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Blue Cross says Jabra enhance pro 30 is over the counter and will not reimburse for them

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In reply to @HalfEar

You are fortunate to live in a civilized country like Canada. Here in the good old U.S.A., health insurance is only for the elderly, over 65, or those employed by a company that offers health insurance. Otherwise, the rest are entitled to emergency care only. It’s the Wild West for the rest who may be able to buy health insurance through the ACA, (Affordable Care Act), That’s until the Republicans try to kill it again.

In reply to @wilfried

If your Aetna coverage has the same requirements as mine and Aetna paid it certainly does sound like it met the requirement.

The full description in my coverage is that a covered hearing exam needs to performed by either:

  • A physician certified as an otolaryngologist or otologist
  • An audiologist who:
    • Is legally qualified in audiology
    • Holds a certificate of Clinical Competence in Audiology from the American Speech and Hearing Association in the absence of any licensing requirements
    • Performs the exam at the written direction of a legally qualified otolaryngologist or otologist

And they cover Electronic hearing aids, installed in accordance with a prescription written during a covered hearing exam.

So congratulations that you got paid.

If you are OK to say how much did they cover and how much did the hearing aids cost?

Of course, it depends where you received the information. If it didn’t come directly from Blue Cross, you may have been given wrong information.

How about the general approach of going to an audiologist for an ear exam and a prescription, then taking that to Costco to be filled? Costco may want to redo the exam. But the cost of the exam and prescription from the audiologist will be a lot less than paying the full-service price for from the audiologist. I did something like that for my first set of aids. I went to my local UT Health Medical Center. The audiologist didn’t work with any brands I was interested in. I took her prescription to another audiologist who worked with TruHearing, and she just used the original audiologist’s prescription to order my hearing aids, IIRC.

Edited

Further advice:

Short answer: the Jabra Enhance Pro 30 (Costco) is a prescription hearing aid fitted by a licensed provider—not an model—and, like virtually all prescription hearing aids, it’s -regulated (registered/listed) but not “FDA-approved” via a 510(k) the way drugs are. Jabra’s OTC products are sold under different names (e.g., Jabra Enhance Select and Jabra Enhance Plus), and those are the ones FDA classifies as OTC. FDA Access Data+3Soundly+3Jabra+31

Here’s the breakdown you can show Blue Cross:

  • What Pro 30 is: Jabra markets Pro 30 as a hearing aid fitted by professionals at Costco (i.e., prescription channel). Independent reviewers also describe Pro 30 as prescription-only at Costco. Jabra+2Costco Wholesale+21

  • What Jabra’s OTC models are called:
    • Jabra Enhance Plus — explicitly cleared by FDA as a self-fitting OTC hearing aid (510(k) K213424).
    • Jabra Enhance Select — listed with FDA as OTC air-conduction hearing aids (product code QUG).
    Pro 30 is not those products. FDA Access Data+2FDA Access Data+2

  • How FDA frames it: In FDA’s own words, “A prescription hearing aid is any hearing aid that is not an OTC hearing aid.” Prescription devices are dispensed through licensed professionals; OTC devices are labeled “OTC” and sold directly to adults with mild–moderate loss. Also, most hearing aids are Class I/II devices regulated by FDA (often 510(k)-exempt)—they’re registered/listed rather than “approved.” U.S. Food and Drug Administration+3U.S. Food and Drug Administration+3FDA Access Data+32

How to prove this to your insurer (step-by-step)

  1. Model identification: Ask the Costco Hearing Center for a written invoice or spec sheet that clearly says “Jabra Enhance Pro 30” with model numbers/serials and states that it was professionally fitted. (Costco’s site and Jabra’s product page back this up as a pro-fit device.) Costco Wholesale+12

  2. Not OTC evidence:

    • Print the FDA listing page showing Jabra Enhance Select is OTC (QUG) and the FDA 510(k) for Jabra Enhance Plus (self-fitting)—then point out that Pro 30 is neither of those OTC SKUs.

    • Include FDA’s line that anything not OTC is prescription. FDA Access Data+2FDA Access Data+22

  3. Audiologist documentation: Submit your , prescription, and any prior authorization your plan requires. (FEP/BCBS often require this for coverage.) U.S. Food and Drug Administration

If Blue Cross is still calling Pro 30 “OTC,” ask them to provide the specific FDA product code or listing they’re relying on; the public FDA records show OTC for Enhance Plus/Select, not for Pro 30. FDA Access Data+1

Just the fact that the Jabra Enhance Pro 30 can fit mild to profound loss shows that it is NOT an OTC hearing aid. OTC hearing aids are only allowed to fit mild to moderate loss.

In reply to @Flyboybob

@FlyboyBob - I just went through this with my insurance company. It 11 months trying to get reimbursed for another treatment, but your comment of insurance company not wanting to pay is so true. 11 months talking to ‘at least’ 15-20 different advocates that gave me different status And different requirements for me filing my own claim. I’m talking $1,800 that they owe me. No question that the treatment was covered just the submittal. I finally called the Chief Financial Officer. He called me back. I explained clearly, firmly and professionally the issue of the past 11 months. He agreed it should not be that hard. I sent him my invoices , he said he would have have his ppl look at them. 2 weeks later I’ve received payment of 12 of the 20 claims. I tell you this because the insurance companies hired brain dead representatives or representatives that do not have any authority except answer the phone and pass on misinformation. Call your CFO and explain. That is ridiculous and Blue Cross should pay!

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