BAHA/Transear and Insurance coverage

[ppearl214]

Hi all, I've split off these discussions re: hearing devices (ie: BAHA, Transear) and insurance converage and moved to their own topic... great discussions... let's keep this one going here, ok? Thanks! Phyl

[Ellenmn]

I have my insurance broker helping me appeal with Blue Cross Illinois. Here is an excerpt from the letter so I think this is the code you are looking for.


The CPT code, V5040 was on the original predetermination letter drafted by the Ear Institute of Chicago.  This same CPT is on the medical policy written by Blue Cross Blue Shield of Illinois.



Sorry for the slow answer but I haven't been on the board much lately.

[leapyrtwins]

Ellen -

good luck with the insurance coverage issue.  Ask your broker if your policy covers Cochlears.  My broker told me that if it does, by law, it has to cover BAHAs.

BAHAs and Cochlears are basically the same thing - it's just that Cochlears are for those who are bilaterally deaf and BAHAs are for those was are unilaterally deaf (SSD).

Who's going to do your implant surgery?  Wiet or Battista?

Battista did mine back in March - and I truly love it 

Jan

[Ellenmn]

Jan
That code is for the Transear. I'm am going to try to get the transear covered, if not I'll do the BAHA.
If I have the BAHA Battista will do it.
I'm a bit tired of surgery right now. I had the AN surgery 6-28-07, a complete hysterectomy including ovaries 7-25-08, and facial nerve surgery on 12-23-08.

[leapyrtwins]

Ellen -

sorry, my mistake.  I didn't read this thread back to page one   If I had I'd have realized you were talking about the TransEar 

I didn't know that insurance companies covered the TransEar; I figured it was classified as a hearing aid (not an implant, like the BAHA).

I'm sorry to hear about all your surgeries; I hope 2009 is a better year for you 

Take care,

Jan

[Pooter]

Just an aside, I read in my "Schedule of Coverage" for my insurance that my insurance pays a maximum of $1,000 per 36 months, 90% after deductible for hearing services INCLUDING HEARING AIDS.  I guess depending on how it's coded, a BAHA might be an implant for insurance purposes and therefore not restricted to the $1,000/3yrs, but TransEar will be covered under that restriction.

How much do these things run?  Nobody at TransEar is emailing me back with a list of providers in my area so that I could go talk to them directly about it..

Regards,
Brian

[Debbi]

Brian- Just FYI, I had better luck just calling TransEar - their customer service people were incredibly helpful and spent probably 30 minutes on the phone with me looking up doctors in New York, NJ and PA within certain area codes.  Now, I am going to re-look at my medical insurance to see what they say about hearing aids.  I really want to get a TransEar.

Debbi, getting a little tired of spinning in circles when the bell chimes....

[Mei Mei]

Hi!

In frustration because the secretary never replied about sending my Dr. Monfared letter to Pre Certification at United Healthcare, I called TransEar and they sent me to the inventor of the TransEar.   I have read that so many of you have had fitting problems and that going to the inventor in the same town in Tennessee would probably the best place to go with the exception of Jersey Girl 2 who said she had a nice fitting.   I sent the United healthcare all my audiograms and a request for Trans Ear as well as Soundbite and see what they come up with.   The secretary at the inventor's office quoted me a price of about $2300 and then corrected herself to something like 3200 and I didn't have a pencil but was too excited to be in touch with them.  I told her I wouldn't come to Tennessee until the TransEar were precertified and she understood that and said she would work with me and email me the forms and I emailed her all my audio grams.   So we are on the road.   I've copied down the CPT code and hope it works.

Take care all,
Mei Mei

[JerseyGirl2]

In frustration because the secretary never replied about sending my Dr. Monfared letter to Pre Certification at United Healthcare, I called TransEar and they sent me to the inventor of the TransEar.   I have read that so many of you have had fitting problems and that going to the inventor in the same town in Tennessee would probably the best place to go with the exception of Jersey Girl 2 who said she had a nice fitting. 

Hi, Mei Mei,

oops, wrong Jersey Girl!

I'm Jersey Girl 2, and you'll notice from my signature that I had a BAHA implant at the same time as my acoustic neuroma surgery in January 2008 at House in Los Angeles.

 Eve (Jersey Girl) is the NJ resident with Transear. I've met her at a couple of the NY / NJ acoustic neuroma functions and I believe that she is quite satisfied with her Transear. She certainly seemed to be doing fine with it.

Catherine (JerseyGirl 2)

[Mei Mei]

Thanks...I write to her.   I know Monmouth County well.   We were in Lincroft and my parents were in Holmdel.
Mei Mei

[Mei Mei]

They called in for the precertification of the TransEar and I called in for the SoundBite.   United Healthcare said they considered them Hearing aides and that my insurance with them would only cover hearing aides for my minor children.   I am the only one on the policy that I now as a retiree on disability am paying $400 a month for.

Will pursue.
Mei Mei

[Mei Mei]

They wrote to me and said there is no hearing aid allowed on our policy with the School System but invited me to appeal this denial as often times they approve denials.  It was strange to encourage me to submit additional information so I printed out the article on balance, asked for a letter from my nurse practitioner and neurologist with my cover letter included in the Priority Mail folder pre paid.   They will send it off.   Then I received a separate letter from my Otologist and they said they wouldn't read these separately.   I also had my primary care send his letter to the Precertification number as well.   I should have had them send the letters all to me.   There is no way for them to collate what comes in separately and put them in a folder.   I sent them a link to my doctor's letter saved in google Docs and still haven't heard from them although they said they get back to you in two days.

I tried to attach the letter because it was so beautifully written about the medical necessity for a TransEar.

Well if anyone is successful at an appeal, please let me know.   Also please let me know what CPT Code is.
Sincerely,
Mei Mei

[New girl]

Hi Mei Mei,

CPT codes are numbers assigned to specific medical procedures or services.   These numbers are then used by insurance companies to determine reimbursement.   You may have seen adds for medical coding courses.  The same codes are used by all docs to help make the reimbursement process consistent.  My sister got her medical coding certification not too long ago.  Feel free to PM me if you have specific questions that I can relay to her.  Good luck with your transear quest. 

[Mei Mei]

The United Healthcare denial of appeal for the TransEar came on Saturday.   I was expecting it but was very hopeful in that Georgetown and Johns Hopkins wrote very convincing letters that I am trying to attach here.    Georgetown's letter said that I've developed Cervical Dystonia which I am getting Botox injections for tomorrow and have been approved for every 2 months.

   Mei Mei
Clicked attachments and didn't get anywhere.

[Mei Mei]

I called the local audiologist that Angie's List rates very well and he gave the CPT Code at V 5040 which means digital hearing aide and doesn't mention bone conduction.    I have to gather up my energy and send a cover letter to two more doctors (a friend that is an insurance agent said to include letters to two more doctors on the second appeal).  She also said that United Healthcare is particularly difficult.    Once I gather the papers and cover letters, I will ask them to write the letters and forward them to me so that I can put my appeal letter in the envelope along with all previous appeal documentation.

Persist we must!
Mei Mei