My husband lost his hearing 25 years ago, when he had a cholesteatoma removed from his ear canal. The tumor had grown around his ear drum, so after the surgery, he was suddenly and quite completely deaf on his left side. The doctor who did the surgery was a pioneer in his field, and during the procedure, my husband received what was, at the time, an experimental bone-conduction hearing implant. It took the form of a screw placed in his skull and under the skin of the scalp. There was an amplifier which was carried in his breast pocket and attached to the screw via a magnet at the end of a long wire running from the unit. The screw in his skull acted as a surrogate eardrum, conducting sound through the bone to his inner ear. It wasn't ideal, but at least he could hear.
Alas, that hearing aid stopped working about 5 years ago, before I'd even met him, and he's struggled with single sided deafness, and no options, ever since.
A few months ago, we began investigating the possibility of a new kind of implant--a BAHA (Bone Anchored Hearing Appliance), since the old implant is now completely obsolete. My husband went through all the preliminary steps, saw the doctor, got on the January schedule for the surgery, and cleared up his perpetual ear infection. The doctor's office contacted our insurance company (Anthen BCBS) and it seemed all systems were go. We were excited. The kids were excited (no more, "I'm sorry, sweetheart, but what happens when you whipser in my left ear?" "Nothing, daddy.") We were going to meet our entire deductible for the calendar year, but it was worth it.
Last week, the doctor's office called and said our insurance company had denied payment for the surgery. Hearing aids aren't covered, they said. Immediately, we traded hope for disappointment and anger.
Then we started our research again, because we were told by several people that the job of health insurance agents is to reject claims. We discovered that while there is an exclusion explicitly stated in our insurance coverage, there is also an exception listed within the exclusion: "Hearing aids are not covered, unless otherwise specified within this policy." It took only a little more work to discover that there are at least two places in the policy pamphlet where the BAHA and like appliances are covered.
We spoke with the bulldog at the doctor's office, a very kind but tenacious woman who is, fortunately, very much on our side in this. She is now embroiled in a lively discussion with our insurance company, armed with my husband's research and the appeal letter he wrote yesterday.
He has a pre-surgery appointment today, and we have no way of knowing yet whether or not the insurance company will cover it. It's just maddening, that the folks whom we pay hundreds and thousands of dollars every year, these folks that we'd like to believe are working for us and not against us, are actively working against my husband's needs. I'm aware it's not personal. For them. But for us, it's very personal. I don't know what it's like to go through a single day, let alone 25 years, with single-sided deafness. But I know it keeps my husband in chains, and I know Anthem has the power to remove those chains. Isn't this one of the reasons why we have health insurance?