BAHA, part II

A few weeks ago I mentioned that I am scheduled to have a BAHA installed. However, last week, we found out that, contrary to the audiologist’s expectations, the insurance company, Anthem Blue Cross Blue Shield, has declined to cover the procedure. Naturally, I’m very disappointed. I do tend to expect that a company will honor their agreements with me, particularly when I am paying them a large amount of money every month to do so.

As I read it (and, I admit, Insurance has always been confusing to me. I presume they do that on purpose.) my policy clearly states that it covers reconstructive surgery to restore hearing that has been damaged due to trauma or earlier surgery. It says that cochlear implants are covered. It says that reconstructive hearing surgery, and hearing prosthetics, are all covered. And then there’s this weird clause that says that hearing aids are not covered, unless stated differently elsewhere in the document. Which it is.

So, the appeals process has now begun, but it seems that the chances of getting the surgery done next month are pretty slim. Folks on the BAHA Patients Site report battles with insurance companies lasting 6 – 18 months, which isn’t terribly encouraging. But they seem to report that insurance companies are gradually becoming acquainted with this device, and becoming more open to it.

I also spoke with folks from the Let Them Hear Foundation, who gave me some tips of how to appeal this, which I’d be glad to share with you if you’re going through this process yourself. They couldn’t assist me directly in the appeals process, because their funding is specifically to help kids in this process.

It certainly seems to me that insurance companies say no the first time, regardless of the issue, and that this is pretty much how they are geared to operate. And it seems that this is more the case now than it ever has been. It’s not right that insurance companies are the ones making medical decisions. And it’s not right that no matter how many presidents and governors have promised to fix this situation, it just gets steadily worse.

Well, it’s been 25 years since I lost my hearing, and I expect that another year or two isn’t going to be so terrible, if there’s an end in sight. And I’m pretty sure I’m just stubborn enough to win this battle. But it’s pretty discouraging to find this out 3 weeks out from my surgery date.