If you have used the new hearing aid law for children in MA, either successfully or unsuccessfully, we would like to hear from you! Please post a comment to let us know how it is going out there....
We continue to chart implementation of the law and find it helpful to know what roadblocks families are encountering with insurance companies or providers. We also love to hear that children are accessing hearing aids successfully under the law! If you leave a comment, it is helpful to know the issue and the name of the insurance company so that we may keep better track of how implementation is unfolding.
We would also like to remind you that you may seek assistance with accessing the hearing aid benefit under the new law by contacting one of the three agencies listed at the bottom of our FAQ page (scroll down to January 2013 posting).
Thanks,
The MassHAFCC Team
The Massachusetts Hearing Aids for Children Coalition 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.
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
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ReplyDeleteI just tried to get batteries from my Audiologist and was told there was no way to bill the insurance company... So I would need to purchase them and then get reimbursed. I came on here and found out that there is a billing code that my Audiologist should have... is there anyway to get this code so I can tell them what it is so I dont have to purchase the Batteries?!
ReplyDeleteWell come to find out its not even a billing code issue... They say their computer system isnt updated yet and wont be until July 1st so I have to buy them until then... (even thought this bill was effective Jan 1st)... I called other places like Mass Audiology to see if I could get batteries through them and they told me that they don't charge insurance co for batteries they only take private pay (meaning for me to pay) I told them its the new law and that they are supposed to and they told me their office doesn't follow that and told me to go to CVS... How can an Audiologist say they dont follow the law... Called another place "affordable Hearing Aids" they basically said they arent an audologist and do do that... so looks like I have to purchase the batteries so my son can hear until July 1st when my doctors will do it. Since no one will sell batteries to me
ReplyDeleteThe challenge as I understand it is it takes 20 minutes to verify insurance which may or may not be covered, depending on how your insurance is administered. It would be impossible to call on every battery - it is easier to ask the person pay at the window, have the agency submit a bill to the insurance company, and have the insurance company reimburse you. They should be willing to do that for you.
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ReplyDeleteI submitted my first two claims for pediatric hearing aids and related service fees (fitting, dispensing, etc.) last week and I received my first payment today from BCBS!
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ReplyDeleteOne year after this bill was enacted, and there are numerous problems audiological practices are having with insurance companies -
ReplyDelete1. Despite fitting children and promptly submitting insurance claims, there is over a six months wait for payment on the majority of the claims.
2. There is no clarity on how to get payment for ear molds and batteries.
3. Increasingly, we are being told by insurance companies that since we are out of their network, the reimbursement will be significantly less than $2000 per hearing aid.
Anyone else having a similar experience?
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