Need insurance help!!!

[manderson]

I am trying to get a BAHA for my right side.  My insurance company, ODS (Oregon), has denied my grievence and my level 1 appeal.  I am preparing my level 2 appeal and am looking in to getting a lawyer.  Dr Freidman is going to write a letter for me.  Does anyone have any suggestion.  I have sent an e-mail to Entific and posted on the BAHA-user-support forum.  The insurance keeps stating that the BAHA is a hearing aid.  How can it be an aid when there is not hearing to aid?!!!

Please help!!!

I am mad and frustrated

Maelynn

[ppearl214]

Maelynn,

Email/PM JoeF here on the site.  Not only did he have his surgery at HEI, but also (if memory serves me right), had the BAHA done at time of this AN removal surgery.  He may be able to help.

Phyl

[Joef]

Not sure if I can help .. but are they paying for the surgery at least? .. as far as the "hearing processor"    some pay for it... and some dont .. 

[matti]

When I was looking into a BAHA a few years ago, my insurance company would only pay for the surgery part,  not the processor. As of recent, they do pay for a portion of the processor.   I was told by my doctors that since my deafness was due to surgery which was necessary, that "some" insurance companies will comply and allow benefits. Letters from your doctors, surgeons, and audiologist are the next step. I agree with you, this whole AN process is frustrating

Hang in there!!

Cheryl

[manderson]

Thanks for the info so far.  The insurance company has not denied the surgery part yet because the first to letters were prior to my AN surgery and we were trying to get them to cover BAHA (and required surgery) for the same time.  I did get a sample letter from Entific that has worked in the past with some insurance companies.

Maelynn

[Obita]

Hi - I remember reading somewhere that some people had won their appeals when words like Device were used instead of Aid.  I wish they would change the name of the BAHA to BAHD. 

Good luck to you,  Kathy

ps:  If I remember where I read it, I will post again.

[Obita]

Maelynn:

I found some old notes I had from a year ago when I was thinking of getting the BAHA.

Definition of hearing aid:  any device that amplifies sound

I don't think the BAHA actually amplifies sound, does it?  BAHA experts?

I am very glad Dr. Freidman is on your side.  You would think that if anyone could help get it approved, he could.  I am sure he knows by now how to word it correctly.

Good luck

[manderson]

I have been using device but it is falling on "deaf ears"  .  Entific refers to the BAHA as a prothstesis which insurance does cover.  I will sent all my new info to them next week.  I will keep everyone posted.

Maelynn

[Raydean]

Most insurance companies follow the lead of Medicare.  More often then not if Medicare covers something, insurance companies will follow Medicare lead.  I'm curious, knowing that Medicare now covers BAHA, what reason is your insurance company giving for denial?

best to you
Raydean

[manderson]

Each time the insurance company comes back saying they dodn't cover hearing aids.  Each time I have explained that the BAHA is not an aid and that medicare covers them.  We will see what happens this time around.  I am going to be the thorn in their side that won't go away.

Maelynn

[redgrl]

Glad i found this post. Having been looking at my hearing options and my mother keeps telling me to check with my insurance to what's covered.