February 2012

Empowered Parents Appeal Insurance for Hearing Aids

Even though Minnesota has a law requiring health insurance companies to cover hearing aids for children, parents who work for employers who provide self-insured health policies often have to campaign for coverage to pay for their child’s hearing aids—and they’re feeling empowered by the process.

Minnesota Statute 62Q.675, which requires health plans to cover one hearing aid in each ear every three years for children under age 18, originally passed in 2003 and applied only to children who were born with hearing loss. The law was amended in 2007 to cover children who became deaf or hard of hearing at any time. But this legislation doesn’t apply to employers that provide self-insured health policies. That’s because the federal law ERISA, which was designed to encourage employers to provide voluntary health coverage for employees, excludes self-insured companies from state mandates for health coverage.

Our Southwest Parent Guide Kris Hemstock has a son whose hearing loss was first identified when he was in Kindergarten. The family’s health insurance policy fell under the ERISA law, and didn’t cover hearing aids.

“Feeling already behind the listening/learning curve, we immediately purchased a set of hearing aids, despite zero insurance coverage,” Kris said. “It was not until a number of years later, when we were looking into replacing the hearing aids, that we considered appealing our health insurance.”

To help them through the appeals process, the Hemstocks used the “Hearing Aid Appeals Information Packet,” created by the state’s Deaf and Hard of Hearing Services (DHHS) office. The packet includes an explanation of Minnesota Statute 62Q.675, sample letters from other parents, and documents to support an appeal. These documents include testimonies given during the 2003 Legislative session, a sample audiogram with common environmental and speech sounds, facts and figures about hearing loss in children, and comparisons of the cost of hearing aids versus the cost of education, speech and social services. The staff at DHHS created the packet in response to calls they were getting from parents like the Hemstocks who were facing insurance coverage denials. The packet is on the DHHS website, with a link on our website under “Resources & Information>Technology>Hearing Aids.” See www.mnhandsandvoices.org.

“In the end, we were successful and our policy changed to include a $1,500 benefit every 3 years,” Kris said. “This seems to be a customary amount, even though it is only about 25% of the actual cost of the hearing aids. We appealed a second time in an attempt to increase this amount, but were unsuccessful.”

She said the process was painstaking, but rewarding—providing her family with insights and advocacy skills they’ve come to value.

“Even though we had been a part of the deaf and hard of hearing community for more than four years when we first appealed our insurance denial, it was not until we sat down and composed our story, and requested that our son’s needs be met—and outlined why—did we realize the actual scope and importance the hearing loss would play in his life and ours for years to come,” she said. “It seems the actual process of fighting for something helped to provide the insight and the foundation about our situation that would help us to advocate many more times in the future.”

Another parent who found the process empowering is Nicole Mathes. The Mathes family includes two children who wear hearing aids. When her employer’s self-insured plan denied coverage for the hearing aids, Nicole did not take “no” for an answer. She contacted Mary Hartnett, director of the Commission of Deaf, Deafblind and Hard of Hearing Minnesotans (MCDHH), who helped her complete an appeal packet using the information from DHHS. Nicole’s packet included 30 pages of supporting materials: the boy’s audiograms, Nicole’s testimony on behalf of mandating Newborn Hearing Screening in the state, a “Parent Welcome Letter” about her family she’d written for Minnesota Hands & Voices to give to families with newly diagnosed babies, recommendations from her sons’ doctors, and more.

“I have found that if you have enough documentation to support your argument or disagreement, it is difficult not to come to some sort of compromise,” Nicole said. She also found that part of the appeal process is educating the insurer (her employer) about the value of getting kids fitted early with hearing aids.

“Most people think of hearing loss with elderly individuals,” she explained. “Once I appealed it, I found out I was the only one that had made my employer aware that there was no coverage.” She said the process helped shape her as an advocate for her kids. “It made me stand up for what I believe in,” she added.

MCDHH’s website explains the state law requiring health insurance coverage for children under age 18. The site provides additional information about laws affecting hearing aids, answers to frequently asked questions, and a link to the DHHS packet. See www.mncdhh.org/faq/16/hearing-aids.

MCDHH would like parents who have appealed insurance denials for hearing aids to contact the office so they can track the number of children who are not covered by the law. Contact information is on their website, www.mncdhh.org.