Jan--yes, I think that's what Blue Cross meant--that they will say they'll cover it, but not guarantee payment until the claim is reviewed. I guess insurance companies can find reasons not to pay (hopefully they wouldn't do that!).
I have been confused about the cost of the device, but I think I've finally figured it out--I think the EXTERNAL processor, the snap-on part, is what costs around $4,000, while the total cost for whole device--the implant, abutment, and processor, in other words all the hardware--is around $10,000. This is what the insurance person at the doctor's office told me and what I saw on the BAHA users' forum.
I'm having a hard time thinking about how I could come up with that kind of money, short of taking out a second mortgage! If I'd known in 1999 (when I lost my hearing) that eventually there would be this expensive, non-covered device approved four years down the road that might help me, I might have started saving some money for it--or I might have thought about suing the doctor(s) who missed my sudden hearing loss and thus my best chance of saving hearing! (Although I seriously doubt I would have sued them, as I'm not litigious and it probably wouldn't have made any difference anyway.)
And even when I found out about the BAHA three years ago, I was told by an audiologist that my insurance would probably cover it within a year or two. If I'd known they wouldn't, I might have started saving THEN. Plus, I wouldn't have made the large contributions to a free medical clinic that I have been making for the past 3-4 years--I would have put that toward a BAHA fund!
Now, I don't know... plus we have taken out big loans for college tuition for two kids and paid more out of pocket for tuition and living expenses--paying $10,000 or $20,000 for the BAHA would be very difficult. At our stage of life particularly, with my husband nearing retirement and with my own health somewhat uncertain, I am really hesitant to take out another big loan.
Well, we'll see what happens with the other insurance and/or possibly appeals. Sorry to ramble...
Jan, I sure hope your insurance company pays as expected, without any nasty surprises for you! Best of luck with your healing and BAHA, too!