translab and baha

[kixit]

My Anthem insurance policy states the following:
 
"Your coverage does not include benefits for hearing care except as defined on page 33 of this booklet.
Your coverage also does not include benefits for implantable or removable hearing aids, with the
exception of cochlear implants".           

There is nothing on page 33 about hearing coverage---nothing!

When speaking with Human Resources earlier she said this was a gray area ( I had asked her about my chances of getting an approval) and that it is a case by case basis. She had not heard back from the policy administrator yet. Hopefully they will say YESSS give her the BAHA!!

UVA said a peer-to-peer with my surgeon is probably not necessary because it's not a medical necessity issue it's a non-coverage one.

I am sending Cochlear all my paperwork for the appeal. I got the "denial" letter today. Don't get me wrong-I'm not angry at anyone, just annoyed that there is coverage for bilateral hearing loss but not unilateral hearing loss.

[james e]

Are you reading the 2009 policy or is it a current policy? If you have the old policy, your page 33 is probably different than their page 33. Try to get the current policy so you know what their page 33 says.

I might throw this in. My insurance company lists my BAHA as a PROSTHETIC, not a hearing aid. The abutment, the little screw that gets drilled into your skull, is not an implant...it becomes part of you...it does not come off...your skull grows into screw. The BAHA is a sound processor, not a hearing aid. The key word here is PROSTHETIC.  It is not a removable hearing aid. The processor is removable for maintenance and it cannot get wet. The abutment is not removable.

So this is the problem. You have an old policy, they have a new policy. Your page 33 is different than their page 33. You are thinking prosthetic, and they are thinking hearing aid. Ask about their prosthetic policy.

James