The Health Insurance Association of America describes Medicaid as a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.” (America’s Health Insurance Plans (HIAA), pg. 232). Medicaid also has enrollment programs for children with specific conditions, depending on state policy. Medicaid programs are funded jointly by the federal government and each state and the programs are administered under this partnership on a state by state basis.
Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States. The system can be quite complex. States establish their own systems for delivery of services under their programs. Add the fact that states have their own policies regarding coverage, and it’s more than a full-time job to keep up with federal and state regulations—especially because they’re constantly changing. It takes the time and care to look into each individual’s case to fully understand and utilize coverage.
In an effort simplify the process of obtaining replacement sound processors and soft bands, Oticon Medical has enrolled as a provider in many state Medicaid programs. Because we are enrolled providers, not only can we provide assistance in ensuring that patients have necessary coverage in place for devices, we can also bill those programs directly.
No matter what kind of healthcare visit or procedure you have, insurance can be confusing—so much so that it can sometimes feel like a completely different language. In addition to various companies, each individual insurance company has many, many policies. So, what works for someone with similar insurance might not work for you. That’s why we offer free insurance support for patients and clinics. Our team acts as a trusted guide to educate, address concerns and help you ask the right questions.
We work with you to do everything from verification of benefits to submitting the paperwork to insurance providers to requesting and receive pre-authorization. In the event that your request for pre-authorization is denied, we’ll investigate the reasons for denial and help to form and submit your appeal. We can truly help as little or as much as you need.
We sat down with Lindsay Fisk, Oticon Medical’s manager of customer reimbursement services, to learn more about how she helps hundreds of people navigate the world of insurance coverage. With over 500 authorizations complete, Lindsay and the rest of the team have a defined process that will get you on the right track for coverage.
Angela Holley wanted a sustainable hearing solution for her six-year-old son, Evan. Even when it meant calling insurance companies daily, Angela was Evan’s unwavering advocate. Now, Evan has what he needs and is a happier child who hears better than ever.
Here’s Angela Holley’s story–
Evan, who has bilateral hearing loss, started out wearing Cochlear hearing devices. We had a lot of issues and were constantly sending them in for repair. When we finally received the devices back from repair, our Audiologist was unable to program them. The Windows computer system wasn’t compatible with the device program, which caused yet another huge delay for us, and more importantly, for Evan. We were frustrated, and the Audiologist was frustrated.
During this time, our aggravation encouraged us to try demos of the Oticon Medical Ponto. We were excited by Evan’s response and couldn’t wait to get him a pair of his own. So, we sent in the order to the insurance company. To our surprise, it was denied. Because Evan had additional hearing loss from his last screening, we were truly in shock that his case was denied. So began the journey to getting coverage for devices that worked well for Evan…
What I Did to Make the Case
First, I appealed with a letter saying that the devices are not a want but a need. That they contribute greatly to him functioning as a successful individual. He needs the devices to be successful in school and to thrive with his peers. Then, I search for helpful information and made sure I knew about everything that could be helpful. Ear Community and Melissa Tumblin were an excellent resource. Finally, I collected any kind of documentation I could get to help build a case for Evan. Gather and submit documentation such as:
Letters from Evan’s teachers
Information from Evan’s ENT and speech therapist
Hearing Screen Results
Information from Evan’s pediatrician
Even a letter from myself explaining our own experiences in communicating with Evan—we were having to repeat ourselves more than ever
I didn’t rely on others to help get the job done, and I suggest the same to other parents. Make sure that you are organized and submit every piece of paperwork in a timely manner—there are deadlines that will affect the outcome. Work with the Audiology clinic that’s pushing through the paperwork, and make sure they’re meeting deadlines. Finally, follow up and then follow up again. Make sure information was received. It is a lot of work, but it can be done. Don’t just accept the denial and don’t rely on other people to do their part.
And hopefully, as with our case, you’ll see the light at the end of the tunnel. Finally, the insurance company approved coverage for one Ponto. Even though Evan needs bilateral aids, we were only approved for one and we felt lucky for that.
Well Worth the Work
All of us moms know we need to fight for our kids, and we need to remember that. Don’t rely on anyone else to fight our children’s battles— it has to be us to do that. What kept me going? The fact that Evan’s demo devices had him hearing better than he ever had before.
The day we got the demos, Evan walked into the bathroom with his shoes on. When he came out, he said, “Mommy, my shoes—they make noise.” Now, at night, he doesn’t want to take them off. It’s still amazing to watch him explore and experience little noises for the first time.
Fighting for what we deserved has helped shape Evan’s future. It’s a lot of work, but well worth it for a positive future for my son. I couldn’t have had a better partner along the way than Oticon Medical. The experience has been fantastic, and more than anything, the people at Oticon Medical LISTENED when no one else did.
Are you working to get insurance coverage? We can help. We can also help connect you with others who have successfully navigated the insurance process. Let us know in the comments section below or on Facebook or Twitter if you’d like help or to be connected.
It can be hard to find helpful information from people who fully understand the impact of dealing with hearing issues. Here’s a list of resources that we update on a regular basis. In addition to the resources below, you can also connect with others on our networks: Facebook, Twitter and Pinterest. And, if you’re looking to talk to someone specific to your condition, we can help connect you.
The benefits of bone anchored hearing systems vary greatly from person to person due to differences in hearing loss as well as listening preferences and lifestyle. A good way to gain insight into what life might be like with Ponto or another type of system is to talk to other users. Below are some useful links for getting connected to user organizations.
Acoustic neuroma & single-sided deafness (SSD): Acoustic Neuroma Association
US organization for people with acoustic neuroma and other benign tumors of the cranial nerves
Atresia, Microtia, Treacher Collins and Goldenhar Syndrome:
Ear Community
The Ear Community is a warm and supportive community for those who have any or all of the following: varying degrees of hearing loss, Microtia, Atresia, Treacher Collins or Goldenhar Syndrome.
Goldenhar
A support charity for families and individuals affected by Goldenhar syndrome and related issues.
Treacher Collins
A support charity for families and individuals affected by Treacher Collins Syndrome.
Yahoo online discussion support group
This community is intended as a forum for people with, and parents of children with Aural Atresia and/or Microtia.
This is an ever-growing list. Help make it better by adding your suggestions. Please let us know what we should add in the comments section below or tell us on Twitter of Facebook.
