medically necessary??? help

[tenai98]

I need some documentation has to why a BAHA is medically necessary...the VA will cover my ponto if I can prove that...ughhh

Jo

[CHD63]

Jo .....

Aside from the obvious ..... so you won't get hit by a car when you cross a street because you did not hear it coming on your deaf side ..... I'm not sure this can be documented by research, but I firmly feel that bilateral hearing assists in my balance.  It certainly assists in my emotional well-being to be able to hear other people speaking in a social setting.

Hopefully others will chime in here with additional suggestions.

Blissfully, I had no difficulty getting mine approved on the first try.

Clarice

[leapyrtwins]

That's a hard one to prove.

Lots of insurance companies take the issue that the BAHA processor - and hearing aids in general - aren't medically necessary.

Especially in the case of SSD, because afterall you still have one hearing ear.  Although hearing aids/BAHA processors improve the quality of our lives, technically they aren't medically necessary 

Cruel, yes, but most insurance companies look for ways to deny things that will cost them money.

I'd ask your doc and Cochlear/Oticon (whoever you are getting your BAHA from) to "fight" your case for you.  They are well-versed in things like this; both Cochlear and Oticon have insurance divisions that routinely handle stuff like this.

Good luck,

Jan

[Paul F]

Good points Jan.  I am SSD and draw a disability from the VA for that reason. The VA has provided me with a Phonak Bi-Cros.  The VA also does BAHA implants in the Seattle Clinic.  It almost sounds like a reply you may have gotten from the VA Ocupational Health people. They seem to have different standards than anyone else.  Because of HIPPA, it is up to you to get the required info to whom ever requested that info.  The VA has government contracts with many of these suppliers, both hearing aids and BAHA so, Jan is right, go to them for help.
Good luck, never fun dealing with the "system"

Paul

[james e]

Contact Cochlear. They will give you some reasons.

[tenai98]

My audio has sent a letter and I've contacted Oticon about a letter..  the problem is CHAMPVA wants to know why the newer unit (ponto power) is needed versus the old bp100...my good ear is impaired and the bp just wasnt cutting it...but wow with the ponto power...its awesome.   So hears to keeping my finger crossed...

[CHD63]

Fingers and toes crossed, Jo!!  Oticon Medical and/or a well-written letter from your audiologist should be able to jump this hurdle!!

Clarice

[leapyrtwins]

My audio has sent a letter and I've contacted Oticon about a letter..  the problem is CHAMPVA wants to know why the newer unit (ponto power) is needed versus the old bp100...my good ear is impaired and the bp just wasnt cutting it...but wow with the ponto power...its awesome.   So hears to keeping my finger crossed...

Jo -

while I'm hoping for the best for you, I've heard from others that most insurance companies don't pay for processor upgrades unless the processor being replaced is 5+ years old. 

In other words, some insurance policies have a provision that they'll only pay for a new processor every 5 years.

When I upgraded to my BP100, my Divino was only 1 year old and didn't have any issues so I never approached my insurance company about coverage.  I used funds from my flexible spending plan at work.

Jan