Tag Archives: insurance

Oticon Medical Insurance Support Helped Katie Upgrade to Ponto 4

When Katie Maslar ran into difficulty with getting insurance coverage, Oticon Medical’s  Reimbursement Support Team helped her file the appropriate paperwork and get her upgraded device. In her own words, Katie shares her experience going through the insurance process and how she’s hearing better with her new Ponto 4.

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I had started hearing really good things about the Ponto 4 on social media, and I hadn’t upgraded in a few years, so I decided to look into an upgrade. I initially saw my audiologist and ENT to fill out the appropriate paperwork to submit to my insurance. After not hearing anything for a couple months, I reached out to Oticon Medical. Unfortunately, my doctor’s office never submitted the paperwork.

In the interim, my previous Ponto Plus Power got broken, so my need for a new processor was even greater. After going back and forth with my insurance for a few months, the Oticon Medical staff and I were able to sort it out. I cannot say enough good things about how easy Oticon Medical made the process for me. Once we determined that I would be able to get the new device, the upgrade process was very simple and quick! I had the new Ponto 4 in a matter of days.

I’m very happy with the new features in Ponto 4. I honestly don’t mind not having onboard controls at all, since I really never need to manually tell the Ponto 4 what to do. I love that it’s smaller and more discreet. I was a little nervous, because I have an Android™ phone and wasn’t sure how easily they would work together, but I don’t find the need for the ConnectClip™ to really stop me from anything. It is much simpler to set and work, especially compared to using a streamer with my previous device.

It’s also really nice to be able to control the volume and check the battery level from my phone and not need the ConnectClip to do so. I am only deaf on my right side and have normal hearing in my left ear, but when listening to music and YouTube, I prefer to listen through my Ponto. The ease of connecting the ConnectClip with my tablet, and the sound quality it gives me, is great. I really do love it!

I can hear people in noisy environments easier now. The Ponto 4 makes a huge difference.

The biggest thing the Ponto 4 does for me is give me confidence. I’m no longer constantly straining to hear people and worried that if they speak, I will accidentally ignore them. I can hear people on my deaf side without even really thinking about it! I’m more confident and spend less time worrying about who’s speaking and whether I’ll hear them. I’m happy when I can pay attention to all the details and sound quality the Ponto 4 gives me, because that’s when I realize just how fantastic it is.

I liken the difference to this: My old processor was like writing with the blunt tip of a pencil, and the Ponto 4 is like writing with the tip of a sharp pencil.

The Ponto Loaner Program: Bridging the gap, because sound matters

Early access to sound is the key to linguistic development

Children require a lot of things to acquire speech as they grow. Chief among these? Exposure to sound – specifically spoken language, as early access to sound promotes optimal speech and language learning. The best way to ensure they receive this access is by providing hard of hearing youngsters with premium hearing care as soon as possible.

The role of sound in childhood development

From infancy through early childhood, we pick up language through daily exposure to spoken words, eventually reaching the stage where we begin to speak and repeat those words. Research indicates that children need to hear and understand how words are used contextually — and hear themselves repeat those words — to achieve comprehension and the ability to use language clearly and accurately.[1]

Although sound enters through the ears, hearing occurs in the brain — particularly language processing. Physically, the growth of a child’s auditory brain center requires regular sound stimulation, without which they might never fully develop the ability to process and comprehend language. Kids whose hearing loss goes untreated will typically experience linguistic developmental delays and struggle to make themselves understood verbally throughout their lives.[2]

Difficulty hearing contributes to educational and social challenges

Unless they attend a school for the deaf and hard of hearing, children with unaided hearing loss will likely experience significant difficulties learning.[3] Mainstream schools require kids to listen to lessons in the classroom, directions during playground and sports activities, and engage verbally with teachers and classmates throughout the day. Those who cannot hear often fall behind their peers, especially if they are held back a grade. Combined with frustrations stemming from straining to hear and communicate daily, academic delays can lead to youngsters withdrawing, avoiding in-school socializing and extracurricular activities. Feelings of isolation and being overwhelmed academically could contribute to negative lifelong issues like loneliness, depression, and low self-esteem.[4]

Aiding children who have conductive hearing loss

While traditional hearing aids can help many children, some kids require greater assistance – a bone anchored hearing system (BAHS) – because they are missing all or some of the organs required for natural hearing (i.e., conductive hearing loss). This presents parents with an additional challenge, as children typically must reach the age of five before they can receive an implant, plus many parents need insurance coverage to afford them. Since we develop many of our fundamental language skills before five, this creates a treatment gap that could permanently affect linguistic development.

Fortunately, BAHS can be used to help children even before implantation. Babies and toddlers can wear the devices with a softband, which is basically a head band that holds the BAHS processor against their skull without surgery. While skin contact doesn’t provide the same level of amplification as when the processor is affixed to an abutment, a child will still receive significant developmental benefits, such as early acquisition of the building blocks of language and the ability to participate more easily in the world around them.

However, the question of affording the processors remains, as insurers often take some time to approve coverage of these necessary devices.

What to do while waiting for insurance coverage

You might find yourself frustrated while waiting for your insurer to approve your child’s BAHS, especially after being told all the benefits of early-as-possible treatment. Fortunately, Oticon Medical offers an option while you’re awaiting insurance approval, so you can get your child the hearing device they need now: the Ponto™ Loaner Program. This program is designed to help your child receive the premium hearing care they need to thrive without delay.

The program provides Ponto sound processors and softbands for children from birth to five years of age who require direct amplification to hear speech and sounds. Your child will benefit by being given the ability to hear sounds during their critical early years, enabling them to participate actively in the world around them while you’re awaiting third-party reimbursement approval.

For details on how to enroll in the loaner program, please speak to your audiologist or feel free to contact us.

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Gabrielle Simone is a Clinical Territory Manager in New England with Oticon Medical. She has worked in private practice and hospital settings and has a specialization in clinical application for hearing aids and cochlear implants.  For the past 6 years, Gabrielle has worked as a Training and Education Specialist for the Northeast and Western New York region, for Widex and Oticon. In this role, she provided technical, clinical, and product support to audiologists and hearing instrument specialists (HIS). She also served as an adjunct professor at Northeastern University in the AuD program. An alumna of Emerson College, she earned her M.S. in Audiology from the University of Connecticut and her Doctor of Audiology from the University of Florida. In her current position with Oticon Medical, she provides clinical, technical and sales support to physicians, audiologists, and hospital personnel.

[1]  Committee on the Science of Children Birth to Age 8: Deepening and Broadening the Foundation for Success; Board on Children, Youth, and Families; Institute of Medicine; National Research Council; Allen LR, Kelly BB, editors. Transforming the Workforce for Children Birth Through Age 8: A Unifying Foundation. Washington (DC): National Academies Press (US); 2015 Jul 23. 4, Child Development and Early Learning. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310550/

[2] Early Intervention and Language Development in Children Who Are Deaf and Hard of Hearing Mary Pat Moeller Pediatrics Sep 2000, 106 (3) e43; DOI: 10.1542/peds.106.3.e43

[3] Vogel, S. & Schwabe, L. (2016). Learning and memory under stress: implications for the classroom. npj Science of Learning 1, Article number: 16011

[4] Theunissen SC, Rieffe C, Netten AP, et al. Self-esteem in hearing-impaired children: the influence of communication, education, and audiological characteristics. PLoS One. 2014;9(4):e94521. Published 2014 Apr 10. doi:10.1371/journal.pone.0094521

Finding A Hopeful Future: Life After An Acoustic Neuroma with the Ponto Plus

Think back to the last time you felt alone.

Maybe you had just moved to a new city where you didn’t know anyone. Maybe you experienced an unexpected breakup. Or, maybe you just felt unappreciated. The thing is, with any of those ‘alone’ moments, the moment passes. You make friends. You meet someone new. Somebody compliments you.

For Rebecca Davenport, that moment never passed.

“My world was so quiet. You’re isolated. You don’t know what’s going on in your environment.”

Rebecca, a mother of four and PhD candidate, was diagnosed with an Acoustic Neuroma in August 2013, a tumor of the Eighth Cranial Nerve responsible for hearing. Rebecca met with physicians in Portland and after weighing the pros and cons, they deemed it necessary for her to have two surgeries.

As with most surgeries, there were no guarantees. From the routine to the most complex, there is always some degree of risk involved. In Rebecca’s case the risk was high.

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Two Pontos Help 14-Year-Old Andrew Overcome Maximum Conductive Hearing Loss

Being a teenager is a fun, but it can be hard work too. Andrew Perry, a 14-year-old born with Treacher Collins and Bilateral Microtia and Atresia, has maximum conductive hearing loss in both ears making participation, working in groups of students and hearing class lectures even more draining than it can already be.

“Straining to hear can make someone with a hearing loss tired throughout the day,” says Melissa Tumblin, Founder of Ear Community. The background noise common in rooms full of students made concentration difficult for Andrew. Clyde, Andrew’s father, said that Andrew’s academic performance had declined significantly, and he believed it was because of the difficulty of hearing and following instructions in the classroom.

Here’s how an Audiologist went the extra mile for Andrew, as first told on Ear Community

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Voices Heard – Bone Anchored Hearing Systems Remain Covered by CMS

On October 31, after a several-month-long battle, the Centers for Medicare and Medicaid Services (CMS) ruled that Bone Anchored Hearing Systems and auditory osseointegrated implants (AOIs) will remain a covered benefit for Medicare enrollees with qualifying indications.

Oticon Medical Advocates

As many of you know and have experienced, Bone Anchored Hearing Systems (BAHS) are an important and life-changing tool to fight against hearing loss that cannot be duplicated by traditional hearing aids. More than 100,000 people are currently benefitting from a BAHS.

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Three-Year-Old Ava’s Journey to Hearing

A few months ago, we first introduced you to Shannon and her daughter Ava. Shannon took the time to tell us about her journey in finding out that Ava had hearing loss and what came after. Today, we’re excited to share another milestone in Shannon and Ava’s lives, as told by Melissa Tumblin, Founder of Ear Community.

Meet Ava Katuszonek, an adorable little three year old girl who was born with Microtia and Atresia of her right ear. Ava is a very happy little girl who enjoys playing with friends and is excited to learn the alphabet and begin reading. However, when Ava was about one year old, her mom, Shannon, began noticing her struggling with her hearing. Ava wasn’t always responding to Shannon’s voice when she would call for her. Two years ago, Ava and her parents, Paul and Shannon, attended an Ear Community Microtia and Atresia picnic in Pleasanton, California where they were given the opportunity to learn more about bone conduction hearing devices. Ava’s parents tried to obtain a BAHA for little Ava as soon as they could, but their insurance plan under Kaiser Permanente denied their coverage for a BAHA. Ava’s mother, Shannon, also did not realize there were many options available on the market for BAHAs. Now knowing this information, Ava’s parents continued appealing with their insurance provider in order to help Ava hear better with a BAHA.

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Bone Anchored Hearing System Medicaid Insurance Support for Clinicians & Patients

The Health Insurance Association of America describes Medicaid as a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.” (America’s Health Insurance Plans (HIAA), pg. 232). Medicaid also has enrollment programs for children with specific conditions, depending on state policy. Medicaid programs are funded jointly by the federal government and each state and the programs are administered under this partnership on a state by state basis.

Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States. The system can be quite complex. States establish their own systems for delivery of services under their programs. Add the fact that states have their own policies regarding coverage, and it’s more than a full-time job to keep up with federal and state regulations—especially because they’re constantly changing. It takes the time and care to look into each individual’s case to fully understand and utilize coverage.

In an effort simplify the process of obtaining replacement sound processors and soft bands, Oticon Medical has enrolled as a provider in many state Medicaid programs. Because we are enrolled providers, not only can we provide assistance in ensuring that patients have necessary coverage in place for devices, we can also bill those programs directly.

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An Important Message to Bone Anchored Hearing System Users, Advocates & Families

As you may have heard, The Centers for Medicare and Medicaid Services (CMS), the governing body that runs Medicare, is proposing to eliminate the coverage for bone anchored hearing devices in 2015. The proposal’s aim is to classify bone anchored hearing systems as hearing aids, which are specifically not covered under Medicare. If this proposal is passed, it will effectively terminate all Medicare coverage for new bone anchored implant surgeries as well as terminate funding for replacement processors for current bone anchored implant users under Medicare.

MedicareEqually disturbing is the potential ripple effect this proposal will have on non-governmental private payers and state Medicaid policies. These groups routinely look to Medicare as the standard for their policies and use Medicare coverage guidelines for justification of coverage, or removal of coverage for treatment options. It is not overstating a concern to say if this proposal passes, coverage for everyone using a bone anchored system is threatened.

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Insurance Support: Guiding You through the Process to Get Your Ponto

No matter what kind of healthcare visit or procedure you have, insurance can be confusing—so much so that it can sometimes feel like a completely different language. In addition to various companies, each individual insurance company has many, many policies. So, what works for someone with similar insurance might not work for you. That’s why we offer free insurance support for patients and clinics. Our team acts as a trusted guide to educate, address concerns and help you ask the right questions.

Healthcare Questions

We work with you to do everything from verification of benefits to submitting the paperwork to insurance providers to requesting and receive pre-authorization. In the event that your request for pre-authorization is denied, we’ll investigate the reasons for denial and help to form and submit your appeal. We can truly help as little or as much as you need.

We sat down with Lindsay Fisk, Oticon Medical’s manager of customer reimbursement services, to learn more about how she helps hundreds of people navigate the world of insurance coverage. With over 500 authorizations complete, Lindsay and the rest of the team have a defined process that will get you on the right track for coverage.

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Angela Holley: Our Journey & How We Finally Got Insurance for Evan’s Ponto

Angela Holley wanted a sustainable hearing solution for her six-year-old son, Evan. Even when it meant calling insurance companies daily, Angela was Evan’s unwavering advocate. Now, Evan has what he needs and is a happier child who hears better than ever.

Here’s Angela Holley’s story–

Evan, who has bilateral hearing loss, started out wearing Cochlear hearing devices. We had a lot of issues and were constantly sending them in for repair. When we finally received the devices back from repair, our Audiologist was unable to program them. The Windows computer system wasn’t compatible with the device program, which caused yet another huge delay for us, and more importantly, for Evan. We were frustrated, and the Audiologist was frustrated.

During this time, our aggravation encouraged us to try demos of the Oticon Medical Ponto. We were excited by Evan’s response and couldn’t wait to get him a pair of his own. So, we sent in the order to the insurance company. To our surprise, it was denied. Because Evan had additional hearing loss from his last screening, we were truly in shock that his case was denied. So began the journey to getting coverage for devices that worked well for Evan…

What I Did to Make the Case

First, I appealed with a letter saying that the devices are not a want but a need. That they contribute greatly to him functioning as a successful individual. He needs the devices to be successful in school and to thrive with his peers. Then, I search for helpful information and made sure I knew about everything that could be helpful. Ear Community and Melissa Tumblin were an excellent resource. Finally, I collected any kind of documentation I could get to help build a case for Evan. Gather and submit documentation such as:

  • Letters from Evan’s teachers
  • Information from Evan’s ENT and speech therapist
  • Hearing Screen Results
  • Information from Evan’s pediatrician
  • Even a letter from myself explaining our own experiences in communicating with Evan—we were having to repeat ourselves more than ever

Evan HolleyI didn’t rely on others to help get the job done, and I suggest the same to other parents. Make sure that you are organized and submit every piece of paperwork in a timely manner—there are deadlines that will affect the outcome. Work with the Audiology clinic that’s pushing through the paperwork, and make sure they’re meeting deadlines. Finally, follow up and then follow up again. Make sure information was received. It is a lot of work, but it can be done. Don’t just accept the denial and don’t rely on other people to do their part.

And hopefully, as with our case, you’ll see the light at the end of the tunnel. Finally, the insurance company approved coverage for one Ponto. Even though Evan needs bilateral aids, we were only approved for one and we felt lucky for that.

Well Worth the Work

All of us moms know we need to fight for our kids, and we need to remember that. Don’t rely on anyone else to fight our children’s battles— it has to be us to do that. What kept me going? The fact that Evan’s demo devices had him hearing better than he ever had before.

The day we got the demos, Evan walked into the bathroom with his shoes on. When he came out, he said, “Mommy, my shoes—they make noise.” Now, at night, he doesn’t want to take them off. It’s still amazing to watch him explore and experience little noises for the first time.

Fighting for what we deserved has helped shape Evan’s future. It’s a lot of work, but well worth it for a positive future for my son. I couldn’t have had a better partner along the way than Oticon Medical. The experience has been fantastic, and more than anything, the people at Oticon Medical LISTENED when no one else did.

Are you working to get insurance coverage? We can help. We can also help connect you with others who have successfully navigated the insurance process. Let us know in the comments section below or on Facebook or Twitter if you’d like help or to be connected.