Procedure Code and Cost for BAHA Implant Surgery

[LizAN]

Does anyone happen to know the procedure code for the BAHA implant surgery?  I'm trying to find out whether I'm covered for it.  May not be much  point in spending time shopping for a doctor to do the procedure, if I don't have coverage.  Does anyone know what is costs, if I have to pay out of pocket?

Liz

[CHD63]

Hi Liz .....

I do not know the procedure code for the BAHA because my doctor's office (House Ear Clinic) did all of the paperwork/processing for me.  My insurance approved it on the first try.  I cannot speak for other medical facilities, but HEI would not put in the BAHA abutment without prior approval.

Perhaps you could call the medical facility you would like to use and ask for their insurance department.  Tell them you want to check with your insurance before agreeing to the procedure.  My feeling is if your insurance will pay one place, they must pay anywhere.  They should also be able to tell you how much implanting the abutment would cost if your insurance will not cover it.  Note:  some patients have had to fight to the top of the appeal ladder for approval, but did eventually get it.

Secondly, you could call Oticon Medical or Cochlear directly and ask how much their charge is ..... that would not cover the cost of implanting the abutment, of course ..... but their reps might have a good idea how much it might cost.

Clarice

[pjb]

Does anyone happen to know the procedure code for the BAHA implant surgery?  I'm trying to find out whether I'm covered for it.  May not be much  point in spending time shopping for a doctor to do the procedure, if I don't have coverage.  Does anyone know what is costs, if I have to pay out of pocket?

Liz

Hi, there was so many of them for different descriptions I just googled it and found a Baha coding sheet "Baha Surgeon and Facility Codes" and of course numerous versions hope that helps I had trouble copying it for you and posting it here...

Best Wishes,

[kixit]

LizAN-

I am currently in the appeals process with Anthem of Va because they "don't cover hearing aids
 was there 3rd excuse. Anyway, UVA will do my BAHA for $25,213 once I get an approval or the funds (all to paid up front).

I wish you great luck with the insurance company. Although I shouldn't complain, they did pay for my AN surgery but hearing from both sides would make my life more enjoyable as far as conversations and working conditions.

[LizAN]

Thanks everyone for the good ideas!

How do I go about determining who the good local surgeons are, for the BAHA?  I'm going to talk with my ENT, but is anyone aware of a surgeon in Austin, Texas who is good at it?  I'm thinking of getting a Ponto Pro, as I like the shape of it and the description of its features.

Great West has already told me they will not cover it.  BCBS is my primary policy.  They do pay $1000 toward hearing aids, so I'm hoping they will cover the surgery, too.  Without the procedure code, they will not give me an answer.  I'll see if I can find it online.  I hadn't thought to just google "BAHA procedure code."

kixit, I'm praying for you to win your appeal!

Liz

[LizAN]

Found this on Cochlear's site:

http://professionals.cochlearamericas.com/reimbursement-and-insurance/reimbursement-and-billing/baha-billing-codes

Should I assume a one stage procedure, without mastoidectomy, ie. 69714?

Liz

[leapyrtwins]

How do I go about determining who the good local surgeons are, for the BAHA? 

Liz -

the Cochlear website (www.cochlearamericas.com) has a listing of docs who implant BAHAs under "find a clinic".  Because the Ponto Pro isn't a Cochlear product (it's an Oticon product), not all of the docs listed on the Cochlear site offer Oticon products.  Some might, some might not; you'd have to call them and ask.  Oticon's website might have a "find a clinic" section also, I don't know.

BAHA implant surgery isn't like AN surgery when it comes to finding a doc with experience.  Even a doc who has implanted only a few BAHAs is good at it; no need to find someone who's implanted hundreds. 

As far as the cost of surgery goes, it all depends on the doc you go to, the facility you go to, and whether you have local or general anesthesia.  The doc who implants the BAHA can give you local anesthesia, while general anesthesia means an anesthesiologist or nurse anesthetist (i.e., local is cheaper than general because it doesn't require another medical professional). 

Cochlear lets docs/clinics price their processors, so the cost varies from place to place.  Not sure about Oticon.

Jan

[pjb]

Thanks everyone for the good ideas!

How do I go about determining who the good local surgeons are, for the BAHA?  I'm going to talk with my ENT, but is anyone aware of a surgeon in Austin, Texas who is good at it?  I'm thinking of getting a Ponto Pro, as I like the shape of it and the description of its features.

Great West has already told me they will not cover it.  BCBS is my primary policy.  They do pay $1000 toward hearing aids, so I'm hoping they will cover the surgery, too.  Without the procedure code, they will not give me an answer.  I'll see if I can find it online.  I hadn't thought to just google "BAHA procedure code."

kixit, I'm praying for you to win your appeal!

Liz

I did not read this whole post but I thought I posted the other day that I found under Baha Surgery and Facility Codes there is a whole slew of Procedures codes I could not copy it for you hope you can find it.

Best Wishes,

[LizAN]

I got these codes from Oticon:

69714 – for surgery
L8690 – For the actual processor

[Denise S]

The above are the EXACT codes I was given too

[jaylogs]

IMHO, this just really bites...all these insurance issues are just nuts!!  I hope everyone on here that is currently having insurance issues get some resolution!  It surely helps having people on here to help, but having to jump through these hoops...sheesh!  Ok, I am off my soapbox now.  Liz, let us know how it goes, ok?
Jay

[LizAN]

IMHO, this just really bites...all these insurance issues are just nuts!!  I hope everyone on here that is currently having insurance issues get some resolution!  It surely helps having people on here to help, but having to jump through these hoops...sheesh!  Ok, I am off my soapbox now.  Liz, let us know how it goes, ok?
Jay

LOL - you are so right, Jay - it should not be this difficult, especially when we are already stressed out by our situations!

Oticon is being very helpful, as I'm sure Cochlear would be if I asked them.  I truly think the insurance reps are paid to discourage us from filing any claims.  As we all know, in the US at least, insurance companies are in the business of making money, not spending it on those of us who pay them...

Liz

[LizAN]

I had sent the codes to BCBSTX and I heard back from them today.  They won't give me an answer about coverage on the BAHA surgery or processor without a letter of medical necessity from my doctor.  I don't know who I want to have do the surgery yet, so I guess I won't get an answer for awhile.  One more obstacle.

At least they didn't just turn me down flat, which is what Great West/CIGNA did.  There is hope.

Has anyone had House write the letter, even though you were planning to have the procedure done locally?

Liz