Author Topic: Insurance appeal denied for BAHA hearing device  (Read 4287 times)

tlwand

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Insurance appeal denied for BAHA hearing device
« on: February 20, 2015, 11:49:14 am »
Hello everyone, My name is Tyler and I'm 24 years old. This past September (2014) I Had my Acoustic neuroma removed at Missouri Baptist Medical Center In St. Louis, Missouri. This is also my first time posting on these forums.

I'm now going through the process of trying my insurance company, Blue Cross Blue Shield, to cover a BAHA hearing device. I sent in my first request and it was denied. We sent in an appeal and I received a letter two days ago saying "the appeal has been denied based on page 78 of the Titan International, Inc. Benefit Plan. it states hearing aids or examinations for the prescription or fitting of hearings aids, unless otherwise specified in this booklet are a benefit are a benefit exclusion, therefore no payment will be made." The letter later states that I am allowed to only appeal once and I have now exhausted all my appeal chances.

Titan International is my father's place of employment and I am still on his insurance.

I was hoping for someone to shed some light on the steps I need to take in order to get coverage approved or if there is still any hope for me to get any coverage at this point.

Thank you all so much for your time! I truly appreciate any advice that is given since this is all a bit new to me. Thanks again!

-Tyler

CHD63

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Re: Insurance appeal denied for BAHA hearing device
« Reply #1 on: February 20, 2015, 12:22:09 pm »
Hi Tyler and welcome to this forum .....

Regarding a BAHA and insurance ..... a bone-anchored hearing device is technically a prosthetic and therefore must be considered the same as having any prosthetic device.  Usually it is a matter of using the correct medical codes when submitting the request for coverage.  It is NOT just a hearing aid!

If I were you, I would go back to the doctor who will be implanting the abutment and ask his/her insurance clerk to be sure it is coded correctly and resubmit it.

If you are getting a Ponto device, contact Oticon Medical for assistance or if a Cochlear product, contact them.

You might be interested in this article in which Medicare/Medicaid (CMS) tried to remove bone-anchored hearing devices as a covered item and could not.  Usually insurance companies are therefore required to follow their leading on this.  See:  http://www.hearingreview.com/2014/11/cms-will-maintain-coverage-bone-anchored-certain-auditory-implants/

Good luck and keep pushing.  Insurance companies notoriously deny things hoping patients will give up and they won't have to pay.

Clarice
Right MVD for trigeminal neuralgia, 1994, Pittsburgh, PA
Left retrosigmoid 2.6 cm AN removal, February, 2008, Duke U
Tumor regrew to 1.3 cm in February, 2011
Translab AN removal, May, 2011 at HEI, Friedman & Schwartz
Oticon Ponto Pro abutment implant at same time; processor added August, 2011

tlwand

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Re: Insurance appeal denied for BAHA hearing device
« Reply #2 on: February 20, 2015, 01:12:19 pm »
Clarice, thank you so much for the advice. I will contact my doctor today and follow your suggestion. After I speak to them I'll update the progress on here. Thanks again for your time! I appreciate the suggestions and information  :)

Necromancer

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Re: Insurance appeal denied for BAHA hearing device
« Reply #3 on: March 27, 2015, 11:42:30 pm »
This may also be of some help. This link is to bc/bs of NC.
http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/implantable_bone_conduction_hearing_aids.pdf
I hope this is of some help. Good luck!
One other question, which blue cross plan do you have? I can see what I can dig up for you if you would like.
« Last Edit: March 27, 2015, 11:54:17 pm by Necromancer »
Left SSD 5 days post flu vac. Severe vertigo x 3 weeks. Left ear AN found on MRI 11/5/14 6mm x 4mm watch and wait. 22 hyperbaric O2 tx, no change. BAHA5 Attract 4/17/15 changed to post 12/15/15 2.5 year  MRI shows no change.

 


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