MassHAFCC: April 2011

Frequently Asked Questions Regarding Hearing Aid Law for Children

Where can I find the text of the law? To read the text of the law, click on "Massachusetts Hearing Aid Law for Children" on the right side of this page under "Links." The citation for the law is: Part 1, Title XXII, Chapter 176B, Chapter 4EE.
What does the law provide? Chapter 233 provides insurance coverage for hearing aids for children 21 years old and younger up to $2,000 per hearing aid for each hearing impaired ear in each 36-month period.
When is the effective date of the law?The law applies to all health plans that are delivered, issued or renewed on or after January 1, 2013. This means that coverage becomes effective as policies are renewed throughout 2013. Following this year, coverage will remain continuous under health insurance policies. Before you begin the process of purchasing hearing aids, check with your health insurance carrier to verify the specific date on which your coverage will be effective. Example: Your health insurance plan renews on July 1st. Coverage becomes effective under your policy on July 1st. This means that you may not purchase hearing aids for your child or seek coverage for related services and supplies under this law until July 1st.
What does the $2,000 cap include?The $2,000 cap includes coverage for each hearing aid device. An insured may select a higher-priced hearing aid and pay the difference in cost above the $2,000 limit for the device. Plans must also cover all services related to a covered hearing aid device, including the initial hearing aid evaluation, fitting and adjustments and supplies, including ear molds. These amounts are not included in the $2,000 coverage limit that applies to the hearing aid device, but are covered separately and outright under your plan.
Are batteries covered? Yes. Coverage under this law includes related services, including the initial hearing aid evaluation, hearing aid fittings and adjustments and supplies. Batteries are covered under the "supplies" section of the law. A billing code already exists for hearing aid batteries- your dispensing audiologist should have this.
How about ear molds? Ear molds are covered under this law.
Who is covered? Children 21 years of age or younger who are covered under fully-insured plans.
Who is not covered?Children who are covered under self-insured plans are not covered by this law. A self-insured (or self-funded) plan is one in which the employer assumes the financial risk for providing health care benefits to its employees, even if an insurance company is used to process the claims. Self-insured plans are governed by federal ERISA laws and are not subject to state mandates or regulation by the state Division of Insurance. This means that self-insured employers will not be required to provide hearing aid coverage under Chapter 233.
How do I know if my plan is fully-insured?You may find out if your plan is fully-insured by contacting your insurance carrier or your Human Resources department at your place of employment.
What do I do if I find out that my plan is self-insured? You may advocate for your child! Contact your employer to explain why they should add this coverage to their insurance plan. Often employers will follow state mandates by adding similar coverage. One reason employers decide to self-insure is so that they may customize a plan to meet the specific needs of their workforce. If an employee is in need of specific coverage, an employer may consider adding the benefit. The final decision rests with your employer.
What if my plan has a high deductible? Chapter 233 allows carriers to apply deductibles, coinsurance, co-payments or out-of-pocket limits to hearing aid devices, supplies and services related to hearing aids, but they may not be greater than any applied to other benefits covered in the health plan. If you have a high deductible that would effectively cancel out the benefit afforded by this law, you may wish to shop around for another health insurance carrier. If this is not possible, consider appealing to your health insurance carrier to provide the coverage. Every health insurance carrier has a dispute resolution process and must consider your appeal.
Must I live in Massachusetts to be covered under this law?Not necessarily. If you work for an employer that is located in Massachusetts but reside outside of Massachusetts, you are most likely eligible for benefits under Chapter 233. To be sure, check with your Human Resources department.
What if I live in Massachusetts but work for an out-of-state employer? If your employer is located outside Massachusetts, you are most likely ineligible for benefits under Chapter 233 because your employer would be subject to insurance mandates and oversight by the state in which it is located. To be sure, check with your Human Resources department.
What do I do once I find out that my child is eligible to purchase hearing aids under this law? Once you determine that your child is covered by a fully-funded plan and are certain of your renewal date, you will need a written statement from your child’s treating physician that the hearing aids are necessary. Either your child’s pediatrician or ENT may provide this written statement. Then, your child’s audiologist will recommend a hearing aid that best fits your child.
Can my child be denied hearing aids depending on how the hearing loss occurred? No. Chapter 233 provides that a child must be afforded coverage for hearing aids if a treating physician or ENT issues a written statement that the hearing aids are necessary regardless of how the hearing loss occurred (e.g., at birth, late onset, accident, illness).
Is this law based on income levels? No. Any child 21 years of age or younger who resides in Massachusetts, is covered by a fully-insured health plan and meets the other requirements listed in the law is eligible to receive the benefit.
Is there anything that I need to know about talking to my health insurance company? Always get the full name, phone number and extension of the insurance representative with whom you speak in the event that you or someone else will need to follow up on the conversation. Take notes during your discussions and keep the notes in a file or notebook so that you may refer to them again, if necessary.
What if I am eligible for coverage under this law but my insurance company denies or delays coverage? If you are denied coverage or coverage is unduly delayed by your insurance company, you may file an appeal or grievance with your insurance company or you may contact the Bureau of Managed Care at the Division of Insurance in Boston to file a complaint by phone, fax or e-mail. You may also contact the Office of Patient Protection at the Department of Public Health in Boston.
Additional resources:Bureau of Managed Care Division of Insurance Office of Consumer Affairs and Business Regulations 1000 Washington Street, Suite 810 Boston, MA 02118 Tel: (617) 521-7372 Fax: (617) 521-7773 www.mass.gov/doi/ E-mail: bmc.mailbox@state.ma.us
Universal Newborn Hearing Screening Program Department of Public Health 250 Washington Street, 5th Floor Boston, MA 02108 Tel: 1-800-882-1435

Thursday, April 21, 2011

Hearing Aid Opportunity for Children!

If you know a child in need of hearing aids in MA, this is a great opportunity! Please see message below for event and contact information.

From: Ziegberman, Jana [mailto:Jana.Ziegberman@bmc.org]
Sent: Wednesday, April 20, 2011 3:21 PM
Subject: Pediatrics with Starkey and Red Sox

Hello all!

I was contacted by Barry Freeman, Justine Hammer, and Brady Forseth at Starkey regarding a great opportunity for our hearing loss children in the Boston area! The Starkey Foundation is going to team up with the Boston Red Sox and provide hearing aids for children that do not have medical benefits or their parents/guardian are unable to provide them due to financial hardship. These children will need a current hearing evaluation and earmold impressions taken prior to the event (end of May/early June). If you have any children or families that fall into this area, please let me know or you can contact Justine Hammer or Brad Forseth to obtain more information (contact info is below).

Please note that they will also need audiologists to volunteer to help fit the hearing aids that day! Yes, the Yankees fan will be there but I promise to behave!

Thank you for your help with this ahead of time! Please feel free to forward this email to anyone else you know. Unfortunately I do not have every audiologist’s email in the Boston area!

Jana

Justine Hammer, Au.D.
1-800-769-2799 ext 2726
Justine_Hammer@starkey.com

Brady Forseth
612-910-4450
Brady_Forseth@starkey.com

Jana L. Ziegberman, Au.D.
Clinical Pediatric Audiologist
Newborn Hearing Screening Coordinator
Boston Medical Center
Ph: 617-414-4898
Fax: 617-414-4953
Pager: 6690
jana.ziegberman@bmc.org

Janet M. Farrell, Program Director
Universal Newborn Hearing Screening Program
250 Washington Street, 5th floor
Boston, MA 02108
617-624-5959
fax: 617-994-9822

Thursday, April 7, 2011

HEARING DATE FOR BILL SCHEDULED!

The Joint Committee on Children, Families and Persons with Disabilities has scheduled a hearing for House Bill 52, "An Act to Provide Access to Hearing Aids for Children" for May 17th, at 10:30 a.m., in Room B-2 at the State House. Please consider joining us to testify in support! Each person gets 3 minutes before the Committee and we have requested that the Committee take us first that day because of the presence of children in the hearing room.

If you or someone you know cannot testify, but you would like to relate your "story," please e-mail your story to me and I will include it as part of a packet that I am submitting to the committee as written testimony.

Also, we are organizing a rally prior to the hearing in front of the State House, beginning at 9:30 a.m.

Please spread the word and we hope to see you there!

Thank you, Lisa Adams
Massachusetts Hearing Aids for Children Coalition (MassHAFCC)

Yahoo Group: http://health.groups.yahoo.com/group/MassHAFCC/
Facebook: http://www.facebook.com/group.php?gid=107850185906949

Link to text of bill: http://www.malegislature.gov/Bills/187/House/H00052