Insurance and Bone Anchored Hearing Devices: What Audiology Professionals Need to Know
AudiologyOnline: What would you say is the best way for an audiology professional to ensure their patient will receive the insurance coverage for their procedure and device to which they’re entitled?
Brianna Rusay: The best way to avoid hassles is to make sure their initial insurance submission is as complete and accurate as possible. However, if they are new to working with bone anchored hearing devices – which are treated differently by insurance than traditional hearing aids – they might not know the best practices for getting these devices approved.
AudiologyOnline: With that in mind, what is your first tip for improving the chances of the insurance submission proceeding smoothly?
Brianna Rusay: Providing complete and accurate clinical information is vital. The professional has to make sure to include the most current clinical information in their submission. This includes the patient’s audiogram, the Letter of Medical Necessity – filled in correctly by the standards of the insurer – and relevant case notes. All documentation should bear relatively recent dates. Some insurance companies will even require that these documents be dated within the last six months.
AudiologyOnline: What would you say is the linchpin of a successful insurance submission?
Brianna Rusay: The Letter of Medical Necessity can make or break a request for coverage. Professionals need to keep in mind that it has to focus on the patient’s medical needs, not just “nice to have” features. They need to ensure that the Letter of Medical Necessity contains detailed information that will justify the need for a new bone anchored hearing device or an upgraded processor. Avoid including “convenience” features, such as the size of the device or the color options, as these are not helpful for meeting the medical criteria required by insurance companies.
AudiologyOnline: Let’s discuss upgrades. How often do insurers typically cover processor upgrades?
Brianna Rusay: When it comes to private insurers, it varies. Some insurance plans will cover an upgrade approximately every five years. The professional should consult with their patient before moving forward on an upgrade request to make sure it will be covered, and if so, whether that time is now or a year or more from now.
AudiologyOnline: Do you have any tips for making the Letter of Medical Necessity more compelling when requesting upgrade coverage?
Brianna Rusay: If your patient’s current device is out of warranty, be sure to mention this in the Letter of Medical Necessity, and if applicable, any issues the patient might be encountering with their current device that are affecting their hearing health. An example would be explaining how the new features of the latest iteration of the bone anchored hearing system will enhance sound quality and improve the patient’s overall activities of daily living.
AudiologyOnline: What is a common error made on insurance coverage submissions audiology professionals should avoid?
Brianna Rusay: One of the main reasons for an insurance claim to be denied is incorrect coding. When it comes to bone anchored devices the most common error is coding them as “hearing aids.” Most private insurers do not cover traditional hearing aids, so if a submission comes in with the hearing aid code, they will likely deny it immediately. However, durable medical equipment is much more likely to be covered by insurance, and this includes auditory osseointegrated systems – aka bone anchored hearing devices.
AudiologyOnline: There are too many insurance codes to list in this interview, but what are the ones you would consider vital for audiology professionals to remember?
Brianna Rusay: As of right now – because codes are subject to change -- the correct code for bone anchored hearing devices is L8690 – auditory osseointegrated device, includes all internal and external components. Code L8691 – auditory osseointegrated device, external sound processor, replacement can be used for upgrades. And if they’re fitting the BAHS with a softband, they will need to use L8692 – sound processor for attachment to headband.
One thing I’d like to note: sometimes it’s the insurance payers that incorrectly classify bone anchored devices as hearing aids. In these cases, local policies might require billing under a hearing aid code like V5060 – dispensing fee, unspecified hearing aid.
AudiologyOnline: What about Medicare billing codes – are they the same?
Brianna Rusay: Medicare has a number of rules dictating how certain codes may be billed. I advise audiology professionals to consult their Medicare contractor or payer for assistance clarifying their coding restrictions and requirements.
AudiologyOnline: Is there anything manufacturers of bone anchored hearing systems do to help audiology professionals with the insurance submission process?
Brianna Rusay: Manufacturers of bone anchored devices typically employ in-house insurance reimbursement support teams to answer patient or professional questions about insurance, including figuring out what is and is not covered by the patient’s insurer, providing the forms needed for a complete submission package, and answer questions related to getting initial purchases or upgrades covered. They can also help with appeals should the insurance company initially deny the request. Our goals are the same as the audiology professional and their patient – to make sure the patient can afford to purchase the hearing health treatment they need to enhance their quality of life.