Baha insurance denial

[MNTim]

I know this has been addressed several times on the forum but I would like some fresh feedback.  I was notified late last week that my insurance provider only covers hearing devices for people under 18 years of age.  I contacted customer service and explained that it affects my daily living but the rep said "No exceptions".  Anyone had success appealing or any advice? 
Social interaction is virtually eliminated in noisy environments and I am tired of standing there smiling not knowing what people are saying.

Tim

[Tumbleweed]

Hi, Tim:

This is not a done deal. Contact the Insurance Division for your state and file a complaint. At the same time, file a formal appeal with your insurance company who denied your claim. At the bottom of the letter requesting an appeal, note ("cc:") that you have also sent a copy to your state's Insurance Division. That will get your insurance company's attention. Also have your treating doctor send to the insurance company a copy of all relevant medical records detailing your AN history and treatment; this will support your case that you need the BAHA because of an underlying medical condition and not because of a natural aging process.

I was initially turned down for a hearing aid for my AN side. I took the steps detailed above and just a couple weeks ago won my appeal.

Good luck!

Best wishes,
TW

[MNTim]

Thanks TW

[jaylogs]

You are right Tim, this has been a constant in getting hearing aides approved.  Sometimes it's how the doctors code the procedure, other times the insurance companies thing hearing aids are needed because of normal hearing loss (our hearing losses are medically induced and should be treated as such).  As you may know, insurance companies always like to deny the first time...just because.  I hate them, but a necessary evil.  Tumbleweed gave good advice, so just keep at them! Let us know how it goes!
Jay

[Tumbleweed]

Tim, one other thing: Make sure the medical records you copy and send to the insurance company and state Insurance Division include all of your audiograms from the time you started having hearing loss on your AN side. Those will show the progressive ipsilateral loss indicative of an AN and help support your claim that your loss is induced by disease and not aging.

I did this in my case, accompanied by a letter pointing out the characteristic curve of attenuation in my audiograms and how that was typical for damage caused by an AN. I believe that letter and documentation were key to my winning my appeal.

Best wishes,
TW

[leapyrtwins]

Tim -

you should contact the company that will be manufacturing your BAHA equipment and processor; i.e., Cochlear or Oticon.

Both these companies have separate insurance divisions that will contact your insurance company for you and explain why you need a BAHA, etc.,  Cochlear and Oticon employ people who do this for a living and they get results.  There is no cost to you as far as I know.  You just need to contact whichever company you/your doc intend to purchase your BAHA through.

Another thing to do is ask your insurance company if they pay for Cochlear Implants (CIs).  CIs are for people who are bilaterally deaf - BAHAs are for people who are unilaterally deaf (SSD).  If they cover CIs and don't cover BAHAs they are discriminating against you because you aren't bilaterally deaf.  Make sure you point this out to them.

Finally, and very importantly, don't take no for an answer.  It's a well known fact that insurance companies tend to turn down coverage for a BAHA the first time you inquire but, if you are persistant and keep asking, chances are you'll get positive results.  Insurance companies aren't ever happy to part with their money and if they can give you a simple no that you don't "call" them on, it's money in their pocket.  They're playing the odds that you'll just drop your request.

It took me 9 months to get my insurance company to agree to cover my BAHA implant and my processor - a process that should have taken 4-6 weeks.  They kept losing my request; told me they weren't sure how I became SSD - which was laughable since they paid for my AN surgery and my operative report specifically said I lost the hearing in my left ear; asked me repeatedly what a BAHA even was; etc.  In the end they paid for everything 100%.

Bottomline, don't give up.  Fight this!

Good luck!

Jan

[Archer]

Tim,
How did this turn out.  I just got my denial letter today with the same reasons stated.  I will be starting the appeal process tomorrow.  Just thought you might have an encouraging outcome to report.  I hope! 

Rich

[MNTim]

Archer,

Sorry I haven't replied sooner it has been a busy month.  That being said I have not had time to pursue the matter but plan to soon.  I am sorry I cannot offer encouraging words but only because I haven't done my part. If you have any news let me know.

Thanks,
Tim

[Archer]

Tim,
I did an appeal with BCBS and have yet to hear back.  They have 60 days to respond so I may have an answer this summer.  Meanwhile I have a surgery at Hose and am recuperating for a while.  I'll be trying the CROS before going to a BAHA if and when insurance covers one.  I tried to tell them this isn't an aging problem so much as it is something that happened due to a medical condition and maybe they will understand better.  I'll send you my letter if it works for me.  I'll keep you updated.

Good luck,
Rich

[MNTim]

Rich,

I hope your recovery goes well.

I started an appeal process today with a state supported insurance for "uninsurable" people.  I am self-employed and no companies would cover me so this option is nice.  I am not feeling very confident about the initial outcome.  I talked to the provider, insurance company and Oticon today.  Oticon will provide advice but the insurance company quickly rebutted the claims.  After talking to the provider I get the feeling they can get it approved but it will be a long process after jumping through all of the hoops.

Likewise I will keep you informed.

Best of luck.
Tim

[james e]

My insurance company considers a BAHA to be a prosthetic device. It is a device that is surgically screwed into your skull, and it is not removable. The processor is removable from the abutment for maintenance and to keep it dry while bathing or swimming. The skull bone actually grows into the screw (abutment) and it cannot be removed. You can't go out in the garage and get a #1 phillips head and back it out. There are so few people that even know what a bone anchored hearing aid is. The moment you mention "hearing aid" the word "no" is soon to follow, and it is hard to get them to listen to you after that.  It is similar to a hip replacement or knee replacement...it becomes part of you. Ask the customer service about prosthetic devices before you mention that it is a BAHA...it is worth a try.

James

[Al Welch]

Hello everyone,

My name is Al Welch and I have recently suffered a traumatic brain injury that has caused SN hearing loss on my left ear, I have been approved by ENT to get the BAHA soft band for now. My skull fractures have not healed enough for me to have the surgery. I have got it approved through my insurance company who has listed my device as a "durable medical device" and said that they would cover that completely. However I have run into a brick wall with a certain company out here in Southern California who will not accept the authorization from my insurance and continue to list it as a "hearing aid" which my insurance will not cover. I have heard from many it is a pain to get this approved and if any of you have suggestions as to what I could do next your help would be greatly appreciated.

[leapyrtwins]

Al, maybe I'm missing something obvious here but what do you mean by a "certain company in Southern California" 

Currently there are only two companies that manufacture BAHAs - Cochlear located in Colorado and Oticon located in New Jersey.

Both of these companies know that BAHA processors aren't hearing aids, they are protheses or implants. 

Can you explain a little more?

Thanks,

Jan

[james e]

Jan, it might be a company that does not accept his insurance. I have Aetna, and House would not accept my insurance as full payment. I am happy they it worked out like it did for me...found a great doctor locally and follow up was easier. Al, if it is a company/doctor that will not accept your insurance, Cochlear can probably offer you some local ENTs that have their products.

James

[Al Welch]

Dear Leapyrtwins,

This company is not the one that is making the device, but the one that will be supplying me with the BAHA. It has been a long process and will find out more tomorrow my primary care has now got the approval and told me I must file a grievance so that the company providing me with the BAHA will get a letter in writing stating, my insurance will pay for my BAHA and that they have no choice but to give it to me will let you know how it goes.