover Cochlears they cannot deny your BAHA request or they are discriminating against you.  Cochlears are for those who are bilaterally (totally) deaf - BAHAs are for those like you who are unilaterally deaf (SSD).

I also have a contact @ Cochlear who may be able to help you with your insurance company.  I'll PM you her name and contact information.

Jan

[lori67]

My audiologist was so used to the initial request for the BAHA being denied that he would send all of his supporting documents, along with the records from my neurotologist and a letter of necessity with the first request.  He found it saved him the trouble of having to do it later anyway, and that way the patient didn't have to wait even longer.

You said you've already appealed, but you should make sure you have the letter of necessity and the documentation from your doctors sent to the insurance company.  They should be familiar with the process and the correct hoops to jump through.

If all else fails, write a complaint letter to the Insurance Commissioner for your state.  Nothing gets insurance companies moving faster than an Insurance Department complaint (I worked for an insurance company for 10 years).

Good luck!
Lori

[Jim Scott]

Pwurtz ~

I heartily concur with Lori's suggestion regarding contacting your state insurance commissioner's office to file a complaint. 

I first did that in the 1970's when I had a minor auto accident.  The other guy's insurance company was the same as mine - and they refused to pay, even though I was clearly not at fault (the point of impact and resulting damage to my car proved it).  I fired off a civil, fact-filled complaint letter to the state insurance commissioner and presto!, the insurance company settled (paid) my claim within a week - and sent a letter of apology along with the check.  I never forgot that incident.  Complaining has it's benefits - if you complain to the right person and do it with civility and facts.  I hope you'll try it.

Jim