BAHA Preapproval! No wait..Denied?! WHAT?!

[hannalou]

I am newbie...I have been to the site many, many times over the pastyear, reading posts and getting lots of good info.(Thank you:) but I never posted before.   I was diagnosed with an AN Jan. 2010 and had surgery to remove less than 3 wks after being diagnosed.  I have spent the past year slowly recovering and finally went in 3 wks ago (Dec. 2010) to get my BAHA implant done. My doctor assured me that my insurance had preapproved the surgery and I was covered and so I went for it.  Now that the surgery is done, my insurance recently sent notification that my claim was denied and that it wouldn't be covered.  I would have never gone through with this had I know my insurance wouldn't be covering it. I just graduated in Dec. with my degree in teaching and know how hard it was being in the classroom with SSD during my student teaching- I can't believe that they would deny something that would improve someone's quality of life.  I am wondering if this has happened to anyone else post-surgery and if anyone has any helpful advice for dealing with this insurance issue? 

Also I am about to go in for my 1 year check and have an MRI - which after surgery last year was pretty painful, so I am wondering how painful it will be when the put all those supports around my head now that I have the BAHA abutment sticking out? (When will the pain go away? I feel like I have had constant pain for the past year, not to mention the constant ringing - Ugh!)  Sorry for complaining so much - I think today's insurance issue is getting to me more than I realized!

[Jim Scott]

Hi, Hannalou ~

I'm delighted to learn that you've received useful input from the ANA discussion forums and decided to register and post.  Welcome!

I'm sorry your medical insurer denied coverage for your BAHA after the fact, which seems wrong.  I would definitely ask your doctor to help you with an appeal of the insurance company's decision.  You want them to treat the BAHA as an implant, not a 'hearing aid' because hearing aids, like eyeglasses, are usually not covered by most medical insurance policies.  Of course, the fact that you need it in your chosen profession (teaching) is important and worth mentioning but insurance companies are notoriously unsentimental.  The reality is that your quality of life is probably not a major factor in their decision,  Still, there seems to have been some kind of mis-communication that led you to believe the BAHA would be covered.  That needs to be cleared up, preferably in your favor.  I don't recall reading that BAHA wearers have an issue with the MRI apparatus being painful and I hope it isn't for you.   I'm sure BAHA wearers will soon add more relevant information.  Thanks again for your kind words about the forums and best of luck with getting your medical insurance company to see the validity of your BAHA claim.

Jim

[keithk]

I had my implant done in Nov 2010. Before I went for my evaluation I did research on my insurance company's website and found their requirements for the BAHA. I took that along with me so the doctor would know how to submit the claim. I was surprised to  get the approval in two weeks. Cochlear has a division that helps with insurance companies. Maybe you should contact them for help.

Good luck

[lori67]

I had the same problem with my insurance.  They approved it and then after the fact, they denied it.  I was going to just take the implant out and sell it on E-bay because I didn't have that kind of loose change laying around to pay out of pocket.   

Turns out, when they submitted it, the coder in medical records submitted it under the wrong code (one number off) so it wasn't billed as a "prosthetic" but as a traditional hearing aid.  Have your doctor's office check and make sure it was submitted correctly and work your way through the system until you make sure everyone that had his hands on your claim entered the correct thing.  In my case, it took a while because everyone kept passing the buck and blaming the "other guy".  Eventually, it took a phone call to the hospital administrator and boy, did it get fixed fast after that!   

As far as the MRI, I've never had a problem.  I actually enjoy the downtime and the chance to take a nap without kids bothering me!  If you think it will cause discomfort, you can certainly ask for some meds to take beforehand that will take the edge off.

Vent all you want - this is a great place to do it and insurance issues have a way of making all of us want to vent and complain!!!   

Lori

[dalern]

Hi Hannalu,
My abutment was placed June 30, 2010.  The insurance had pre-approved.  I had also investigated before that and they did say they covered it.  I got my processor on June 30th.  Shortly after that I started getting insurance EOBs.  The insurance paid for the surgeon, the anesthesiologist (for the conscious sedation) and the pre op and post op appointments.  However, they denied the hospital bill ($14,000 and some change) saying the hospital never got back to them with the further information they requested.  to this date, I have not received a hospital bill.  I am thinking that since I made a payment when I went to the hospital to cover the balance of my deductible and my co-insurance, the hospital may not bill me more.  However, I'd be shocked if they didn't go after the insurance company.  I'm not going to stir the pot, but it seems like it's in a black hole!

No problem with the MRI for me at all.  I had an MRI a couple of weeks after my abutment was put in, and there was no pain or discomfort at all.
~Dale

PS  You may also want to go to the Cochlear site and see if they can help you with your insurance if it becomes a problem.  They do have a department that does that.  That is, of course, if your Baha is made by Cochlear.  There is also one by Oticon.

[leapyrtwins]

Never had this insurance issue.  My biggest issue was getting my insurance company to approve the implant surgery and the processor in the first place.  I fought with them for about 5 months.

As for the MRI, I've had 3 MRIs since my BAHA implant and haven't had a problem with any of them.  I've never experienced any pain.  Good luck.

Jan

[hannalou]

I just want to thank all of you for your help.  After reading all of your feedback, I have contacted my doctor's office and they are going to check into why it was denied - they are thinking it may have just been a coding issue. Finger's crossed it will get processed and approved!  I went in for my MRI on Tuesday - no pain this time! YEAH!  Must have just been really sore last time after my other surgery.  Everything looked good for my one year, post surgery, check up, and we discussed some options for facial reanimation.  Not sure what I will do there - I am just nervous when it comes to my face.  I don't like living with the paralysis but am afraid surgery might make it look worse. I am going to have to do more research there - and make sure confirm insurance coverage before I do anything:)  Thanks again for all your support