Baha insurance denial

[Denise S]

Just making sure you ALL are aware that a 'newer' Phonak CROS was introduced last year.   Forist not coverEd under insurance either, but costs are ranging about $2,500-3,000 total.  SO, just letting you all know there are other options still

[august22]

I have United Healthcare and they covered the BAHA surgery then would not pay for the snap on processor. I fought it with letters explaining it was comparable to Cochlear Implants which they cover completely. It is not a hearing aid, it is a component of the surgical implant which they covered. Don't give up.

[leapyrtwins]

I've heard about insurance companies covering BAHA implant surgery, and then not covering BAHA processors.

All I can say is "WTF???"  The surgery without the processor is pointless - so this makes absolutely no sense.

Insurance; a necessary evil 

Jan

[august22]

Dr. Slattery from House Ear Clinic wrote this letter for me to assist in getting United Healthcare to cover ALL of my BAHA:

"To Whom It May Concern:
This letter concerns Sally Hamilton who is insured through United Healthcare. This letter is to assist in seeking positive pre-determination of coverage and authorization for a bone anchored hearing aid (BAHA) partial implant surgery and follow-up. The surgery is an outpatient procedure with general anesthesia and will be performed at Emory Hospital, Georgia by Dr. Douglas Mattox.

Sally Hamilton, age 44, has been diagnosed with single-sided deafness as a result of an acoustic neuroma. This was removed on 1/3/02, at St. Vincent Medical Center in Los Angeles by me and a team of doctors. She an excellent candidate for the implantable BAHA device. Previous trials with traditional hearing aids have not been successful due to the profound nature of the hearing loss, the demands of her employment and postoperative sensitivity of her deaf ear.

The BAHA device is a vibrotactal sound processor that will pick up sound on her deaf side and send it to the intact cochlea on the contralateral side. The partially implanted vibrotactial sound processor is similar to other prosthesis such as a cochlear implant.
 
If you have any further questions regarding Ms. Hamilton, please do not hesitate to contact me."


I also wrote a lengthy letter to UHC asking them if they'd rather pay out medical benefits for the rest of my life after I got hit by a car because I didn't hear it approaching on my deaf side, and how could they pay for reconstructive surgery for losing a breast to cancer or for a prosthesis for losing a limb and not cover a device that could help give me back such an important sense such as hearing. I went on and on but in the end it worked!  I even went as far as to say I'd gladly give up a breast if I could have my hearing back.

[pjb]

Dr. Slattery from House Ear Clinic wrote this letter for me to assist in getting United Healthcare to cover ALL of my BAHA:

"To Whom It May Concern:
This letter concerns Sally Hamilton who is insured through United Healthcare. This letter is to assist in seeking positive pre-determination of coverage and authorization for a bone anchored hearing aid (BAHA) partial implant surgery and follow-up. The surgery is an outpatient procedure with general anesthesia and will be performed at Emory Hospital, Georgia by Dr. Douglas Mattox.

Sally Hamilton, age 44, has been diagnosed with single-sided deafness as a result of an acoustic neuroma. This was removed on 1/3/02, at St. Vincent Medical Center in Los Angeles by me and a team of doctors. She an excellent candidate for the implantable BAHA device. Previous trials with traditional hearing aids have not been successful due to the profound nature of the hearing loss, the demands of her employment and postoperative sensitivity of her deaf ear.

The BAHA device is a vibrotactal sound processor that will pick up sound on her deaf side and send it to the intact cochlea on the contralateral side. The partially implanted vibrotactial sound processor is similar to other prosthesis such as a cochlear implant.
 
If you have any further questions regarding Ms. Hamilton, please do not hesitate to contact me."


I also wrote a lengthy letter to UHC asking them if they'd rather pay out medical benefits for the rest of my life after I got hit by a car because I didn't hear it approaching on my deaf side, and how could they pay for reconstructive surgery for losing a breast to cancer or for a prosthesis for losing a limb and not cover a device that could help give me back such an important sense such as hearing. I went on and on but in the end it worked!  I even went as far as to say I'd gladly give up a breast if I could have my hearing back.

Just a thought his letter and your letter was terrific but the statement with the accident (God Forbid) be careful with that in any future comparisons because they can turn it around and say you should not have been driving if you cannot hear totally

Best Wishes,

[august22]

I was referring to getting hit by a car walking in a parking lot.

[MNTim]

Thanks for all of your input.  I was recently notified that my first formal appeal was denied based on the fact that they do not cover all types of durable medical or prosthetic devices.  The audiology department at the Univ. of MN is now assisting with another appeal and has gotten Oticon involved.  So I guess this is the beginning of a long process.

Tim

[leapyrtwins]

Unfortunately the insurance battle can be a long one, but hang in there, Tim.

It took my insurance company 9 months to approve my BAHA implant and processor; but it was well worth it IMO.

From what I was told by the folks @ the ANA, oftentimes the first request is turned down but if you are persistent you generally prevail.

So keep the faith and keep on pushing. . .

Jan

[kixit]

**UPDATE  ON BAHA APPEAL**

I received a letter from Anthem UM. They said they would let me know of their decision by July 11th.  Fingers crossed and prayers sent up that they change their minds in my favor.

[kixit]

I just went to the Anthems website to check pre-auths like I do every day a 100 times a day...Anthem APPROVED my BAHA!! Well for me it's an unoffical approval until I get that pretty little letter in the mail 

[lrobie]

That's great news!!

[kixit]

Estatic could not even touch my emotion right now. I told Clarice if I could do cartwheels I would!!

[Jim Scott]

I just went to the Anthems website to check pre-auths like I do every day a 100 times a day...Anthem APPROVED my BAHA!! Well for me it's an unoffical approval until I get that pretty little letter in the mail 

Congratulations!  I know this has been a struggle and I'm delighted that your tenacity paid off.  I'm sure you'll be delighted with your new BAHA.

Jim

[james e]

Squeaky wheel.......

[kixit]

@ James E--what does your comment mean?