Nicole and David Mathes of St. Paul , MN know all too well how much hearing aids cost. They have two young children who were diagnosed with hearing loss. For this family, they never considered not purchasing hearing aids for their boys. But when presented with a bill for $12,000 for two sets, any family would flinch at the news. The Mathes were fortunate enough to have primary coverage from David's employer while Nicole's employer was a secondary insurer. At the time of the initial diagnosis, Nicole was working for another employer, not the huge Minnesota-based electronics company, Best Buy. David's insurance coverage was 80/20 for hearing aids, which still meant the family had to contribute $2,000 towards the expense.times 2 boys.every three years.
At first, the family just came up with the $2,000 for their oldest son, not knowing that there was any other way to get help or to question the coverage. They didn't realize they had the right to appeal the company's decision. And at that time, Minnesota had not yet passed the Hearing Aid Legislation that required non-self-insured employers to cover children under the age of 18 who had congenital (from birth) hearing loss. However, for companies large enough to "self-insure" [or have a large enough pool of insured individuals that the company accepts the financial risk of claims spread over those covered], ERISA, a federal law, exempts self-insured companies from state mandates.
When time came to file a claim for their younger son, the boys' audiologist warned Nicole that Medica might refuse paying because they tended not to cover specific brands of hearing aids. And her sons needed high-end digital aids. They submitted their claim with Medica under Nicole's new employer, Best Buy, and later received a denial.
Nicole did not take "no" for an answer this time. She went to Minnesota Commission Serving Deaf and Hard of Hearing Individuals (MCDHH) and sought the guidance of the director, Mary Hartnett. She led them to materials created by Deaf and Hard of Hearing Services (DHHS). (See below for reference.) Nicole drafted a letter; Mary Hartnett reviewed it, and gave Nicole the "okay" to send it to their off-site benefit support center. Nicole was careful to include all the supporting documentation she could: the boy's audiograms, Nicole's testimony on behalf of mandating Newborn Hearing Screening in the state, Nicole's "Parent Welcome Letter" to newly diagnosed families through a project at the Family Support Connection, recommendations from their ENT.in all, 30 pages of supporting materials. She sent this February 7th of 2006.
In May of 2006, Nicole and David heard back from the benefit support center. Their boys' hearing aids would be covered. But not only that, the benefits were a result of a new policy at Best Buy. All four Best Buy health plans would start covering hearing aids for children staring in 2007. This meant that 105,000 Best Buy workers, both retail and corporate, would have coverage for their children.
What has Nicole learned through all this? "Never give up. You can always appeal the insurance company's decision, appeal again, and go different channels. I wasn't going to stop until we had coverage." She went on to advise parents, "Be detailed. You have to have enough documentation and support for your argument. Many people overlook this step."
And Nicole is not alone. Southeast MN Parent Guide, Amy Deneen, also appealed their employer's health plan coverage and won. What we all need to learn is we can harness the power of parents, the power of our story to make incredible changes for our youth who are deaf and hard of hearing. As for Nicole, she has not stopped advocating for new issues. And the Family Support Connection is proud to have her serving as a member of our Parent/Professional Advisory Meeting. After all, she's already moved mountains.
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