translab and baha

[kixit]

I'm new to this forum and just figured out how to post, so I really am a newbie. I have been diagnosed with acoustic nueroma, 9mm--rather tiny but casing symptoms. I woke up Feb 17th deaf in my left ear. I thought nothing of it since I was battling a cold all week and thought it was just sinus related. I woke up the next morning with my world spinning, still deaf. I went to urgent care for the spinning and nausua. I followed up with my PCP on Monday. She prescribed Z-Pac for sinus infection as well as Prednisone for sinus swelling. I asked her if I would be better by the weekend so I could go back to work, she said sure. By Wed. the ear was still deaf so I requested an ENT. After my visit with him he ordered an MRI which showed the lil bugger in my left inner ear. I wasn't so concerned with the tumor as I was the deafness. Needless to say all through this I've been walking like a drunk person.

I had an appointment with ear surgeon (1 PM) and neurosurgeon (3 PM) at UVA in Charlottesville, Va.  Dr Kesser (ear surgeon) explained everything. We discussed treatment. I said if my balance will not get any better without surgery then it has to go. So we decided on the translab approach and I'm also attempting to get the BAHA. I'm wondering if my Anthem insurance will pay for that. My policy states no hearing aids and they consider bone anchored ones just that.
 
My balance is a lot better (I was told it would improve because the right side compensates.
My surgery will be on May 24th and I won't need the neurosurgeon : ).

[Tod]

Hi Kixit, welcome to our little community. I'm sorry you had to find us, but I am glad you did.

I can't tell you specifically if Anthem will cover your BAHA. However, I can tell you that as a state employee on Anthem in Virginia, Anthem covered all my surgeries (at MCV/VCU), including the BAHA implant and device without a squawk. Hopefully your experience will be similar.

I would be remiss in asking, even though you have made decisions, whether or not you considered radiation therapy, such as CyberKnife, GammaKnife, or other? Some find that a preferable approach to a small tumor.

Best of luck to you,

Tod

[kixit]

Thank you for the warm welcome!     I told the surgeon straight out no gamma knife. I don't want radiation in my head. He agreed wholeheartedly because of my age, the SSD and research has only been recent (approx 15 years) about future results of tumors turning malignant. I also tols him that radiation can leave scarring and that if sugery was required in the future it would be difficult to remove the tumor. He seemed impressed with my knowledge on the subject. I told him I had been off of work for a month and I'm in "research overload", lol.

I am a local government worker for the police dept. ( a proud animal control officer, lol) and that's why I am concerned about insurance paying for the BAHA. As you can imagine my hearing is pretty much my job. My insurance is Anthem of Va and the policy states:
"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"
 
So that has me nervous if the insuance is going to pay. If I get a denial. does anyone know how long an appeal takes? I have 7 weeks until translab surgery along with BAHA (fingers crossed).

[pjb]

Thank you for the warm welcome!     I told the surgeon straight out no gamma knife. I don't want radiation in my head. He agreed wholeheartedly because of my age, the SSD and research has only been recent (approx 15 years) about future results of tumors turning malignant. I also tols him that radiation can leave scarring and that if sugery was required in the future it would be difficult to remove the tumor. He seemed impressed with my knowledge on the subject. I told him I had been off of work for a month and I'm in "research overload", lol.

I am a local government worker for the police dept. ( a proud animal control officer, lol) and that's why I am concerned about insurance paying for the BAHA. As you can imagine my hearing is pretty much my job. My insurance is Anthem of Va and the policy states:
"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"
 
So that has me nervous if the insuance is going to pay. If I get a denial. does anyone know how long an appeal takes? I have 7 weeks until translab surgery along with BAHA (fingers crossed).

Just wanted to comment on the surgery after radiation I have read that is definitely possible but of course only with trained hands..As far as the insurance there is always an exception that the doctors can write to a Supervisor, Manager or their Medical Board and do a strong letter on your behalf and 99% of the time they will allow it. It is time consuming and a game that is played but can achieve good results.

Best Wishes,

[leapyrtwins]

BAHAs aren't conventional hearing aids and shouldn't be coded as such for insurance purposes.  Technically a BAHA is a prosthesis or an implant.

Your best bet is to contact the company that will be manufacturing your processor (Cochlear for the BP100, BP110 or Oticon for the Ponto series) and ask them to fight your insurance battle for you.  Both these companies have insurance divisions that will help you and they know what insurance companies generally need to grant coverage.

If you don't know which company to contact, ask your doc(s).

Good luck,

Jan

[kixit]

I've been reading where there are different styles of Baha's depending on your degree of hearing loss. I am SSD thanks to AN with 70dB (last hearing test was 3/14/12). On one site it showed a BAHA with an attatchment to be worn on the body for my degree of hearing loss. I don't want that style. Any suggestions?  Also, this may be a dumb question-do I wait for a response from the insurance company to see if they are going to pay or should I contact the facility (UVA) that is going to do the surgeries to see if they have submitted the procedures yet?

[CHD63]

Hi kixit and welcome .....

As a Ponto Pro wearer, I am a little confused by what site you are looking at with a BAHA that has an attachment to be worn on the body.  To my admittedly limited knowledge, it is my understanding that all bone anchored hearing devices have a processor that attaches to the abutment implanted in the skull.  The processor is what receives the sound to conduct it through the abutment and your skull to your remaining good auditory nerve on the opposite side from your AN.  See:  http://www.oticonmedical.com/

Translab surgery removes all hearing apparatus from the AN side, along with the tumor, so you will be totally deaf or essentially have a "dead ear" on what will then be your former AN side.

Maybe you have also read about CROS hearing aids, which is an entirely different way of conducting sound to your "hearing" ear.

I, too, had no difficulty with insurance coverage for my Ponto.  Previously, I had to pay 100% on my hearing aids, but insurance picked up 100% on my bone anchored device.

Clarice

[jaylogs]

Hello, I just wanted to add my welcome to this rather exclusive club!  It sounds like you are pretty well informed...I think a majority of the people who find this forum, myself included, seem to handle things better because of all this information!  This was pretty evident as when I had my surgery done at House Ear Institute, and I was staying at Seton Hall and there were a few people coming in who had absolutely NO clue what was coming are what to expect... and you could tell they were definitely worried about the whole process. Jan gave very good advice about the BAHA insurance...the hearing loss is medically induced, not caused by too loud of music or whatever, so it should be treated as a medical procedure.  Good luck to you and keep us updated!!

Jay

[alabamajane]

Hi Kixit and welcome,
We just had a support group meeting and had rep from BAHA there.. VERY informative. There is a device that you wear like a necklace for some people. I did not pay much attention to that as it was not for me. But one lady has untreated AN on one side and bad hearing on other and he demonstrated it for her. But he also demonstrated the "typical" behind the ear device on everyone of us and it is amazing how well it works. . of course there was a lot of static noise and was not as clear as one implanted, but you could get the idea of help it would give. So just wanted to add to other posts, that yes there is a device worn in front like necklace,, but evidently not used by many.
It was also mentioned that most insurances will pay,,, "eventually",,, after some appeal as these are not actually considered "just ' hearing aids,, but prothesis hearing aids,,, definintely go through BAHA co. insurance/customer serv, dept, for help.. I have not begun the process yet, as I plan on recovering before moving forward with all of that.. maybe soon.. good luck,, Jane

[kixit]

I called my insurance carrier today (Anthem of Va) to check to see if my surgeries were approved. My translab was, no question. They had not gotten a request from my doctor for the BAHA!! After speaking with the insurance nurse-she said they do pay for the BAHA if the criteria is met and it sounds like I meet it. All she needs is the request from the doctor-so don't think as soon as I hung from her I called UVA right away!! It was probably an oversight on his part. He added it to my permission for treatment form after I signed it.

It definately is a good idea to double check behind your medical provider. They do get busy and have more patients than just you/me. The nurse said a lot of people don't check and then they are faced with charges that weren't pre-approved and can't be approved after the fact.

The countdown is on-- 6 weeks (May 24th) till Translab and BAHA. Then 3 months until I can hear on BOTH sides again.

[kixit]

P.S. As I went through the "people tree" with Anthem, I found it humorous that I knew more about the BAHA than they did (except the nurse). Both phone techs had no idea what a BAHA was and what it is for.

[leapyrtwins]

kixit -

the device you saw with the "body attachment" isn't a BAHA, it's called a Cordelle and it's not for those of us who are SSD.  Cordelle's aren't widely worn these days.

Lots of medical people have no clue what a BAHA is - including my kid's pediatricians and my ENT (gasp!).  I had my implant at a hospital (outpatient) where my doc usually doesn't do BAHAs; in fact I was the hospital's "first".  My doc and I were only 2 of 3 people who knew what the BAHA was.  One of the nurses had seen the schedule the day before and researched BAHAs on the internet; pretty impressive.

Jan

[kixit]

I was denied coverage for the BAHA. There is an exclusion in my policy for them but there is coverage for cochlear implants. I immediately called insurance company, got the run around about coding and unanswered questions. I sent Cochlear an email for help. I plan to write my appeal letter sometime today (Imworking). When I got the denial email from my surgeon I felt like I had been punched in the stomach.

[pjb]

I was denied coverage for the BAHA. There is an exclusion in my policy for them but there is coverage for cochlear implants. I immediately called insurance company, got the run around about coding and unanswered questions. I sent Cochlear an email for help. I plan to write my appeal letter sometime today (Imworking). When I got the denial email from my surgeon I felt like I had been punched in the stomach.

Don't give up keep appealing 99% of the time persistence pays off...Now the denial letter from your doctor did they fight for you and lost or this is only the first time and they sent just a normal letter..The key to winning with insurance companies is a strong letter from the doctors and yourself I have not heard of any BAHA denials usually these are covered and hearing aids are definitely never covered, but do not give up that is what they want and how they win if someone keeps up with it they will soon win...Hoping you will be one of them..

Best Wishes,

[kixit]

I talked with Cochlear today. They sent me the appeal paperwork. The consultant wanted to know if my insurance was self-funded. She said if it was the I may have a better chance of winning the appeal because the employer can overturn the denial. I put a call in to HR. Also, I called Anthem requesting the denial letter. I was told they didn't have one because it's straightforward BAHA is not covered but they could "create" a letter. I mentioned Cochlear helping with the appeal     A few hours later......Anthem calls to say they are putting a hold on the letter for further investigation into my case. I said you told me its straightforward "no coverage". She said she has put a call in to Dr Kesser for further information. So......you deny my coverage for the exclusion in my policy then tell me hold up I'm investigating further. Should I be confused?  I am cautiously excited that I may not have to fight for my hearing!