The Four Most Commonly Used Insurance Codes (DME codes) for BAHAs are:
L8690 (for the processor and surgical supplies for an implant)
L8691 (for a replacement processor only for the soft band head band)
L8692 (audio integrated device without integration for a soft band head band)
* This is a code that was created by Medicare. However, it does not meant that it is always covered.
L8699 (for a prosthetic implant NOS: Not Otherwise Specified)
Cochlear Americas made a wonderful suggestion in regards to using the term “hearing aid” associated with “BAHA.” Please read below:
“There is one thing that I would like to bring to your attention, which can greatly affect the ability for insurance companies to cover sound processors, Softbands, and eventually bone-anchored implants. The use of the term “BAHA” inherently implies an acronym “bone anchored hearing aid”. This is an historical term that we have worked to change. As most insurance companies, including Medicare, do not pay for hearing aids, we have been very careful to try to change the use of the “BAHA” term. This is one of the reasons that we now use Baha® as our brand name, and use “bone-anchored auditory device” or “bone-anchored auditory implant” to describe the Baha hearing solution. This terminology was instrumental in Cochlear persuading insurance companies that this technology is different from a hearing aid and ultimately gained coverage from Medicare, some Medicaid programs and many major insurance plans. As an incredible advocate for your daughter and educator of parents for countless children, I believe that by using more generic terms, without the words “hearing aid”, more parents will be able to get insurance to provide the hearing solution that their child needs.” – Cochlear Americas
Again, in order to prevent further insurance complications with the acronym, BAHA…please try using “bone-anchored auditory device” or “bone-anchored auditory implant” to describe the Baha hearing solution.
How Much Does a BAHA or BCHA Cost?
There will always be different costs quoted for BAHAs (bone anchored auditory devices and bone conduction osseo-integrated processors) and BCHAs (bone conduction hearing aids) as each medical facility will have differently negotiated and contracted prices.
For example, one may be quoted $7,400.00 (USD) for one Cochlear BP100/BAHA, $6,700.00 (USD) for an Oticon Ponto Pro, and $4,200.00 (USD) for a Sophono Alpha 1 (S). However, pricing may vary based on contracts that have been negotiated with the manufacturers that are through Children’s Hospitals, through outpatient facilities, or through private hearing aid businesses. So, a Cochlear BP100/BAHA3 may be quoted at $7,200.00 (US), an Oticon Ponto Pro at $5,400.00 (USD), and a Sophono Alpha 1 (S) at $4,800.00 (USD) somewhere else when compared to the original numbers mentioned above. So, you can expect to pay a flat out right amount of anywhere between $7,400.00 and $4,200.00.
Cost With Insurance Coverage for BAHAs
Now, don’t let these numbers scare you. For example, say you have insurance coverage at 80%, with 20% being out of pocket for hearing aids. The Cochlear BP100/BAHA (quoted at $7,400.00) would now be covered by your insurance at $5,800.00 and your out of pocket expense (our cost to you) would cost $1,480.00. The Oticon Ponto Pro wold now cost you $1,340.00 and the Sophono would now cost you $840.00. Also, inquire about additional discounts. For example, some Children’s Hospitals may be able to help you with additional discounts, especially for families who have restrictive incomes that allow for them to fall within specific socioeconomic guidelines. One example may be a 35% discount based on combined income. Many Children’s Hospitals offer scholarships that you may be able to qualify for in order to save some money if you have an income below $80,000.00 (household). Again, according to your insurance provider and the Hospital billing department, this 35% may be deducted off of the original quoted cost or the cost after it has been quoted out of pocket to you or simply as a reimbursement (hence the scholarship aid). They are all different.
Other Example Costs for the BAHA Across the World
In the United States:
- $3,500.. for an Oticon Ponto Pro, insurance covers up to $1,700.00 annually for hearing aids (Harvard Pilgram Health insurance), out of pocket expense was $1,800.00 not including $420.00 worth of co-pays and deductibles. (Jay in the US)
- Johns Hopkins Medical quoted $4,200.00 for an Oticon Ponto Pro (TriCare insurance), denied coverage by insurer and patient is now appealing. (Angela in the US)
- $5,000.00 quoted for a Cochlear Divino (six years ago in 2006). (Anel in the US)
- $3,470.00 for the Cochlear BP100/BAHA 3, however, government pension paid in full. (Patrick in the US)
- I was told my insurance was billed $8,000, I was worried I’d have to pay 20% as durable medical equipment, but ended up paying nothing. The audiologist mentioned the cost is $4,000 without replacement insurance on it. (Jennifer in the US)
- I was quoted everything from $5k to $12k. However we found a licensed to sell audiologist in network and it ended up costing us nothing because we’d met DS deductible already. (Cynthia in the US)
- Quoted $7500, medicaid denied, primary insurance denied repeatedly, audiologist called medical director at primary insurance, moments later approved and covered 100%….granted we had met our out of pocket max. Otherwise would have been covered at 80%. (Kristin in the US)
In South Africa
- R45 000, but paid R30 000, medical aid paid R9 600 and then paid the remaining balance. In addition, for mixed hearing loss, has Oticon hearing aid for R12 000 and had no medical aid toward the Oticon. (Caryn in South Africa)
- At least 80% of surgical fees are covered by insurance in South Africa, the hospital was 100% covered and (was hospitalised twice) came to about R50 000 and didn’t pay anything for. The ENT was about R10 000 and probably paid R2 000. The audiologist was not expensive at all and most of these fees were covered by our medical aid. I would say in total about R3 500 and we paid about R800 and medical aid took care of the rest. (Caryn in South Africa)
- Paid R 32 000 with the cost of the softband, Oticon Ponto. (Annelize in South Africa)
- My daughter’s first one was free, along with the operation, but the cost for a new one is $3850 Canadian. (Michelle in Canada)
- Cochlear Divino was priced at $3850 Canadian about 2 years ago (2010). I got mine free through a program for Deaf/HoH who are in emergency need (my old one broke and I can’t work without it!) (Lori in Canada)
In the UK
- Paid nothing for a Cochlear Divino through the NHS. (Gayle and Louise in the UK).
- Surgery fees were $3514.50 (Aussie dollars) and after health fund rebate and medicare rebate, paid $2940.05 out of pocket. The Cochlear BAHAs cost was $6500 and the actual implant (called ‘flange fixture’ on my invoice) cost $1930.00 both of those were paid for in full by private health insurance (HBF insurance). Since being a private patient through HBF there was no wait list or waiting period. The other option in Australia is to go public with insurance, but there is a waiting list for a few years. (Jessica in Australia)
Always Check Directly With Your Insurance Provider
It is important to remember that insurance coverages and insurance plans are all different, all vary, and all have different stipulations and guidelines. While some insurance providers may offer 100% coverage, others may only offer 50%. Some, unfortunately may not offer any coverage toward hearing aids at all and my deny your claim for hearing aids or a BAHA/BCHA. Always work with your audiologist as he/she knows which codes to submit through to your insurance provider.
What If I Have Been Denied Coverage By My Insurance Company for My Hearing Aids?
If you have received a denial for your hearing aids, you can still appeal. Many hearing aid manufacturing companies have specific departments that can help assist you in the appeals process and help you argue why hearing aids are a necessity for you and for your life. Contact the customer service department and ask for their Financial Assistance Department for Insurance claims. Hearing aid companies want to help you because they believe in their product helping you. They also know you will be able to hear better wearing their product. If your appeal has been rejected, you can still appeal to your insurance company again. However, you may have to seek the assistance of an attorney at this point or helpful services that can help assist you though the paperwork process or by contacting your state official asking for help. There are also many organizations and foundations that are available who can help you possibly obtain a BAHA.
Can Early Intervention Services Help Fund My Child’s Hearing Aid if Our Insurance Provider Declines Coverage?
Yes and No. Sometimes you can qualify through your child’s Early Intervention or Birth 2 3 program and get your child’s BAHA paid for. However, I would like to help clarify something. Not all states have the same funds for the birth to three programs (Early Intervention) and therefore can not pay for BAHAs. For example, in Colorado funds have been cut for unilateral hearing support so it may not be possible for early intervention programs to pay for a BAHA. However, in New York or California, this may be a different story and there may be adequate funds for paying for BAHAs. Every person can try to have a BAHA paid for by applying for scholarships and discounts due to income restrictions and such. Especially, if your insurance company has denied you coverage. It is only after all of these options have been exhausted that it is possible to then apply for Medicare through part 3C. Then, maybe the state services through the Early Intervention program can reach out and help you. Funds are taken on a first come first serve situation of course and every city, county and state are different regarding bucket money, funds, and guidelines.
What About Insurance Coverage for BAHAs?
When purchasing a bone-anchored auditory device or implantable auditory processor (or any hearing aid for the matter), the manufacturer that you make your purchase from will offer insurance coverage. Often times, there is an original two year factory warranty on the processor. Some (not all) bone-anchored auditory device manufacturers offer one complimentary replacement if the processor is lost or destroyed beyond repair with in the original two year warranty itself. However, each manufacturer has guidelines that are very specific to the product warranty and it is best that you are made aware of this information when purchasing your processor at first. In addition to the original two year warranty, you may also purchase extended insurance coverage for your processor through the original manufacturer (OEM). Extended coverage may also be offered through a third party company called ESCO “Ear Service Corporation.” Details on ESCO insurance coverage can be found at www.earserv.com. Another option for extended insurance coverage may be through your home owners insurance plan just as you would for have jewelry and such. However, each home owner’s policy is different and it is very important to know the details of the coverage plan as home owner’s plans may be worded very carefully where the processor is only covered if lost or stolen, but not damaged. It is best to speak with a representative from your insurance company for the most accurate information and best suggestions.
Note: It is suggested by most ENTs to purchase extended insurance coverage for a processor in the event that the processor casing should crack or internal components are compromised. This can happen if the processor is dropped or “other.” Processors are built pretty tough, but they are not built to withstand every single challenge life throws its way.
Note: In the event that your processor is damaged or destroyed and needs repair, please contact the customer service department for the manufacturer in which you purchased your bone-anchored auditory device from and seek guidance. It is possible that it can be returned (RMA’d) back to the manufacturer (OEM), repaired, and simply returned back to you within an acceptable amount of time depending on the situation. Often times, a loaner processor (of same or similar style) can be sent to you while your processor is being repaired.
Are BAHA Accessories Insured?
Always check with your insurance company regarding what is covered and what is not covered. For example, a new soft band head band can range anywhere from $64.00 (USD) to $189.00 (USD) for a replacement. It is possible that your insurance plan will cover this. Also, safety lines and adapters and receiver cables for FM Transmitter Systems may also be covered. You should be able to order most accessories directly from the manufacturer you purchased your BAHA/BCHA or FM System from.
Deals on Batteries
BAHAs use a lot of batteries. Each battery can last anywhere from a few days to two weeks before needing to be replaced. Batteries cost between $8 and $9 and come in packs of six and eight.
* Best deals and places to buy these batteries:
– CVS, Longs Drug, Walgreens, or your local area drug stores. Look for the buy one get one (BOGO) sales from time to time and save your coupons as you may be able to apply them to the sales in addition.
– Sam’s or Costco stores also allow you to buy them in bulk which will save money.
– On line…check E-Bay and other battery distributors for deals.