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

That may be the issue. As I posted in another thread my insurance (Aetna) only covers hearing exams from qualified Audiologists and probably more important only hearing aids installed in accordance with a prescription written during a covered hearing exam

This unfortunately precludes Costco (confirmed by Costco).

Costco has excellent certified fitters but they are generally not qualified audiologists. The Jabra Enhance Pro 30s are prescription hearings but I could not get them from Costco and meet Aetna’s requirements (and you can’t get them anywhere else than Costco)

@Nabb read the small print on your coverage to understand what Blue Cross requires for covered hearing aids.

In my case it was still much cheaper to go with Jabra Enhance Pro 30’s from Costco at $1700 vs paying $6000 to $8000 at an Audiologist and getting $2000 insurance back from Aetna.

I think you are correct. However, Blue Cross should have said that they require a doctorate degree in audiology to prescribe and fit a hearing aid and that Costco generally uses 2 year degree hearing aid fitters.

Unfortunately, under the Jabra label, they only make OTC hearing aids. However, the ReSound Viva 9 and Costco’s Jabra Enhanced Pro 30 are the same hearing aids. However, they are twice as expensive. Costco uses the Jabra name on their version of same hearing aid. Insurance companies require that you must go to an audiologist and pay through your nose to get some reimbursement.

If you want to get reimbursed from Blue Cross and Blue Shield, you may have to return them to Costco and go to an audiologist on their list. Pay the full price, and then get reimbursed. I have their insurance at work and I just didn’t use them and paid out of pocket at Costco. One of my colleagues used our insurance for hearing aids and the insurance paid $3,000 to the audiologist and he paid $1,600 out of pocket. BTW the audiologist offered him three levels of quality and he chose the middle one. At Costco you have the top of the line hearing aids just like the ReSound Biva 9s. Same out of pocket cost as just going to Costco but getting top of the line hearing aids.

Most costco have audiologist on staff speak to them and see if they can submit a letter explaining the Costco dispensing system

It’s worth a try, but Costco’s policy is that they don’t file insurance claims and they may consider that as filing insurance. Unfortunately, I don’t think that Blue Cross and Blue Shield’s underwriting policy will change.

@Flyboybob said:

Unfortunately, under the Jabra label, they only make OTC hearing aids

Actually, at jabra.com3, their brochure for Enhanced Pro hearing aids says you can only get them from a Costco Hearing Care Professional. Furthermore, their website specifies that the Enhance Pro hearing aids are “prescription grade” and “professionally programmed” at Costco. The insurance could pay less than the $3k your colleague’s policy paid and save money, yet still cover @Nabb for hearing aids entirely by covering Costco. There’s bound to be an AuD considered to be supervising the 2-year degreed fitters somewhere along the line. I suspect the insurance person on the phone is thinking solely of Jabra as a maker of OTC audio products.

Your issue is that you are trying to use logic and insurance companies are always looking to not pay claims. Especially health insurance companies. Once an underwriter makes a decision to deny a claim they rarely change their position. Insurance underwriters bonuses are based on how many claims they deny.

@Nabb said:

Yesterday I requested claim forms to get reimbursed for my hearing aids

Requesting a claim form and submitting a claim are 2 different things. Check your policy to see what is or is not covered and what is required.

For example, my insurance wanted a pre-authorization submitted before proceeding.

Although Costco does not submit* claim forms on your behalf they will sign a prepared form. There are exceptions, for example in Ontario, Hearing aids are “assistive devices” and the government covers a set portion per aid every 5 years. Costco will submit* to that program as only the provider gets paid.

I had prepared the pre-authorization form with all my info and had the Costco Audi fill in the make / model they were prescribing along with their info - license # and signature. I submitted that and once approved, I submitted my claim by filling out another form and submitting the approval with a copy of the Costco receipt.

As @Flyboybob indicates, insurance companies don’t like to pay. When armed with the right information, some persistance and connecting with the right people you can likely get reimbursed for a legitimate claim.

There is a book by Tim Dorsey, called Florida Roadkill. It includes a character who works for an insurance company renowned for its claim denials. He is the top of the denials pyramid, the guy to whom all claims deniers plagued by persistence and appeals refer their claimants. As a result, he is wealthy due to bonuses received for denying claims to an extraordinary extent. He is hoist by his own petard when his own care at an emergency room is denied by his own voice mail! (This book is NOT for everyone - set in 80s-90s Florida, there is explicit language, violence, copious drug and alcohol use, and many references to sex. It is, however, also possessed of multiple plot lines, outrageous events, and a lot of dark humor.)

Jabra Enhance Pro 20, 30 are NOT over-the-counter hearing aids. Mine have been professionally tweaked several times. (You don’t just pick one up in a box and head to ‘check-out’.) They are high quality instruments that deliver excellent hearing improvement to those who need it, and they are adjusted for each client by a professional technician. –a satisfied customer.

I’ve seen it from the other side. I sat on a technical advisory committee for a government administered health program.

There are the front line people that do the initial approve or deny. There are more layers upwards that will further adjudicate the front line decisions when requested. There are appeal processes and there are always exceptions that might be considered.

For example, an individual might be denied replacing their hearing aids based on a frequency limitation (once every x years). Upon appeal, it is determined that the individual was evacuated from a wildfire zone in a remote area and lost all their belongings including their aids in the fire. This is something that would likely be considered an exception.

Speaking hypothetically, when I got my hearing aids, I saw an ENT and got a hearing test at a hospital. I then got the hearing aids fitted and dispensed elsewhere. The dispensing audiologist also needed a letter from the ENT clearing me for the hearing aids. Insurance (Aetna) paid for the ENT and hearing test. Would this count as “installed in accordance with a prescription written during a covered hearing exam”?