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Click here to read the results of our
Hearing Aid Insurance Poll
***** Please remember that if you have an unused hearing aid laying around, many of
the
organizations listed under Other Sources
would be more than happy to receive it and pass it along to someone who can use it!
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Your Insurance
Most of the time (we hope), there are no
problems getting your insurance to cover hearing aids or cochlear implants. We
didn't have any problems with our insurance covering either our son's hearing
aids, or his cochlear implant. Unfortunately, this is not always the case. See Does Your Insurance Company
Cover Your Hearing Aid Expenses? from the Where
Do We Go From Hear? Website. We hope some of the following information will
be helpful to you who are having problems getting your hearing aid or cochlear
implant covered by your health care provider.
- Advocating for Your
Child: One Parent's Approach to Securing Health Insurance Coverage for Hearing
Aids - From AG Bell.
- Health
Benefit Plans and the ADA - If your employer's Health Benefit Plan does not cover
hearing aids or cochlear implants, they may be in violation of the ADA Title I.
- Health Insurance Benefits for Cochlear Implants
- Insurance Coverage
of Hearing Aids
- A SHHH Fact Sheet
- If you were turned down by your insurance because they said a Cochlear
Implant was a hearing aid, and hearing aids are not covered under their policy,
it might be worth it to get a copy of the decision mentioned in Arizona's Medicaid Agency to Pay for Cochlear Implant
where it was found that the cochlear implant is not a hearing aid. Once
you have a copy of that document you'll be able to look and see what arguments
brought success in this case.
- One Mother's Insurance Battle - This extraordinary mom turned her battle into a national effort to
advocate for Universal Reimbursement for Cochlear Implants and Hearing Aids
with Hear Us. She recently left that organization, but will continue
her efforts to advocate for universal reimbursement.
- Steps to Obtaining
Coverage for the Cochlear Implant
- From Cochlear.
-
Insurance Reimbursement - From Advanced
Bionics
- Coverage
for Hearing Aids
- If you've been turned down by your insurance company and your insurance is
self-funded through your employer, your employer can tell the
insurance folks whether or not to approve the device. Try to find out who in
administrator in your place of employment for the self-funded insurance and
see if you can't get them to approve it.
- Let Them Hear Foundation
Advocacy - If your insurance provider has denied
a request from your medical provider for certain hearing-related services, the
Let Them Hear Foundation has a nationwide Insurance Advocacy Program to assist
you in appealing the denial, free of charge.
- Kentucky -
Revised Statutes Chapter 304.17A.131 states "All
health benefit plans shall provide coverage for cochlear implants for persons
diagnosed with profound hearing impairment." Bill
SB 152 also passed and
requires all health benefit plans to provide coverage for hearing aids and
related services for persons under 18 years of age.
- Oklahoma - as of Nov.1, 1999, any new or renewed insurance policy in the state will
be required to cover hearing aids and audiological services for children up to
age 13. You can also download the bill by clicking
here.
- Rhode Island -
House
Bill 00H7298 has passed both the House and Senate and will take effect April 1, 2001.
The bill amends Chapter 27 of the General Laws to include hearing aid
coverage.
- Alabama - there is at least progress. SB189
(passed) reads: "This Act removes the prohibition, in §36-29-5, Code,
against state health insurance coverage for hearing aids and provides that
the State Employees Insurance Board may vote to cover these expenses in
whole or in part on or after the Act’s effective date."
- Missouri -
Chapter
376 of the Missouri Revised Statutes states "...shall offer
coverage for the necessary care and treatment of loss or impairment of
speech or hearing subject to the same durational limits, dollar limits,
deductibles and coinsurance factors as other covered services in such
policies or contracts. All Missouri group contracts issued or renewed on or
after December 31, 1984, shall be subject to this section."
- Maryland's Governor just signed into law HB
160 which mandates health insurance companies provide $1400.00 worth
of coverage per hearing aid every three years through the child's 18th
birthday. The bill will go into affect for new plans on Oct 1st, 2001 and as
plans are renewed through Oct 1st, 2001. He also signed a bill authorizing
$250,000 in state funds to create a loaner bank for children birth to three
years. As soon as a child is diagnosed with a hearing loss, hearing aids can
be loaned out for 6 months until the family can get the child their own
and/or decide which kind of hearing aids are appropriate (SB
281 & SB
282).
- Texas - An issuer of a group health benefit plan
shall offer and make available under the plan coverage for the necessary care
and treatment of loss or impairment of speech or hearing. This offer of
coverage is subject to the right of the group health benefit plan holder to
reject the coverage. See the
Texas Department of
Insurance for more info.
- In many states, insurance policies are required to cover the
necessary care and treatment of newborns with medically diagnosed congenital
defects and birth abnormalities. The AG Bell document
Advocating for Your
Child: One Parent's Approach to Securing Health Insurance Coverage for Hearing
Aids covers one parent's experience.
- Read our Sample Letters of
Justification
- One Mom tells me that when she encountered some resistance from their
insurer they called and wrote their local senator and the insurance provider
responded immediately.
- I've gotten a number of requests for names of insurance providers who have
paid for hearing aids. Here are some that folks have told me have paid for
hearing aids. Please keep in mind that coverage can vary from region to region
and by policy to policy. If your insurance isn't here and they've paid for
hearing aids for you, please let us know so we can add them to the list.
- Aetna/USHealthcare -
Visit
their online Cochlear Implant policy statement.
- Blue Choice
- BlueCross BlueShild
- California Public Employees Retirement System (CalPERS)
- Cigna HMO
- Great West Life PPO
- Hartford Insurance
- HealthTexas
- Matthew Thornton
- NYLCare
- State of Minnesota Employees Insurance
- Tricare - PFPWD (formerly PFTH)
- United HealthCare
- A Partial
Listing of Hearing Aid Insurance Coverage In the United States, 2000 -
From SHHH
- Because I've heard from so many folks who are having insurance problems,
here's some info from Appeal Solutions; Medical Insurance Recovery Specialists
Medicaid/Medicare
Medicaid -
We would like to thank Mark, a consultant on CI reimbursement issues, for sending us the following information about Medicaid and their coverage of Cochlear
Implants:
Children
In November 1994, I secured a directive from the Health Care
Financing Administration (HCFA) requiring all States with the sole
exception of Oregon to cover CI for all children under age 21, and any
services and aural rehabilitation necessary to effectively use the CI.
This directive was based on a law called EPSDT passed in 1989.
Oregon is the only State with a waiver from this law (however due to
an appeal I filed in 1994, they still cover CI).
Hawaii's Medicaid officials mistakenly state they have a waver from
this
law (since they are the only State exempt from a different law known
as ERISA) And to my knowledge they continue to fight it.
However, Hawaii's HCFA waiver (found at www.hcfa.gov)
clearly states:
"Hawaii QUEST provides a standard benefit package consistent
with the services currently offered under Hawaii's traditional
Medicaid program, and includes coverage for medical, dental and
behavioral health services. The program emphasizes preventive care
for adults and children and requires that plans provide EPSDT
services for all children up to age 21"
- States must cover CI for children even if their Medicaid program
excludes coverage. So if you call Medicaid and ask whether their
plan covers CIs for children, you may receive "no" for an
answer--which is technically correct. However, if your physician
submits a prior authorization request for an appropriate CI candidate,
Medicaid must provide benefits.
Adults
Even though EPSDT does not apply to those 21 or over, Medicaid must
still cover CI for adults based on laws such as the ADA and Section
504 of
the Rehabilitation Act.
Again, Medicaid's written State Plan may technically not provide
benefits. But if your physician submits a PA request, they legally
cannot refuse coverage. I have filed appeals in several States
on behalf of adults,
most recently in Arizona. In every case, the adult received
coverage.
Hope this helps to clarify this information.
Mark Hobratschk
You can visit the Medicaid Section of Mark's
Website by clicking
HERE.
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Medicare
Medicare & Cochlear Implants
Occasionally I hear folks complaining of Medicare or Medicaid refusing
coverage for Cochlear Implant hookup and mapping sessions. Here is a
little something I found in Health Care Financing Administration's (HCFA) Medicare and Medicaid
Program Manuals with Transmittals and Program Memorandums:
15300. OTOLARYNGOLOGY AND AUDIOLOGY/SPEECH/LANGUAGE TESTS AND TREATMENTS
(CODES V5299, V5362-V5364, 69000-69979, AND 92502-92599)
A. Cochlear Implant "Tune Up" Not In Global Surgical
Fee.--Payment for cochlear rehabilitation services following cochlear
implantation surgery is not included in the global fee for the surgery. When
these services are provided by an employee of a physician (typically an
audiologist) and the requirements for coverage as "incident to a
physician's service" are met, for services rendered prior to January 1,
1996, the physician bills for the services using CPT code 69949 and you pay
for the service on a "by report" basis. For services rendered on or
after January 1, 1996, new CPT code 92510 is used and you make payment based
on the fee schedule amount for code 92510.
Other Sources
***** Please remember that if you have an unused hearing aid laying around, many of these
organizations would be more than happy to receive it and pass it along to someone who can use it!
*****
Air Force Aid Society
Children of the Silent World
Children
with Special Health Care Needs - Directory of State Title V CSHCN
Programs: Eligibility and Scope of Services
Colorado
Neurological Institute
Department of Veterans Affairs (VA)
Department of
Developmental Disabilities - Each state dictates how their funding is
spent and therefore each state offers different types of services. As reported to me by one parent,
deafness alone is not enough to qualify for their program. You are able to use
their financial aid funds the way you see fit, with some limitations. It has to
be directly related to the disability. Another parent tells me that their state
assists individuals or families with funding (up to $1000/year) to travel to
programs that would provide educational information regarding the particular
disability.
Disabled Children's Relief Fund
Dorothy Ames Trust Fund - help for New England kids who need
aids/FM/etc to pursue an oral education.
Dorothy Ames Trust Fund
Key Trust Company of Maine
P.O. Box 1054
Augusta, ME 04332-1054
Attn: Christina Cook
Easter Seals
ESCO - Finance new hearing instruments
with the use of their "HELPcard".
Basically it's a credit card for healthcare.
Financial Assistance for
Hearing Aids - From the Massachusetts
Commission for the Deaf & Hard of Hearing. ** This link changes often.
Follow hyperlink then use the search box to find Financial Assistance for
Hearing Aids.**
Funding Sources - This
is at our sister site...or should that be daughter site? Either way, Sherry's a good friend
of mine and she's got some good info.
Hearing Aid Bank
Hearing
Aid Banks - Here's another list Hearing
Aid Banks
Hearing Impaired Kids Endowment Fund (The HIKE
Fund, Inc.)
Hear Now - The Starkey foundation took over the Hear Now program,
but the Program is still in operation. For more info Contact
- HEAR NOW
- The Domestic Program of Starkey Hearing Foundation
- 4248 Park Glen Road
- Minneapolis, MN 55416
- 1-800-648-4327 [voice]
- 1-952-828-6946 [fax]
- nonprofit@starkey.com
Update: Their website now
reflects the Hear
Now program.
Hike Fund
Lions Clubs
Local CI Support Groups - Many local CI support groups have fundraisers to help those who couldn't otherwise
afford one. Check with your local support group to see how to qualify, or ask what you can
do to help with their fundraiser.
Minnesota Hearing Project
- a pilot program of HearNow Minnesota, A division of the Starkey Hearing Foundation.
There are also Hearing Aide
Chapters in Arizona, California, Colorado, & Florida.
Miracle-Ear Children's Foundation
New Hearing Program Takes Shape -
Connecticut
Optimists
Paying for the Assistive
Technology You Need - A Consumer Guide to Funding Sources in Washington State
Program for Amplification for Children of Texas (PACT)
Public Schools - A possible source for hearing aids for children. Many times it's
difficult to get hearing aids to be provided by the school system for use during
school hours. It's often even more difficult to get the hearing aids to be
allowed to go home with the children. The following may be helpful:
The Office of Special Education Programs (OSEP)
has written guidance letters clarifying for schools that
Hearing
Aids are Assistive Technology and that Presumptively
Denying Assistive Technology is a big "No-No". Also, the Final
Regulations of the IDEA '97, §300.308
reads, "On a case-by-case basis, the use of school-purchased assistive
technology devices in a child's home or in other settings is required if the
child's IEP team determines that the child needs access to those devices in
order to receive FAPE."
Quota International - You can
find out if there is one near you on by
clicking
here.
Resources for
Financial Assistance: Habilitation, Rehabilitation Services, Hearing Aids and
Other Assistive Devices
Scholarship
Trust for the Deaf and Near Deaf - Provides financial assistance for
those in need.
Sertoma International - While they don't appear
to have an International program for helping fund hearing aids, many of their State Clubs have programs that will help
out. Use their site to find the contact info for the Club in your state. You'll even find
a link for the few that have Web Sites.
Title
V Children with Special Healthcare Needs (CSHCN)
Travelers
Protective Association's National Scholarship Program for the Deaf and Near Deaf
- Can be used for equipment.
The AgrAbility Project
- Assists agricultural and agribusiness workers who have physical and mental
disabilities, including such disabilities as amputation, arthritis, spinal cord
injury and hearing impairments. Education and assistance are available to
accommodate disabilities, eliminate barriers, and create a favorable climate
among rural service providers for people with disabilities.
VA Hearing Aid Benefits -
Explains which veterans are eligible for hearing aids.
Vocational Rehab
(VR) - In some states, the Vocational Rehabilitation
program will cover hearing aids. When I contacted our VR program in Texas in
1998, if amplification was necessary for employment (to either get or keep a
job), VR would pay for it. Click on the link to go to an info page about
the Texas
Rehabilitation Commission's Hearing Impaired Program.
Check with your local Department of Health, or your
audiologist to see if there are any local or state programs not listed here.
These following links are not about places that will help
cover the costs of hearing aids, but they offer discounted hearing aids or
services and might be helpful. When choosing a hearing aid that is discounted in
price, please look into it thoroughly. Sometimes a reduced price means a
reduction in services.
Articles About Denial of Hearing Aids or Cochlear
Implants
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