Medical Device denied coverage 7 months down the line
We had to replace a hearing device for one of my kids that was no longer covered under warranty and needed replacing. The previous device was completely covered under Tricare but we knew we would probably pay more under my current employers BCBS. We were told by the company that our device would be covered by insurance. Ordered it, paid a large copay, and have been using the device ever since.
A few months ago we received a bill for several thousand dollars from the company. We looked at the BCBS claims and saw that it had been denied. BCBS stated that it had been submitted incorrectly, so we had cochlear resubmit. We were told by the BCBS customer rep that it was covered. Fast forward to today, we reach out again because it still has not been paid. BCBS complains that the company (this is a large hearing device company) did not correctly submit the coverage of benefits and that our insurance did not cover the device. I don't have the persons title we spoke to today as we were bounced around several times from our initial call.
I've checked the 2023 Benefits program, which is insanely convoluted. The device in question is a BAHA. Our plan indicates bone conduction hearing aids and cochlear implants require prior authorization (which we were told by the company that we received). hearing aids are not covered by this plan and cochlear implants are only covered for hearing loss resulting from injury or a surgical procedure, which is fucked up and also doesn't apply to us. This device is neither a implant nor technically a hearing aid.
What should be our next course of action? I have had success going through my employer and having them put me in touch with a BCBS's customer advocates (not entirely sure on the title). I don't have several thousand dollars laying around to pay for this device unexpectedly either so failing the advocate being able to sort this out I am unsure of what to do. Either the company messed up when they submitted for insurance verification or BCBS are giving us the runaround.
submitted by /u/Jeaglera
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