BAHA humbug

[Sue Vogel]

I was devastated today when my hearing center called to cancel my appointment (snow day) and said that my insurance (Blue Cross Blue Shield) won't even review cases like mine for a BAHA anymore.  They said that way people cannot file appeals because the claims were never accepted in the first place.  I told them that did not sound legal.  I was on the phone half the day between the doctor and the insurance.  My audiologist says that the insurance will cover BAHA in the case of things that affect only the outer ear and the middle ear.  I have a sensorineural hearing loss in the "inner ear" due to the AN removal and they won't cover that.  I found out that they also cover cochlear implants which seems discriminatory against people who have SSD.  The doctor says I am on my own to fight the battle with insurance.  I am heartrbroken at the thought of no chance for improvement as my deafness is causing problems in my classroom.  My confidence is slipping, and I am beginning to doubt my ability to do my job.  I have obtained the name and number for the state insurance commision and intend to contact AARP for support.  I will also write to congressmen and the governor to address the discrimination.   I can't file a suit because they have not denied my claim - they just won't review it in the first place.  The cost of the surgical procedure plus the device is 35K!  Are there any suggestions?   

[leapyrtwins]

Sue -

I am VERY sorry to hear this - and sad, too.  I think everyone who is SSD should have the option of a BAHA.  And I also think that insurance should cover it.

I'd fight your insurance company on the idea that they cover Cochlear implants and not BAHAs.  I have a policy through my employer, and our insurance broker told me specifically that if my insurance company covered Cochlear implants but refused to cover the BAHA I'd have a very good case based on discrimination.  Basically you are being discriminated against because you are "only" SSD - not bilaterally deaf.  It's kind of like them refusing to pay for a prothesis for someone missing a leg, but then covering two prothesis for someone who is missing two legs.

I also suggest that you check out the Cochlear Americas website (www.cochlear.com) and see if you can find any information about insurance coverage and what they recommend.

I met a great Cochelar rep @ the ANA Symposium who may be able to help you - or least give you suggestions on how to fight this.  If you get nowhere through the Cochlear website, PM me and I'll give you her contact information.

Jan

[Jim Scott]

Sue ~

I can understand your feeling of devastation over Blue Cross/Blue Shield refusing to accept your claim for a BAHA.  I also agree with you that this practice appears to be illegal at some level and definitely discriminatory.  I think you're on the right track by appealing to your state insurance commissioner, which can often produce the desired result.  I'm not certain what AARP will do but it's worth talking to their representative to see if they can help.  Writing letters to your governor and congressman about this discrimination may be a futile exercise but I would recommend doing it because 'you never know'.  Contacting a local newspaper and/or TV station to see if you can generate any interest from them in covering this issue might be worthwhile.  All they can do is ignore you, which is a distinct possibility.  However, in my experience, should the local media be interested, the resulting negative publicity could work wonders with a health insurance conglomerate that is trying to avoid paying on valid claims from policyholders, like you.

Meanwhile, try not to lose your self confidence.  I'm sure you're a fine teacher and I hope and will pray that you're successful in the battle to get Blue Cross/Blue Shield to cover your BAHA cost.   

Jim

[ncutt]

Sue,
I am afraid that my husband is facing the same situation.  We have Regence Blue Shield Blue Cross of Oregon.  By all means, check out Cochelear's website.  They have a service called OMS Insurance Support that tries to get the insurance company to cover the BAHA.  It's amazing that medicare will cover and Blue Cross will not. My husband. Les turns 60 this week.  I guess  he may have to wait five years for his BAHA unless OMS can convince Blue Cross.

Best of wishes and keep trying!

Norma

[6pick]

I wonder how this issue is progressing. I'm about to have treatment for my "alien" and since my hearing is gone, will want to acquire a BAHA. I have Blue Cross and it would be good to know what I'm up against before the fact.

Mark

[dalern]

You should have your doctor's office call and find out.  They have all the special coding and will get better results than if you call on your own.  If there is any problem, you can go to the Cochlear website and inquire there, as the Cochlear company will intervene and help you with your insurance if you have a problem. Good luck.  I have had the BAHA surgery but am not "connected" yet to the processor.  Can't wait.  I have Blue Shield and they DID pay for the procedure.  I let my doctor's office handle all that.
~Dale

[leapyrtwins]

Mark -

the first rule of requesting insurance coverage for the BAHA implant and device is, if at first you don't succeed, try, try again.  Most requests that are turned down initially, are ultimately granted.

Any doctor who performs BAHA implants will be well versed in dealing with insurance companies and will know how to get your request approved.  In addition, if you are opting for a BAHA device manufactured by Cochlear (Intenso, BP100) you'll find valuable insurance information on their websites.  Check out www.cochlearcommunity.com and/or www.cochlearamericas.com

It's vital that you stress to your insurance company that the BAHA is NOT a hearing aid - since most insurance companies don't cover conventional hearing aids.  You need to make them aware of the fact that a BAHA is an implant or a prothesis.

Jan

[keithk]

Last Friday I got the ball rolling to get a BAHA. When I went to see my audiologist I brought along documentation from my insurance company's web site. It spells out the requirements to be approved for a BAHA. We have Aetna until April of 2011 when we will be switched to United Health Care. (Union contract change.)

Here is the Aetna info.
http://www.aetna.com/cpb/medical/data/400_499/0403.html

Here is the United Health Care info.
http://www.uhc.com/news_room/health_care_reform/americans_with_disabilities_act_(ada)_protections_expanded_for_2009/relatedinformation/7ff2b6c25a355210VgnVCM2000003010b10a____.htm

[another NY postie]

My aetna approved my surgery 100% coverage, no questions asked,  so you should be okay with them.

I told my neurontologist about Blue Cross Blue Shield and he said "are they trying that again?!?!"  He said ultimately they can't deny you because of American Disabilities Act but he said they try that first round...so I guess keep on pushing if they don't say yes right away.

[leapyrtwins]

BCBS in Illinois seems to be notorious for refusing BAHA coverage also.

There was just a big story on the local news about a month ago.  The patient's parents won and going forward I don't think BCBS will be refusing many more implants 

[dalern]

However, Blue Shield of California is NOT covering any hearing implants as of October 1, 2010.  They sent out a notice to subscribers listing their rate increases (of course) and all of their policy changes.  I actually wrote them a letter to put in my 2 cents.
~Dale