Jay, thanks for asking. I received a denial letter from Humana for the BAHA pointing out multiple reasons for the denial: not medically necessary, no coverage for hearing aids, there are less expensive options (right - hearing aids which they outright refuse to cover), and not the standard for treatment in the medical industry. I am paraphrasing here, not directly quoting the letter.
This denial was apparently only the first level denial and Humana has to review it again then deny it again before my former employer will step in to review. Based on the HR dept response to an email I sent upon receipt of this denial letter, I think the company plan administrator may be reviewing my appeal of Humana's denials for making an exception and covering the BiCROS.
Oticon's insurance dept looked up their code for the Ponto Pro and then checked the Humana policy and said Humana specifically stated that code as being not covered.
In my email yesterday, I made sure to rebut Humana's reasoning point by point but, bottom line, I expect the clause about less expensive treatment options will be my former employer's escape clause. In the meantime, I am qualified for a lower income program that dispenses the Phonak CROS systems with a much lesser grade receiver and I found another HA discount program (not as deep a discount) that I will look into for the upgraded Phonak receiver I tested. All and all a frustrating few months, aggravated by the fact that I currently am not using any hearing assistance...
