Author Topic: Anthem Refused Baha Request 2 years ago...should I retry?  (Read 3621 times)

pwurtz

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Anthem Refused Baha Request 2 years ago...should I retry?
« on: October 05, 2012, 07:05:20 pm »
I was covered under my husband's insurance at the time.  Anthem refused to cover Baha because "it's a hearing aid."
I fought it all the way to the top.  Even met personally with Anthem officials and appealed to the insurance board of IN. 
That was two years ago.  I am now covered under my own employer's insurance, but it's still Anthem.  Have they changed their stance?  Would a different employer matter?  It's still Indiana. 

Denise S

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Re: Anthem Refused Baha Request 2 years ago...should I retry?
« Reply #1 on: October 06, 2012, 11:51:19 am »
Oh YES!
Each employer has a different group/plan.  There may be the littlest differences!  And, since more & more insurances are recognizing the BAHA as a prosthetic vs hearing aid, they (not all of course) are following suit of Medicare and adding it for coverage! 

Ex....I have Cigna as one of my insurances, they added an addendum in the middle of the year to cover BAHA under certain situations. Problem, my husband Cigna plan didn't add it to theirs :(

Good Luck!!
Denise
W&W 2 yrs. (due to watching other brain tumor: it's stable)
Left AN:  1.2 cm (kept growing during 2 yr.)MIDDLE FOSSA  11/9/09;  Michigan Ear Institute Dr. Zappia & Pieper
SSD, mild tinnitus, delayed onset of facial paralysis lasting 3-4 weeks, no tears AN side
BAHA surgery 10/2/12 Dr Daniels G.R.,MI

kixit

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Re: Anthem Refused Baha Request 2 years ago...should I retry?
« Reply #2 on: October 06, 2012, 03:48:17 pm »
I had Cochlear help me with my appeal and I WON first time out. I too have Anthem and they said it was a hearing aid. Cochlear had me write a personal letter of how SSD (from AN) affected my every day life and how the Baha would greatly improve it.

I had the Baha surgery on Aug 1st (the abutment fell out Aug 15th) and I go back for a new abutment and processor on Nov 9th. I am counting the days!  ;D

Good luck and good wishes  8)
left side AN 9mm diagnosed 2/2012
SSD, loud tinnitis left ear
Translab 5/24/12
Baha surgery 8/1/2012 at UVA
Baha hook up 11/09/2012  : ) 

I am a happy camper : )

leapyrtwins

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Re: Anthem Refused Baha Request 2 years ago...should I retry?
« Reply #3 on: October 07, 2012, 12:02:22 pm »
Definitely retry.

Have Cochlear or Oticon (whichever company you decide to get a processor from) contact your insurance company.

The BAHA should not be coded as a hearing aid - most insurance companies don't pay for hearing aids - it should be coded as a prosthesis or an implant.

Also, just wanted to mention even though you have a different policy now, insurance companies oftentimes turn down a BAHA coverage request the first time you ask, but if you are persistant, they generally change their mind.

In addition, find out if your policy covers CIs (Cochlear Implants).  If it does, it has to cover BAHAs.  CIs are typically for bilaterally deaf people (double-sided deaf), while BAHAs are typically for people who are SSD (single-sided deaf).  If your insurance covers CIs and not BAHAs they are discriminating against people who aren't bilaterally deaf.  Feel free to point this out to them and don't hesitate to mention that it's great grounds for a lawsuit.

Good luck,

Jan
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

pwurtz

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Re: Anthem Refused Baha Request 2 years ago...should I retry?
« Reply #4 on: October 08, 2012, 06:43:15 pm »
I did have Cochlear contact the insurance company two years ago.  My doctor wrote a letter, I wrote a letter, and I appealed to the Indiana insurance board.  All turned me down.  I believe it was 3-4 appeals in all. 

I guess I'll try again.  I believe they do cover cochlear implants, so maybe I do need to mention that it's grounds for a lawsuit.  I felt like I played hardball, but maybe it wasn't hard enough.

lyfe20

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Re: Anthem Refused Baha Request 2 years ago...should I retry?
« Reply #5 on: November 04, 2012, 07:54:35 am »
My experience will likely be quite relevant.  We have an Anthem policy in Indiana and just received our second denial for BAHA coverage for our 2 year old son who has bilateral atresia of his ear canals.  The next level of appeal is at the level of the state insurance department. 

The denial of coverage hinged entirely on the fact that our policy does not cover hearing aids.  (In fact, the most recent denial letter which we just received yesterday said, "We acknowledge the medical necessity of the device"....they didn't dispute that!)  I was hopeful that it could be justified as a prosthetic device, especially since cochlear implants are covered. 

So, read the fine print of your policy.  I'd be pessimistic about any coverage if they don't cover hearing aids.   

However, I'm interested to know more about your experience going before the Indiana Dept of Insurance.  I'm inclined to do it as a matter of principle even though I'm not optimistic it would lead to a reversal of the decision. 

leapyrtwins

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Re: Anthem Refused Baha Request 2 years ago...should I retry?
« Reply #6 on: November 05, 2012, 01:49:32 pm »
It is extremely important to stress that a BAHA is NOT a hearing aid.  It is accurately classified - and recognized - as a prosthesis or an implant.

If you need help with proving that classification, talk to Cochlear or to Oticon (whichever company you plan to use for your BAHA). 

Jan
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

 


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