FAQs
What is the Let Them Hear Foundation Advocacy Program?
Few things are more frustrating than being told by your medical provider that you require a particular service, surgery, or piece of equipment, and then being told by your insurer they won’t pay for it. If your insurance provider has denied a request from your medical provider for certain hearing-related services, the Let Them Hear Foundation has a nationwide Advocacy Program to assist you in appealing the denial, free of charge. The specific services we provide appeal support with are: cochlear implants (single or bilateral), Bone-Anchored Hearing Aid implantation, conventional hearing aids, atresia repair, microtia reconstruction, balance disorders, and other hearing related surgery.
Who can apply for assistance?
The Let Them Hear Foundation Advocacy Program is open to everyone. Although the program is headquartered in Palo Alto, we have staff around the country working with clients all over the United States. Approximately half our clients are seeking assistance with appeals related to cochlear implant surgery, and the other half is distributed amongst the other conditions listed above.
My employer’s insurance carrier denied my request for cochlear implant surgery. What are the odds that my appeal will be successful?
If you are covered by group insurance—through your employer, or as the dependent of someone who is employed—excluding coverage for cochlear implants is a violation of multiple federal laws. Even so, a surprising number of insurers and employers illegally exclude cochlear implants from their policies. While insurance companies are not legally required to cover bilateral implantation, the Let Them Hear Foundation has succeeded in getting dozens of bilateral implant denials overturned since the program’s inception.
The insurance company says they will pay for my service but only if I use their in-network provider. Am I stuck?
Not always. The LTHF Advocacy Program has an excellent track record getting out of network service providers covered at in network rates to you.
My insurance policy specifically states they don’t cover the service or equipment I am seeking. How can that be challenged?
As discussed above, some of these contract exclusions are illegal. And even when the exclusion is legal, insurance companies regularly break their own rules if they think it is going to save them money. For example, they will provide a BAHA (at a 97 % success rate and a cost of $15,000) in lieu of atresia repair surgery (at a lower success rate and a cost of over $25,000) even if their plans specifically state they don’t pay for hearing aids or implants. Or they will pay for hearing aids when faced with the argument that a hearing impaired child will require 3 times the amount of speech therapy (when it is a covered benefit) without the hearing aids, than with them.
How can you do this for free?
The Let Them Hear Foundation is funded through grants and donations from individuals and corporations. While there is no mandatory fee for benefiting from our Advocacy Program, we do ask that at the end of your appeal that you consider donating an amount of money you are comfortable to help offset the expenses associated with continuing to provide these services free of charge to the hearing impaired community.
Who will work on my appeal with me?
The Let Them Hear Foundation Advocacy Program is led by Sheri Byrne, J.D., the parent of a hearing impaired child with 9 years of hearing impairment insurance appeal experience. Ms. Byrne leads a team of insurance advocacy interns distributed around the country in writing the appeals and making appearances at in-person hearings before insurance commissioners or arbitration panels, when required.
How long does the average insurance appeal typically take?
There is really no such thing as the “average” insurance appeal. Many factors can influence the amount of time required including the type of service you are requesting, where you reside, the state your insurance company resides in, your insurer’s own internal policies, and whether or not your plan is “self-insured.” 75 % of insurance appeals are resolved within 90 days, but the amount of time can range from a few days up to 18 months.
How can I request assistance through the LTHF Advocacy Program?
Visit https://www.letthemhear.org/appeals/login.php and fill out an application, or call (877) HEAR HELP or (650) 617-2254. Our insurance appeals staff will review your request and let you know within 3 business days if we will be able to assist you.
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