Cost of BAHA processor

[Nancy T]

Hi all. How much did your BAHA processoror cost, and did you have to pay for it, or did your insurance cover it?

My neurotologist's office told me that the processor costs $10,000 via the hospital (because he does the surgery in the hospital and the hospital provides the BAHA hardware--marking it up, of course!).

But on this forum I've seen more in the neighborhood of $4,000.

I'm probably going to try to switch to Kaiser insurance and see if they'll pay for a BAHA. If I have to pay $4000 for the processor, I might go for it, although it would be very difficult for our family financially. But if I have to pay $10,000--no, too much! There are two other neurotologists in town who do the BAHA surgery and maybe they do it in their office and thus avoid the hospital markup.

I am really flailing in the dark here until I get more information and/or go on Kaiser.

Any advice/experiences welcome!

Nancy T.
P.S. I did not have an acoustic neuroma. I had a sudden, severe-to-profound sensorineural hearing loss in one ear 8 years ago, etiology unknown.

[Joef]

Yes the processor cost about 4,000$ (give or take a 1000) .. the surgery is the variable here.... normally it runs about 8-10,000$ ....

most of the time, the surgery is covered under insurance ... the processor is not .. but it is sometimes ... I was a lucky one!, the BAHA surgery was done at the same time as the AN .. so it was just a line item on the same bill .... and was paid....

[1wareagle]

Nancy T

     Like Joef, I had my BAHA surgery at the same time as my AN surgery  and the insurance paid it all less my deductable.  I never got a detailed bill from the hospital so I can't help with the exact cost. My insurance does not pay for hearing aids but Dr. Brackmann coded it so they would.

Ellis

[Nancy T]

Thanks, Joe and Ellis... it sounds like there is a lot of variation in what is paid for and under what circumstances.

I hate to change insurance (which will cost me $900 a year in lost reimbursement for having other insurance) just on the CHANCE that it will pay for BAHA surgery & possibly also the processor, but it seems there is no way to know for sure whether it will pay until you put in a request as a member. A $900 gamble.

Nancy

[dsuvb12]

I haven't got my processor yet and my Dr.'s told me it was about 5,000 dollars and I would have to pay for it out of pocket.  I'm from a very small town so there was a benefit for me so hopefully that will cover most of it!

[Tamara]

Ellis,
  Do you know what CPT codes were used to get insurance payment?  It might be nice if other drs knew.

Tamara

[lori67]

Sorry Ellis - I'm going to jump in on this one!

Tamara - the code they should be using is 69714 - Implant, Temporal bone with stimulator.

This is different than being coded as a regular hearing aid, because the BAHA is considered a prosthetic and most insurances have some coverage for that.

I know the code because the dimwit at my doctors office who does the billing submitted it incorrectly - one number off - and caused me to get a bill for $7000.  after 3 months of playing pass the buck - medical billing said it wasn't their error - insurance said it wasn't their error - aforementioned dimwit said it wasn't her error....well, it was her error.  It was resubmitted and paid for!

Hope that helps.
Lori

[Soundy]

Thanks for the code... I have asked for and not got it from doctors office or hospital and the
insurance people last time I talked to them had asked me for it ...crossing my eyes it helps

[Laurie]

I got a BAHA in January 2007.  My insurance paid for everything, but the attachment.  I believed that they should pay, so I fought it, along with a BCBS Rep. from the County which I work for.  He worked with the insurance and CPT codes with the Hospital and...10months later I got my $4200.00 back.  How great was that.  Don't give up.  I am so proud of myself for sticking with it.
I knew I had to pay, but I wanted the BAHA anyway.  Look how great it turned out.

Laurie

AN in 1/2004
Translab procedure
House Ear Clinic