BAHA not covered by insurance

Posted by jones365 @jones365, Jan 10, 2023

Hello,

My son, who is 8 years old, uses a BAHA from Med-El with the adhear system. It recently broke and our insurance is denying a replacement because they call it a hearing aid, which they don't cover. I do understand what BAHA stands for, but that seems to be a bit of a misnomer. My son has aural atresia on his left side and therefore cannot wear a traditional hearing aid. His device literally acts as his ear canal. A prosthetic ear canal is the truest description. In the past, with different insurance, it has been approved as a prosthetic devise.

Can anyone help with resources, advocacy, and/or guidance regarding getting a replacement for his broken BAHA? We are looking to have his repaired (which is cheaper than buying a new one, but still very expensive), but in the meantime, he is without a device for the first time in his life. You can imagine the challenges that presents to him, us, and his educators.

Thank you very much in advance for your responses.

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John, Volunteer Mentor | @johnbishop | Jan 10, 2023

Welcome @jones365, Sorry to hear you are having trouble with the insurance company for your son's BAHA. You mentioned your insurance company denied replacement coverage. Here are a couple of references if you haven't already seen them.

-- Insurance 101 for the Baha System:
https://hearandnow.cochlear.com/hearing-solutions/services/insurance-101-for-the-baha-system/
-- BAHA Cost and Insurance Information:
https://earcommunity.org/hearing-loss/baha-technology/baha-cost-and-insurance-information/
-- Denied insurance coverage? Cochlear can help:
https://hearandnow.cochlear.com/hearing-solutions/services/denied-insurance-coverage-cochlear-can-help/
-- Tips For Appealing With Your Insurance Company:
https://earcommunity.org/helpful-resources/financial/insurance/hearing-aid-insurance-information/
Have you looked into appealing the insurance denied claim?

jones365 | @jones365 | Jan 12, 2023

Thank you John for the information. Much of this is information we already have. I wish the term "bone anchored hearing aid" was not so prevalent. By using "hearing aid", the insurance companies automatically deny it. It is tough to pull people out of their thinking that a bone conduction device, although it aids with his hearing, is actually a prosthetic. An analogy I use is a prosthetic leg versus a cane. They both assist with leg function, but are two entirely different mechanisms.

I am looking for an organization or resource that may be able to help make this point clearer to the insurance company because as many times as we've said it, they still operate under the premise that it's a hearing aid.

We do have a patient advocate that works with my wife's insurance, but I'm not sure she fully understands either.

There seems to be little knowledge or awareness around the different types of hearing loss which I understand since it's not something most people deal with. It matters though because this lack ok knowledge or awareness is being used as the basis for denial.

Thanks again and thanks for listening.

Julie, Volunteer Mentor | @julieo4 | Jan 12, 2023

Are you familiar with The Alexander Graham Bell organization? Or The Hearing Loss Assn. of America? They both educate, advocate and share a lot of information. http://www.agb.org http://www.hearingloss.org Close to 18% of the population in the USA has hearing loss of some degree. Cochlear implants and BAHA devices both provide considerable help to people with severe hearing loss.

I know that Cochlear Corporation is excellent at standing behind recipients of their devices. Have you gone directly to Med El with your concerns?

jones365 | @jones365 | Jan 12, 2023

Thank you for these resources. We have spoken with Med El and have ordered a repaired replacement for my son. It is quite expensive, but having him continue to go without a device is not what we want for him.