Printed in the Spring 2011 H&V Communicator
Eighteen states now have some kind of insurance mandate for hearing aid coverage gained through the lobbying efforts of parents and professional organizations. Despite these victories, up to half of families, let alone deaf or hard of hearing adults, remain without coverage, even if they are insured. Why? The insurance mandates can only affect companies regulated by a state’s division of insurance.
Insurance plans for companies who “self insure” are untouched by legislative mandates, no matter how creatively written. Large companies and government agencies often pay for all or most health care expenses out of their budget, though an employee might believe that XYZ insurance company is involved, since that’s the name they might see on their claims. The XYZ company is just hired to process the actual claims while the company essentially insures itself. A federal law, the Employee Retirement Income Security Act (ERISA), allows self insured companies to determine which benefits they will pay, regardless of what state law requires. Self insured plans are often referred to as ERISA plans. These plans are not subject to regulation by the Division of Insurance like private insurance and therefore will not be required by state law to provide coverage for hearing aids. To assist with the confusion, insurance companies are required to issue an identification card to all their covered individuals, and this card will have an identifier on it if the policy is subject to regulation by the Division of Insurance. This will probably take the form of the initials “DOI” on the card.
City and county governments, hospitals, school districts, and similar agencies often self-insure, and so employees will find that mandates do not affect their plans.
Congrats to those who have labored long hours in lobbying for legislation (currently in place in Arkansas, Connecticut, Colorado, Delaware, Kentucky, Louisiana, Maine, Maryland, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, and Wisconsin and extra kudos to WI, who also went to bat for cochlear implant coverage.) Many states also proactively assist families through hearing aid loaner banks to give parents time to find other funding. (See the Colorado Funding Toolkit at www.cohandsandvoices.org for some funding ideas.) Parents who desire to pursue amplification for a baby or replace aids for an older child need those kinds of supports, and the people to assist them through the hoops, especially when they find that what they thought was adequate insurance was not at all adequate.
Jodi and Chris Dietrich in Colorado, covered by Chris’ work at the Home Depot, faced such a dilemma. As parents of three, including two daughters who use hearing aids, the self insured plan denied coverage for hearing aids. The Dietrichs requested a change in policy in writing. Jodi notes that “we send in the details of the state law, and explained how our insurance coverage included a lifetime of speech therapy as a benefit but not hearing aids.” Because of their efforts, the Home Depot changed its nationwide policy and now offers hearing aid coverage to all covered individuals, without age limits.
Parents can appeal based on the standard of practice for insurance coverage in their state. Self-insured policies typically follow suit of other insurance coverage available to their pool of prospective and current employees over time.
Can enough states and the parents and professionals in them band together to change a federal law? Will the federal tax credit for hearing aids go far enough for families who would have to foot the bill and then get some percentage of credit up to 15 months later? These are the questions facing us.
Please share your stories of insurance advocacy with us, particularly with regard to self-insured plans, at editor@handsandvoices.org. Sometimes a little encouragement is all we need to speak up on behalf of another and make a lasting change in a system.
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