Madnatory Coverage of Hearing Correction with Adendum to Medicaid Coverage

Currently the means by which Insurance policies such as those offered by Medicaid, Medicare, HMOs, and Private providers work one is to be covered or at the very least reimbursed for the maintenance & correction of their vision but not their hearing. This addendum or revision of sorts is a draft to accommodating those who would be legally deaf in equal proportion to those who would be legally blind. Since one can receive a complete battery of vision tests in addition to a pair of glasses via public assistance or a private insurance policy it should not be that one must completely be void of such assistance when the same is needed for ones hearing.

I) All policies which cover vision tests including those specifically geared towards the tailoring and manufacturing of prescription lenses for a particular vision impaired patient must also cover all similar tests done for hearing impaired patients including those tests performed for the purpose of manufacturing and configuring of prescription assisted listening devices otherwise known as Hearing Aids.

II) All policies are required to cover through disbursement or reimbursement the costs of Hearing Aids in a means similar to which they would cover the costs of prescription lenses (whether Glasses or Contact Lenses). No policy shall set a price cap on the purchase of Hearing Aids that is not reasonable and well based on market values (i.e. In a market where the average hearing aid is $4,000 one cannot cap off at $25 or even $250). No policy shall limit one to the purchase of over the counter Hearing Amplification Devices, since this would be the equivalent of limiting the vision impaired to the purchase of a $2 pair of reading glasses. For those whom are truly hearing impaired these devices are very ineffective at compensating for the loss of hearing and often themselves add audible complications to a persons hearing capabilities. Hearing Aids are not only customized to an individuals hearing disability but are equipped with such advantages as a noise canceling microphone which offset such typical hindering circumstances as the feedback noise created by simple winds.

III) It cannot be required that one get a Cochlear Implant instead of a Hearing Aid in order to be covered or compensated for corrective hearing costs. Such a pre-requisite would be no different then requiring one to get Laser Eye Surgery as opposed to Corrective Lenses in order to be covered or compensated for corrective vision costs. In fact due to the risks involved and the high probability of complications many will not or are slow in covering and/or compensating their patrons for the costs of Laser Eye Surgery. So why someone who has auditory nerve damage should ideally be treated different then someone with visual nerve damage should not only be a cause of great concern by should be remedied by the fact that the ADA (Americans with Disabilities Act) strictly forbids such bias. Hence while this paragraph neither Forbids nor Advocates the use of Cochlear Implants it does fault those that would commit the act of requiring hearing impaired individuals to receive Cochlear Implants without first offering the sensible alternative of Hearing Aids.

IV) Addendum to Medicaid Covered Services:

Medicaid under this direction covers specific hearing care services that are medically necessary for the diagnosis and treatment of ear diseases and for the correction of hearing loss, as required by the condition of the recipient. All services must be furnished within the limits of medicaid benefits, within the scope and practice of the medical professional as defined by state law and in accordance with applicable federal, state, and local laws and regulations.

a. Exam: Medicaid covers routine ear and audiological exams. Coverage for adults is limited to one routine ENT and one audiological exam in a twelve-month period. Exams for an existing medical condition, such as chronic ear infections, will be covered for required follow-up and treatment. The medical condition must be clearly documented on the audiological examination form and indicated by diagnosis on the claim.

b. Corrective listening devices: Medicaid covers class I medical corrective listening devices (aka Hearing Aids). Coverage for adults is limited to one or one set of corrective hearing devices in a twenty-four-month period, unless an Audiologist or Otolaryngolgist recommends a change in prescription due to a medical condition affecting hearing. The hearing prescription must be appropriately recorded on the audiological examination form.

1. For the purchase of analog hearing aids the correction must meet be for a hearing loss equal or greater then 15db, for the purchase of digital hearing aids (with noise cancellation) hearing loss in the patients ear must be equal to or greater then 24dB. For the purchase of one hearing aid per ear the patients hearing loss must be at least 15db in one ear & at least 12db in the other.

ii. If an existing prescription is updated, there must be a minimum 3db audible change in the patients hearing. Exceptions are considered for the following:

1. recipients with a history of chronic inner ear infections; or
2. recipients under twenty-one (21) years of age.

iii. Hearing aids or cochlear implants that are lost, broken or have deteriorated to the point that, in the examiners opinion, they have become unusable to the recipient may be replaced.

c. Cochlear Implants: Medicaid covers cochlear implants, either the original prescription or replacement, under the same terms as defined previously for Hearing Aids. Requests for prior authorization will be evaluated on auditory criteria and/or audiological acuity, the recipients social or occupational need for cochlear implants, and special medical needs. The criteria for authorization of cochlear implants are as follows:

d. OTC Listening Devices: Medicaid does not cover over the counter listening devices such as those advertised on T.V. and in periodicals. While such devices do provide some relief it is believed that such devices provide no more then generic amplification without correcting other associated hearing difficulties nor do they attempt to correct side effects produced by the amplification process such as the whistling often associated with amplifier feedback. Thus use of these devices is akin to the use of OTC Reading Glasses and cannot be a viable alternative to properly prescribed and administered corrective hearing devices.