Steps to take to get BAHA

[sterry]

Good evening fellow AN'ers,
 I am getting more serious about looking into getting a BAHA, but I am confused about where to start. My MD in Wyoming is unfamiliar with the BAHA.  Do I need to go to an ENT to get the insurance thing approved or can I start at House? Dr. Friedman did tell me a year ago that he could do the surgery, and I am leaning towards that option. I have CIGNA for insurance and I did read the book which says no hearing aid....so I am ready for the possible denial and the fight after. Any information will be helpful, thank you.

[kixit]

Sherry-

I have Anthem of Va and had to appeal their denial. Cochlear started the fight for me. All I had to do was write a personal letter to Anthem of how SSD affected my life (I had AN left side) and how the Baha would dramatically improve my life. I faxed it along with my paperwork (Cochlear gives you the paperwork) to Cochlear. They were extremely helpful and kept in close contact throughout procedure. I'm sure God had a hand in it somewhere from what I hear the first appeal is denied.

First, in my case, the surgeon sends in a request for the surgery and then you have to wait for approval from insurance company. Be sure to ask you doctor or surgeon to INCLUDE the processor. My medical facility didn't do that when quoting me a price.

[james e]

Kixit fought quite a battle for weeks with her insurance company, and we all got front row seats. Follow her lead...she won! She can say "been there, done that"

James

[leapyrtwins]

BAHA surgery is nothing like AN surgery, and you may be able to find someone in your area who does the implant instead of traveling all the way back to LA (unless of course, you want to).

Kris (ksiwek) had her AN surgery @ HEI, but my doc (here in Illinois) did her BAHA implant.

Anyway, for docs in your area go to the Cochlear website (www.cochlearamericas.com) and look under the "clinic" area.  You should be able to find someone who does implants in your area.

And as Kixit said, Cochlear can help you get insurance approval - unless you plan to go with Oticon.  From what I hear Oticon has an insurance division also.  Bottomline, go with the company that will manufacturer your processor.

Good luck!

Jan

[CHD63]

Ideally, you should find physicians who do the Oticon Medical Ponto Pro, as well as the Cochlear products and demo each one before making your decision.

Go to http://www.oticonmedical.com/ and click on Find a US Clinic and contact one of your choosing.

Best wishes .....

Clarice

[leapyrtwins]

Great suggestion from Clarice, although the implant procedure is the same for Oticon and Cochlear products.  It's the "equipment" and the processors that differ slightly.

If you find a doc on the Cochlear site, he/she typically would let you choose which company you want to go with.  Docs don't usually play favorites when it comes to choosing a BAHA company 

Jan

[sterry]

Thank you everyone. Clarice you had Friedman do yours? He did my surgery too, he did tell me when I saw him last september that he could do that for me. But would I email him and get House to do the insurance part?  I did just email the Oticon people to maybe try something out first, before making a final decision.  Being in Wyoming is pretty sparse for some of this specialized stuff. Although I do know 2 other women in my city with AN, one had surgery in April at mayo, and the other is a watch and wait.   I will keep forging ahead!

[CHD63]

Yes, Dr. Friedman implanted my abutment at the same time as my translab AN removal.  I had absolutely no problems with it whatsoever.  HEI handled all of the insurance filings for both the AN surgery and the Oticon Medical approval ..... both quickly and with no issues at all.

I presume House would handle all of the insurance paperwork for the Ponto for you, as well.  I received the processor from House while there, but with strict instructions not to open the box until I saw my audiologist for programming in 90 days.

Since no audiologist had been trained to program the Ponto in my immediate area, I contacted Oticon Medical and they gave me a list of the closest clinics who had trained personnel.  I chose to drive not quite three hours to the University of Kentucky in Lexington to an audiologist there.  UKs protocol dictated that I had to see one of their neuro-otolaryngologists for documentation that my abutment had fully osseointegrated ..... which it had.

I would change nothing about the way things worked out for me.  West Virginia is about as remote as Wyoming so I understand your situation quite well.  Email Dr. Friedman about the insurance and I know he will forward it on to the House insurance department or at least give you a phone number to call them.

If you do have a chance to demo a Ponto or BAHA, keep in mind that the actual implanted abutment works far better than the demo.  If you could try the testing device (which is a small plastic tube-like piece that you hold between your teeth), you can get an idea of how it sounds, as well.  They actually give you one in the box so your family can try it out to "hear" what you will be hearing.

Best wishes!

Clarice