MassHAFCC: May 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

Tuesday, May 17, 2011

May 17th is Massachusetts Hearing Awareness Day!

May 17^th is Massachusetts Hearing Loss Awareness Day

For Immediate Release: Monday, May 16th, 2011

BOSTON – The Massachusetts Hearing Aids for Children Coalition (MassHAFCC) announces that Governor Deval Patrick has proclaimed May 17, 2011 “Massachusetts Hearing Loss Awareness Day”.

MassHAFCC is a statewide network of families of children who are deaf or hard of hearing and professionals working together to maximize a child’s lifetime potential through educational, medical, social and emotional support.

MassHAFCC is coordinating with Rep. Sean Garballey (D -Arlington/Medford) on House Bill 52 “An Act to Provide Access to Hearing Aids for Children,” which is scheduled that day for public hearing at the State House before the Joint Committee on Children, Families and Persons with Disabilities. House Bill 52 aims to provide insurance coverage for hearing aids for children 21 years old and under, up to $2,000 per aid every 36 months. To date, 18 states have enacted hearing aid insurance coverage mandates.

House Bill 52 would serve to significantly lessen the financial burden for the families of the approximately 200 children out of 80,000 live births annually in the Commonwealth who are born with some degree of permanent hearing loss requiring hearing aids.

MassHAFCC events on May 17th include:

9:30 a.m.: RALLY on the Massachusetts State House steps at 9:30am. Deaf/hard of hearing children, parents, families, professionals and supporters of House Bill 52 will be present.

10:00 a.m.: MassHAFCC children will meet with members of House and Senate at a special reception hosted by Rep. Garballey.

10:30 a.m.: Testimony before the Joint Committee on Children, Families and Persons with Disabilities at 10:30 in Room A-1 for House Bill 52.

Hearing loss is one of the most common birth defects in the U.S., occurring in ~3 of every 1,000 births. Research has shown that early identification of hearing loss and amplification with hearing aids in children prior to 6 months of age yields significantly better receptive and expressive language and vocabulary, personal-social skills and speech production. Children who do not receive early intervention cost schools an additional $420,000 and face overall lifetime costs of $1,000,000 in special education, lost wages and health complications.

Thursday, May 12, 2011

May 17th is Massachusetts Hearing Loss Awareness Day!!

Please join MassHAFCC at the State House on May 17th to commemorate "Massachusetts Hearing Loss Awareness Day!" We will kick off the day with a rally at 9:30 a.m. on the State House steps, then head indoors to the House Members Lounge for a "meet and greet" with legislators at 10:00 a.m., then over to Hearing Room A-1 where the Joint Committee on Families, Children and Persons with Disabilities will take testimony at a public hearing for House Bill 52, "An Act to Provide Access to Hearing Aids for Children." We hope that you can join us for this special day!

Friday, May 6, 2011

Please Send In Your Testimony!

We encourage you to join us for the rally at the State House on May 17th at 9:30 a.m. and the hearing before the Joint Committee on Children, Families and Persons with Disabilities at 10:30 a.m. in Room A-1! However, IF YOU CANNOT ATTEND THE HEARING, please take 5 minutes to write down your story of why you think this legislation should pass and how it would help your family/child, whether your story is one of hardship or success, and send it to lcadams3@gmail.com. We are collecting written testimony that we will bind and submit to the members of the commiittee at the hearing. We would like to have a big, thick binder of stories to submit to the legislators sitting on the committee! Letters may be addressed to:

Senator Michael J. Rodrigues, Senate Chair
Representative Kay Khan, House Chair
Joint Committee on Children, Families and Persons with Disabilities
State House, Room 146
Boston, MA 02133

Your testimony WILL make a difference and we appreciate your time and effort.

THANK YOU!

Tennessee Bill Passes House and Senate

On Thursday May 5th, the Tennessee legislature passed a bill that mandates insurance coverage for hearing aids for children 18 and under, up to $1,000 every 3 years. The bill has not yet been signed by the Governor. Here is the story: http://www.forbes.com/feeds/ap/2011/05/05/business-us-hearing-aids-mandate-tennessee_8451981.html

If signed, this would bring the total number of states who have passed hearing aid legislation to 19.