Pediatric Hearing Aid Coverage Comes to Idaho!

by Lesa Coleman, Idaho H&V

Pediatric hearing aids, cochlear implants and auditory osseointegrated (bone conduction) devices will now be covered by private, small group health insurance plans sold within the State of Idaho!  The new rule language states that the following will be covered:  “Hearing aids, cochlear implants and examination for or fitting of them, for congenital or acquired hearing loss that without intervention may result in cognitive or speech development deficits of a covered dependent child, covering not less than one device every thirty-six (36) months per ear with loss and not less than forty-five (45) language/speech therapy visits during the first twelve (12) months after delivery of the covered device.”

Idaho parents ought to be very proud as this rule is the most comprehensive rule or piece of pediatric hearing aid legislation in the nation – hands down.

About the Idaho rule:

• It is the only rule in the nation to cover all types of hearing loss and all types of hearing technology including hearing aids, cochlear implants and bone conduction devices. Most other state rules only cover hearing aids.
• It does not have dollar limits because all types of hearing devices are covered.
• It is the only provision in the nation to cover speech therapy – (45 sessions for a year) as new technology is fit.
• It is the only provision in the nation that allows coverage for a “covered dependent child”. Young adults can stay on their parents’ policy until age 26 and continue to have hearing technology covered.
• The rule covers new pediatric hearing technology every three years so children can benefit from the latest technology advances in good working condition.
• The rule specifies that both congenital and acquired losses will be covered.
• Makes clear that hearing loss without intervention results in cognitive or speech delays. 

At the outset, from the start of the legislative session 2018, Idaho Hands & Voices Advisory Board members and the Executive Director were particularly involved in the advocacy, technical writing, and testimony for the ruling change. They, with other community partners and legislators Representatives Ilana Rubel and Pat McDonald, formulated a specific, shared list of rule change components. The rule change team is thrilled that every item on their “wishlist” was met as outlined above. Thank you for your important participation! During a public comment period, the Department of Insurance received over 120 letters in support of the rule change and a petition of over 100 signatures for the change was also submitted from parents, children and educators from all over the state.

Questions have been pouring in about the rule change. We’ll attempt to answer the most common here to the best of our knowledge.

When can my child get hearing aids covered by our insurance?  The new rule change will be effective at the end of the legislative season, March, 2019. However, insurance carriers have already made contracts with the state that are in effect until Dec. 31, 2019. So, new plan requirements will be written into insurance contracts this summer and insurance plans will be required to cover the new provisions January 1, 2020.

Do hearing devices apply to my plan deductible?  Yes, the Department of Insurance Rule change brings pediatric hearing devices into coverage like other needed procedures and devices.

If my insurance plan is through a large group employer (like Albertson’s) does this rule change apply to that policy?  Unfortunately, no, because many of these plans originate outside of the State of Idaho.  (The Albertson’s plan is based in Texas).  However, with this rule governing Idaho insurance plans, there is good reasoning behind an appeal for coverage as our state covers hearing technology and the employing company and employee reside in Idaho.  Also, the state of Texas also recently passed a pediatric hearing aid legislation. In fact, a family in this very situation received coverage upon appeal even before the rule change passed.  Our rule change not only provides coverage for small group plans, it also sets a precedent for large, out of state groups to provide coverage.

Where should I go to get pediatric hearing devices?  Children should be tested and fit with specialized hearing devices by a PEDIATRIC AUDIOLOGIST. There is a big difference between testing equipment, procedures and hearing devices for children and adults.  Insurance provision has to be “medically necessary.” There are many excellent pediatric audiologists in Idaho or nearby states. If you go to the www.ehdipals.org website, you can put in your zip code and locate the pediatric audiologist nearest to you. With the rule change, there will be many non-pediatric audiologists looking to take children as patients. Please connect your child with a pediatric audiologist for all testing and technology needs!

Idaho Hands & Voices team members are willing to answer additional questions. Please write to us at idahohandsandvoices@gmail.com if you have additional questions.  It’s worth reading a copy of the rule change for more information. This rule reads as an exclusion to the exclusions.  ~

H&V Communicator – Summer 2019