BAHA coverage denied; a question for you

[teffaz]

My insurance company has denied my appeal for coverage of the BAHA. The appeals specialist said it had nothing to do with whether or not it was medically necessary. The fact is my insurance policy specifically states that "implantable hearing devices" are not covered.

So now I have to pay out of pocket (ouch!!!!!) for my BAHA. I'm already SSD, and in my neurotologist's office, I have tried the device which gives one an idea of what the BAHA would be like. I was very pleased.

But I have a question for you: what factors led to your decision as to whether to have the BAHA implanted at the time of acoustic neuroma surgery, or to wait and have it done on an outpatient basis? (The out of pocket cost is virtually the same, so I wouldn't be saving any money by waiting.)

My translab surgery is the end of this month, so I need to decide quickly.

Thanks for your help!

Brenda

[JerseyGirl2]

Hi, Brenda,

I'm sorry that your insurance company has denied your appeal for BAHA coverage. It sounds as though your policy would not even cover a cochlear implant for someone needing that procedure ... and I believe that's unusual in this day and age. Have you ascertained that they are denying both the surgical procedure and the processor, or just the processor? One would assume both, but maybe there's a potential loophole there.

I had my BAHA implant at the time of surgery, but I've gathered from this forum that it's not generally a "choice" that all translab patients have. Some surgeons (including those at House Ear in Los Angeles, where I had my procedure done) do it frequently, while other surgeons prefer that patients wait a varying number of months following AN surgery before implanting the abutment. Given your insurance company's practice, one of the advantages of having the implant done at the same time as the AN surgery (i.e., it's not considered a whole separate procedure since you're already under anesthesia, etc. so it's not as expensive for the insurance company) wouldn't really be a factor in your case (assuming they're denying both the procedure and the processor). You should certainly discuss this with your surgeons -- maybe they're in the school of "two surgeries in one," but if they prefer to wait until later I surely wouldn't force the issue. They know what they're comfortable doing!

I'm glad I made the decision to have the implant done at the time of my AN surgery -- it was a total non-issue in terms of the recovery process. Frankly, even though I had absolutely no post-surgical issues or challenges I really didn't want anything coming too close to my head for a long time after my surgery. I know that everyone who has the implant later says that it's no big deal (and I totally believe it), but I'm thankful I didn't have to deal with the psychological issues of having my head "invaded" twice in a relatively short period of time. But don't let that be a deal-breaker!!! My BAHA is a huge help and I'm so very thankful that I have it.

Best wishes with your decision and your surgery!

Catherine (JerseyGirl 2)

[leapyrtwins]

Brenda -

I had my BAHA surgery separate from my AN surgery for two reasons.  1)  that's generally how my doctor likes to do the surgeries and  2) I chose the retrosigmoid approach for my AN surgery, which means we didn't go into it knowing that I'd definitely end up SSD.

As Catherine said, some docs like to combine the two surgeries, some docs don't.  Personal preferences, I guess.

Would I have wanted to have the two surgeries at the same time?  It's hard to say, but I can tell you that having the BAHA implant after the AN surgery wasn't a big deal for me.  When I was first considering the BAHA one of my main concerns was having another surgery, but after talking to many people who had the BAHA I was assured that the surgery was absolutely nothing like AN surgery.  It's completely different and the only invasive part is the drilling.  Your head isn't "opened up" so to speak, like with AN surgery.

Catherine raises a very good point about the surgical procedure vs the processor.  Believe it or not, there have been stories on the forum where an insurance company actually paid for the implant surgery, but the patient had to pay for their processor.  Seems kind of strange, because an implant without a processor is basically useless.

You may have an extremely hard time fighting your insurance company since your policy specifically excludes "implantable hearing devices".  Most policies just exclude hearing aids and since the BAHA isn't technically a hearing aid, it gets covered as an implant.

I would definitely verify that your insurance company doesn't pay for Cochlears.  If they don't, IMO you don't have a lot to base an appeal on.  If they do, they basically have no foundation to deny a BAHA.  In fact, you can claim they are discriminating against you because you are "only" SSD and require a BAHA - as opposed to someone who is bilaterally deaf and requires a Cochlear.

Jan

[mikjul1]

Sorry Brenda about your insurance company I will say this if my insurance company would not have covered it you can not put a price on hearing I would have paid for it but that is me. I do not know your position money wise so that is your decision. Let me ask this can you get the implant coverage if you increase your medical coverage.That might be cheaper then paying for the surgery. Plus look up tax write offs for the medical expences for the year you might be able to take some of it off taxes. Hope this helps you.
                                                                         Good Luck
                                                                            Mike

[wendysig]

Hi Brenda,

It really stinks that your insurance company does not m,cover the cost of a BAHA.  As for why I had AN and BAHA surgery separately, some docs will do them both AN and BAHA surgery  together, others prefer to stage the operations, as mine did,  because they feel you have  enough to deal with  after AN surgery.  I know others, like Catherine (Jerseygirl2) have done very well having both done at the same time.  My BAHA surgery was a pice of cake, especially after AN surgery and I'd do it again in a heartbeat.

Wendy

[teffaz]

Thanks to all of you for responding to my questions/concerns!

To answer your questions:

--I am going to ask the representative who is appealing my case to appeal again to determine whether or not my insurance company may consider covering the surgery for the BAHA (even if it is at the same time as my translab) but not the processor itself. Thanks for the tip!

--Having SSD is very difficult for me and affects my quality of life more than I ever thought it would, so I am willing to pay for the BAHA surgery out of pocket. Of course I realize how fortunate I am that I can even consider doing this (it will still be difficult financially).

--Yes, my insurance policy specifically states ". . . implantable hearing devices including Cochlear devices are not covered, unless provided by an attached supplemental benefit rider." When I inquired about obtaining a rider, I was told that riders are not even an option in my group insurance plan.

--I am going to pursue having the BAHA surgery done at the same time as my translab, but if that does not work out, I appreciate knowing that those of you who have had the surgery later felt that it was not a big deal.

Best,
Brenda

[mikjul1]

Good Luck Brenda.   

[leapyrtwins]

Yes, good luck, Brenda.

Please keep us updated and let us know what happens.

Jan

[JerseyGirl2]

Hi, Brenda,

Sounds as though you've got your ducks in a row and some good plans in place. Hope everything works out to your satisfaction!
As Jan said, please keep us updated.

Best wishes,

Catherine (JerseyGirl 2)

[teffaz]

I was all ready to schedule my BAHA surgery at the same time as my translab (which is in less than two weeks) when I got a call from my neurotologist. He explained that if I had BAHA surgery at the same time as my AN surgery, a second (BAHA) surgery would be necessary. However, if I had the BAHA surgery done at a later time (out-patient), there would only be one surgery. Since I am having to pay for the BAHA & BAHA surgery out-of-pocket, you can guess which option I chose!!!

So, it looks like I'll have to wait awhile for my BAHA, but I'm confident that it will be well worth the wait!!

Okay, so here's another question for you:  how long after AN surgery does one typically need to wait to have the BAHA surgery? (I realize that there is a three-month wait from the time of the implant & abutment surgery until you can actually receive the sound processor, right?)

Best,
Brenda

[JerseyGirl2]

I was all ready to schedule my BAHA surgery at the same time as my translab (which is in less than two weeks) when I got a call from my neurotologist. He explained that if I had BAHA surgery at the same time as my AN surgery, a second (BAHA) surgery would be necessary. However, if I had the BAHA surgery done at a later time (out-patient), there would only be one surgery.


Okay, so here's another question for you:  how long after AN surgery does one typically need to wait to have the BAHA surgery? (I realize that there is a three-month wait from the time of the implant & abutment surgery until you can actually receive the sound processor, right?)

I'm certainly not trying to second-guess your surgeon, but I am baffled by what he means by a second BAHA surgery being required if you have the "first" BAHA surgery done at the same time as your AN surgery. I had my BAHA implant done at the time of AN surgery and I can assure you that I didn't have another procedure after that one!!! Did he explain what this "second BAHA surgery" would entail??

I'll defer your question about length of time between AN surgery and BAHA implant surgery to those who've done it that way, but my impression is that there's no set time and many folks have had the procedure done as soon as they get the go-ahead from their insurance company (a couple of months or so?). Since you won't be waiting for that go-ahead, you'll probably  just want to wait until you're feeling ready for another procedure, the sooner the better.

Best wishes as your plans proceed!

Catherine (JerseyGirl 2)

[leapyrtwins]

Brenda -

I'm with Catherine.  Are you sure you understood your doctor correctly?  I have never heard of someone having combined AN and BAHA surgery and then having to have a second BAHA surgery.  And I know lots of patients who have had the procedures combined.  Does your neurotologist typically do BAHA surgeries?  and has he done enough to make this statement?  Like, Catherine, I don't want to second-guess your doctor, but this just doesn't seem right.

As for the waiting period between AN and BAHA surgeries, I was told by my neurotologist that I needed to wait until my head was "healed", which IMO is a pretty subjective definition.  He also told me that I had to wait until my head was healed to try the demo, and I tried it at 3 1/2 months post AN surgery.  So I'd say that you'd probably need to wait at least a few months between the surgeries, but I'm no expert.  I'd defer to the doctor who will do your BAHA surgery.

Jan

[teffaz]

Catherine and Jan,
It sounded strange to me, too (the two BAHA surgeries), so I actually called Cochlear America. The gal at Cochlear confirmed that when done at the same time as AN surgery, only the first stage (the titanium implant) is done, then at a different time, stage two, the abutment, is put on. But when done on an outpatient basis, the two stages are done at the same time.

My neurotologist is very experienced with the BAHA, so I have confidence in him. When I talked with him on the phone regarding this, I couldn't hear him very well, so I thought I might have misunderstood something. That's when I called Cochlear. During that phone call, I had a clearer connection and I think I got it right. But it (the two surgeries) doesn't sound like what others in this forum that I've read about have experienced! AAGH!

Anyway, I'm not going to worry about it, because waiting for the outpatient surgery is fine with me!

Best,
Brenda

[leapyrtwins]

Brenda -

thanks for the clarification.  I get what the Cochlear person told you, but I'm surprised that attaching the abutment is considered a surgery.

The implant is definitely one, but I thought (and I could be wrong here) that the abutment just basically screwed into the "anchor" in the skull. 

Regardless, I'm glad you're comfortable with having the surgery on an outpatient basis after your translab.  I'm also glad your doctor is well versed in BAHA surgery.  I have to confess I was a little scared for a moment there    But now I know that you're in good hands and I feel much better about that 

Jan

[JerseyGirl2]

Catherine and Jan,
It sounded strange to me, too (the two BAHA surgeries), so I actually called Cochlear America. The gal at Cochlear confirmed that when done at the same time as AN surgery, only the first stage (the titanium implant) is done, then at a different time, stage two, the abutment, is put on. But when done on an outpatient basis, the two stages are done at the same time.

Hi, Brenda,

I'm glad you called Cochlear and got some confirmation on your "double BAHA" surgery.

I'm going to go out on a limb here and surmise that my surgeons at House Ear calculate the time between "stage one" (the titanium implant) and "stage two (the attachment of the abutment) in terms of minutes (!) while other surgeons calculate the time between stages in terms of days or weeks?!?! Whatever, it certainly sounds as though your surgeon knows what he's doing and the very last thing you'd want him to suggest is, "well, I've never done the complete BAHA procedure at the same time as the translab procedure, but let's give it a shot!" Uh, maybe not; let's stick with the way he's accustomed to doing it.

I'll add that I feel totally confident that my simultaneous stagings of implant and attachment of the abutment went quite well at House Ear, so those patients whose doctors do indeed complete the AN/BAHA procedures in one fell swoop needn't worry themselves about this discussion!

You know you will be in good hands and will do just fine. This sounds like just another one of those things in the AN world on which doctors have different views. Vive la difference!

Catherine (JerseyGirl 2)