Insurance Denying Payment for BAHA

[Catflower]

The hospital just called to inform me that BC/BS stated that insertion of the implant and the processor were not a covered service. 

Do any of you that have had success with getting BC/BS to pay happen to know the procedure code that was submitted to the insurance?

[lori67]

Catflower -

The code should be 69714 (implant, temporal bone with stimulator).

Try calling your doctor or audiologist and have them appeal the BC/BS decision.  My audiologist said many insurance companies deny it the first time because they really don't know what it is - but when they send in the medical documentation and a letter from the doctor and audiologist explaining the medical necessity, he's always had it approved.

My insurance company stinks as far as I'm concerned, and if they paid for my BAHA - I would think BC/BS would - they're much better.

Good luck.  Sometimes you have to really fight for what you want - it shouldn't have to be that way.

Lori

[leapyrtwins]

Catflower -

I too have heard that sometimes insurance companies deny coverage the first time, but approve it the second.  As Lori pointed out, its oftentimes a matter of educating them as to what you are asking for and why you need to have it. 

My insurance company was totally unfamiliar with BAHAs - had no idea what they were or why I would need one - but I found out that they cover Cochlears and used that as part of my case.  BAHAs are to unilateral deafness as Cochlears are to bilateral deafness.  Once they knew what a BAHA was and got the information from my doctor they decided they would cover it.  They also requested a copy of my medical records - probably to make sure I truly was SSD - which is a little amusing to me because they just paid for my AN surgery about 9 months ago and got the surgical reports that say I'm completely deaf in my left ear.  Go figure.

Hang in there; I'm hoping this turns out in your favor,

Jan

[Catflower]

Catflower -

The code should be 69714 (implant, temporal bone with stimulator).

Try calling your doctor or audiologist and have them appeal the BC/BS decision.  My audiologist said many insurance companies deny it the first time because they really don't know what it is - but when they send in the medical documentation and a letter from the doctor and audiologist explaining the medical necessity, he's always had it approved.

My insurance company stinks as far as I'm concerned, and if they paid for my BAHA - I would think BC/BS would - they're much better.

Good luck.  Sometimes you have to really fight for what you want - it shouldn't have to be that way.

Lori

Lori, thanks for the information.  Is that the procedure code or the ICD-9 code?

[1wareagle]

Catflower

     It has to be coded like Lori said. I have BC/BS and it paid, less my deductable. Get your doctor to recode it and you should be fine.

Ellis

[leapyrtwins]

Very encouraging news from Ellis.  Hope this helps solve the issue, Catflower.

Let us know how it goes,

Jan

[lori67]

Catflower -

I actually don't know what type of code it is.  They just referred to it as a billing code or something.  Sorry - I've never understood medical billing. 

Lori

[Catflower]

Catflower -

I actually don't know what type of code it is.  They just referred to it as a billing code or something.  Sorry - I've never understood medical billing. 

Lori

I don't understand the coding either.  The only thing I know is that you darn well better have something that can be coded or your SOL.

[lori67]

Exactly!  And I am beginning to think they're making up the codes as they go along and not telling anyone else about them.  Must be a "secret" code!

[leapyrtwins]

Catflower -

good to see that you say "SOL" also.  It's a term I picked up from my father, who used to swear to us when we were kids that it meant "stuck on a log".  He also used to say "TS" which he told us meant "tough sailing" 

Ah, childhood memories - can't beat 'em.

Any word from the insurance company today?

Jan

[Catflower]

Catflower -

good to see that you say "SOL" also.  It's a term I picked up from my father, who used to swear to us when we were kids that it meant "stuck on a log".  He also used to say "TS" which he told us meant "tough sailing" 

Ah, childhood memories - can't beat 'em.

Any word from the insurance company today?

Jan

The finance person from the hospital called yesterday.  She gave the code Lori mentioned to their "coder" and they are resubmitting it to the insurance using that code.  I hope I hear something this week.  I'm scheduled for April 8 and that will be here before we know it.

[lori67]

I don't know why they bother hiring "coders" when we have to do all the work ourselves.  You should send them a bill for services!

I'll keep my fingers crossed for you!!

Lori

[Tamara]

ICD-9 codes are for diagnoses, and CPT codes are for procedures or treatments.  The BAHA code is a CPT code.  I will do some digging when I am at work tomorrow (I work for an allergist), and see if I can get some codes of both sorts that maybe we should all know.

Tamara

[Catflower]

Here's the latest on my insurance saga:  The hospital finance person called this morning to tell me the insurance approved the procedure using the code Lori said to use.  I asked if that included the processor.  She's checking on that now and is to get back to me.  I also told her to make sure it's all in writing.

[lori67]

Yay!  One step at a time!!  Stick to your guns - you're almost there!!

Lori