Health Insurance
HEARING AIDS
For most of us with hearing loss, our best remedy is one or two hearing aids. Unfortunately, most health-insurance policies specifically exclude hearing aids, as does Medicare. So we must absorb those costs ourselves.
The reason for that almost universal exclusion is obscure, but apparently dates from a time prior to electronic miniaturization, when hearing aids were very primitive and largely ineffective. The Hearing Loss Association of Washington is working on Hearing Aid Insurance Legislation (HAIL), to require some coverage for hearing aids.
The picture is a little brighter for those (primarily self-employed people) who have bought high-deductible health-insurance policies coupled with a Medical Savings Account. The tax-deductible money put into the MSA can be used not only to meet the deductible amounts of the insurance policies, but to pay for medical needs not covered by the insurance policy, which includes hearing aids. So for those individuals, hearing aids can at least be purchased using pre-tax dollars.
COCHLEAR IMPLANTS
Cochlear implants (CIs) have proven to be a huge blessing for those who lose all or almost all of their hearing, especially those who do so later in life and have always been part of the hearing community. While often effective and widely prescribed, CIs are expensive -- $60,000 and up. Because of that cost, insurance coverage is critical -- my suspicion has been that many of not most CI candidates will simply forego the treatment if insurance coverage is unavailable.
Private Insurance
Health insurance policies are similar, but not identical, and one hates to speak in generalities because there may be exceptions. That said, my understanding is that most Washington health insurance plans will cover the cost of a CI.
Because insurance coverage is so critical, the implant manufacturers will work actively to make sure that potential recipients are covered by their insurance. Some of the manufacturers band together to support a non-profit corporation in California called the Let Them Hear Foundation Insurance Advocacy Program, which offers low-cost advocacy services to potential recipients.
Public Insurance/Medicare
In 2005, Medicare issued a National Coverage Determination stating that it would reimburse for CI treatment on patients with moderate-to-profound hearing loss in both ears and who receive limited benefit from hearing aids, which involves a test of ability to recognize spoken words in a recorded sentence. When a physician certifies that a Medicare recipient meets the guidelines of the National Coverage Determination, the service doctors and manufacturers should be assured of Medicare reimbursement.
Bilateral Implants
The principal debate presently about CIs is over whether implanting both ears is sufficiently cost-effective to be declared "medically necessary," and therefore covered by insurance. Our understanding is that the trend is in the direction of insurance reimbursement for bilateral implants, but that it is not yet a universally accepted practice.
Medicare appears to be a significant holdout, and the real problem with Medicare is pre-authorization. When Medicare is asked to pre-approve bilateral implants, it doesn't say "yes" or "no" -- it simply doesn't say. Unfortunately, when Medicare declines to pre-authorize, that decision is final, and can't be appealed to anyone. The candidate must undergo the surgery and then ask Medicare to reimburse, and if Medicare declines, that decision can be reviewed internally and ultimately appealed to the courts. Unfortunately, though, few candidates have the resources to undertake expensive surgery without the assurance of Medicare reimbursement.
My office is currently representing a Seattle woman in this exact situation. We believe the most effective approach is to petition Medicare for a National Coverage Determination stating that bilateral implants are covered. Should Medicare either fail to act or determine that bilateral CIs are not covered, then that decision is subject to review, both internally and in the courts. We have asked the LTH Foundation to either undertake this effort or to work in partnership with us. That effort will be the subject of future posts.
