Author Topic: BAHA/Transear and Insurance coverage  (Read 23451 times)

Brewers7

  • Sr. Member
  • ****
  • Posts: 389
Re: BAHA/Transear and Insurance coverage
« Reply #30 on: December 04, 2011, 06:22:02 pm »
I have BC of Miss & Tenn.  They would not cover BAHA or Transear.  I opted for Transear a year ago.  I have been happy with it.  About $2700.00.  I had to go for two fittings but no big deal.
Translab surgery 12/15/2008 followed by CSF leakage repair and 3 additional surgeries for MRSA of the brain (NOT typical) SSD,  facial and vocal cord paralysis, numerous reconstructive surgeries, Transear 12/2010

Mei Mei

  • Hero Member
  • *****
  • Posts: 1278
Re: BAHA/Transear and Insurance coverage
« Reply #31 on: December 04, 2011, 06:27:37 pm »
That's a nice price.   I'm getting $3200 up here.   I'll try one more appeal and then give in.
Mei Mei
1 cm Tumor RetrosigmoidSurgery on Jan 12 at Johns Hopkins
Drs. Niparko and Tamargo
35dB loss pre surgery and now SSD
Post surgical Headaches and Tinnitus
Dr Ducic Georgetown Excision Surgery May 2011
Dr. Schwartz GW  Titanium Mesh  March 2012
Drs Kalhorn/Baker, Georgetown Removal of Titanium Mesh

leapyrtwins

  • Hero Member
  • *****
  • Posts: 10826
  • I am a success story!
Re: BAHA/Transear and Insurance coverage
« Reply #32 on: December 09, 2011, 12:33:45 pm »
I have BC of Miss & Tenn.  They would not cover BAHA or Transear. 

Glad you are happy with your TransEar  ;D

Just wanted to note that BC is famous for denying insurance coverage of the BAHA - but they have been challenged several times by their insureds and they have lost.  One case was here in Illinois not too long ago.  They were denying coverage for a young girl who desperately needed a BAHA.  After lots of media attention, they decided to pay for everything.

From what I know, most insurance companies deny coverage of the BAHA on the first request.  But if you are persistent and keep requesting, you generally can get coverage.  Both Cochlear and Oticon help BAHA candidates with insurance coverage issues these days.

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

cakulmom

  • New Member
  • *
  • Posts: 45
    • My Son-My Inspiration
Re: BAHA/Transear and Insurance coverage
« Reply #33 on: December 28, 2011, 09:36:40 pm »
This was an interesting thread.  Went for my one-year follow-up and audiologist had me try the BAHA device.  Wow!  Never realized how much I missed hearing out my left ear.  Now to talk to insurance company (United Healthcare-ugh).  Maddening to have to jump through hoops when Medicare will pay...but I have 3 more years before that will kick in and I want to hear now!
Age: 61 on Jan. 4.  Retrosigmoid for 2.2 cm AN on Nov. 30, 2010. Loyola-Leonetti & Anderson.
SSD left AN side.
There is nothing "benign" about this tumor.

Mei Mei

  • Hero Member
  • *****
  • Posts: 1278
Re: BAHA/Transear and Insurance coverage
« Reply #34 on: December 29, 2011, 08:29:16 am »
I also have United Healthcare and got denied about two months ago.    I talked with a friend an insurance agent and she said they are very difficult.     I included several beautiful letters especially from Dr. Niparko's office.    The nurse practitioner at Georgetown said that not hearing was causing me to get Cervical Dystonia because I was always turning and straining my head to the right to hear all day long.     Now I have to appeal again.   The denial letter said I could appeal again with more information.    The big problem is that the Montgomery County Public  Schools policy does not allow any kind of hearing device.    Good luck with your application.

Mei Mei
1 cm Tumor RetrosigmoidSurgery on Jan 12 at Johns Hopkins
Drs. Niparko and Tamargo
35dB loss pre surgery and now SSD
Post surgical Headaches and Tinnitus
Dr Ducic Georgetown Excision Surgery May 2011
Dr. Schwartz GW  Titanium Mesh  March 2012
Drs Kalhorn/Baker, Georgetown Removal of Titanium Mesh

leapyrtwins

  • Hero Member
  • *****
  • Posts: 10826
  • I am a success story!
Re: BAHA/Transear and Insurance coverage
« Reply #35 on: December 29, 2011, 10:24:14 am »
This was an interesting thread.  Went for my one-year follow-up and audiologist had me try the BAHA device.  Wow!  Never realized how much I missed hearing out my left ear.  Now to talk to insurance company (United Healthcare-ugh).

BAHAs are fabulous; glad you're considering one.

As for the insurance question.  You don't have to go it alone.  Cochlear and Oticon both have insurance divisions that help BAHA candidates approach their insurance companies about coverage.  Use them; that's what they're there for.

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

MNTim

  • Full Member
  • ***
  • Posts: 124
Re: BAHA/Transear and Insurance coverage
« Reply #36 on: December 29, 2011, 06:02:41 pm »
I met with a audiologist yesterday and asked the insurance coverage question because of concerns that I have read about on the forum.  She told me that she has never seen a claim denied for a BAHA.  As Jan said it may take several attempts but the audiologist and manufacturer should do the hard work.

Tim
8/31/09 hydrocephulus-emergent drain
9/2/09 5 cm AN debulked, Retro Sig Abbott NW
5/18/10 Second debulk, Retro Sig Abbott NW
1/31/11 Translab, 7/12 Graft Mayo Rochester, MN
2/12/11 Lumbar drain
3/14/11 Eustacian tube packing procedure for CSF leak
2/28/13 Platinum weight & Tarsorrhaphy