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Hearing Aid Appeals:
Information for Parents
Deaf and Hard of Hearing Services – Metro Site Address: 85 E 7th Place, Suite Mailing Address: 444 Lafayette Road North, St. Paul, MN 55155-3814
651.431-5940 Voice 651-964-1514 Video Phone 888-206-6513 TTY 651-431-7587 Fax
Equal Opportunity Employers
Updated November 2016
DEAF AND HARD OF HEARING SERVICES DIVISION
Staff at Deaf and Hard of Hearing Services (DHHS) hope that you find this information booklet helpful. If you
have any questions, please contact your local Deaf and Hard of Hearing Services office.
CONTACT INFORMATION FOR DEAF AND HARD OF HEARING SERVICES’
REGIONAL OFFICES:
DHHS – Northwest
Moorhead
800-456-7589 (Voice)
218-227-5495 (VP)
866-488-3829 (TTY)
Fax: 651-431-7534
DHHS – Northeast
Duluth
888-234-1322 (Voice)
218-206-8381 (VP)
866-488-3833 (TTY)
651-431-7775 (Fax)
DHHS – E/W Central
St. Cloud
800-456-3690 (Voice)
320-227-2550 (VP)
866-488-3909 (TTY)
651-431-7777 (Fax)
DHHS – Metro
St. Paul
651-431-5940 (Voice)
651-964-1514 (VP)
888-206-6513 (TTY)
651-431-7587 (Fax)
DHHS – Southern
Mankato
800-311-1148 (Voice)
507-322-3518 (VP)
866-266-2461 (TTY)
651-431-7776 (Fax)
NOTE: Deaf and Hard of Hearing Services has compiled a list of hearing aid financial resources.
Please contact your local office if you would like to receive a copy.
INTRODUCTION
Thank you for contacting Deaf and Hard of Hearing Services (DHHS) for the hearing aid appeals information
booklet. In 2003, the Commission of Deaf, DeafBlind & Hard of Hearing Minnesotans (MNCDHH), with the
help of parent advocates and others, succeeded in getting a hearing aid bill for children passed in Minnesota
(Minnesota Statute 62Q.675). The bill was amended in 2007.
While this legislation (Minnesota Statute 62Q.675) has helped many parents obtain hearing aids for their
children, ERISA (a federal law) exempts self-insured plans from following any state mandates for health
coverage. Also, this law only applies to employers with "Minnesota" health plans. Parents who work for
employers with self-insured health plans or have a health plan from another state, have received denial letters
when requesting payment for their child’s hearing aids. While filing an appeal and writing letters to their
employer has not always reversed the original denial of covering their child’s hearing aid, at least parents know
they have tried to make a change that will benefit not only their child, but perhaps a co-worker’s child, too.
DHHS staff have assembled materials in this booklet that may assist parents who want to appeal the decision
which denied payment for their child’s hearing aid(s). DHHS would like to acknowledge the generosity of the
parents who graciously allowed us to use their materials and to staff at the Minnesota Department of Commerce
for their contributions.
The sections in this information booklet:
Getting Started
Minnesota Statute 62Q.675
First Steps
Some things you should do before you begin the appeals process.
The Appeals/Complaint Process
This information was prepared by the Minnesota Department of Commerce and summarizes the complaint
resolution process for hearing aids.
Sample Letters (These serve as templates to give parents an idea of what to include in their letter.)
To the Insurance Company
This is a composite of letters written by parents and sent to their insurance company.
To the Employer or Human Resources (Benefits) Department
This is a composite of letters and memos that were written by parents whose employers are self-insured, asking
them to add hearing aids to the company health plan.
Supporting Documents
These documents may help explain the impact of hearing loss and what may happen if corrective measures such
as hearing aids are not provided. Please do not feel you have to include all of them – pick the ones you think
will help support your letter.
Websites
These are just a few of the websites parents have found useful when explaining their child’s hearing loss to
others.
Getting Started
62Q.675 OF THE MINNESOTA STATUTES (AS AMENDED IN 2007)
This section is effective August 1, 2007 and applies to policies, contracts, and certificates issued or renewed on
or after that date.
The number and language of the statute is as follows:
[62Q.675] [HEARING AIDS; PERSONS 18 OR YOUNGER.] A health plan must cover hearing aids for
individuals 18 years of age or younger for hearing loss that is not correctable by other covered procedures.
Coverage required under this section is limited to one hearing aid in each ear every three years. No special
deductible, coinsurance, co-payment, or other limitation on the coverage under this section that is not generally
applicable to other coverages under the plan may be imposed.
To view and/or print the statute directly from the Minnesota Statutes website, go to:
www.revisor.mn.gov/ and type “62Q.675” in the Retrieve by number field on the left and press Enter.
First Steps
It is important that you contact your Human Resource department to ask if your health plan is: 1) a Minnesota
plan or if it is issued out of another state; and 2) whether it is fully insured or self-insured. Remember, this
legislation does NOT apply to employers who are self-insured or have a health plan from another state.
Once you receive a letter that denies coverage, you have 90 days to appeal. In your appeal, use compelling
arguments as to why your child should receive the coverage. The materials included in this packet will help you
explain why hearing aids are so important for children.
It is important to keep a list of everyone you contact – always get the name, title and phone number/extension of
the person with whom you spoke. You may also want to include the date and time you spoke to the individual.
If you decide to file a complaint or an appeal, it is important to have all conversations documented with the
information mentioned above.
The Minnesota Department of Commerce regulates the insurance industry to protect consumers and ensure a
fair and competitive marketplace. Commerce investigates complaints on behalf of consumers and works to
resolve disputes between consumers and insurers. The Minnesota Department of Commerce is available to
assist you. Minnesota Department of Commerce: http://mn.gov/commerce/consumers/your-insurance/health-
insurance/
The Appeals/Complaint Process
From the Minnesota Department of Commerce:
All health plans issued in Minnesota and all employers who self-insure their health coverage must provide a
complaint resolution process. A complaint is any type of grievance including issues with coverage, denial or
limitation of services, eligibility issues, administrative operations, quality, medical necessary decision, etc. The
complaint includes the enrollee, provider or anyone acting on behalf of the enrollee.
Appeal Process for an Employer or Individual Who Purchased Health Coverage from an Insurance
Company or HMO
If the employer or individual purchased health coverage from a licensed health carrier, that health carrier must
provide an internal and external review process. Each health carrier must provide a description of their
complaint resolution procedure to the enrollee.
Internal Appeal Process
If you have a health insurance claim that has been denied by your health plan, you have the right to appeal that
denial. The first thing you should do is contact your health plan and ask for more information on why the claim
was denied. This is the first step in the internal appeals process and insurance companies are required to address
your complaint within a strict timeline.
External Appeal Process
If you are still are not satisfied with the health plans' denial of your claim, you may be able to request an
external review.
For the external appeals process, Commerce will work with an impartial third party to determine if the denial
was justified. There is a $25 fee for each External Review unless it is waived for hardship. The health plan
must follow the decision. However, if you are not satisfied with the result of the decision you have the right to
appeal the decision in court.
Appeal Process for Self-Insured (Businesses that Pay the Claims Themselves)
If an employer is self-insured they must have an appeal process. The employee/dependent has 90 days to file an
appeal in writing with their employer. The employer might hire a Third Party Administrator (TPA) to process
claims, but an appeal can be made to the TPA or directly to employer.
The state cannot regulate an employer who self-insures their health care benefits, however, we will attempt to
assist and advise you of what to do. Remember, your employer makes the final decision, thus your final appeal
should be to them.
For Assistance Contact:
Minnesota Department of Health regulates all Minnesota Health Maintenance Organizations (HMOs):
651-201-5100 or 1-800-657-3916
Minnesota Department of Health: http://www.health.state.mn.us/divs/hpsc/mcs/hmo.htm
Minnesota Department of Commerce regulates all insurance companies. Blue Cross and Blue Shield of
Minnesota and Third Party Administrators (TPAs): 651-539-1600 or 1-800-657-3602
Minnesota Department of Commerce: http://mn.gov/commerce/consumers/your-insurance/health-insurance/
U.S. Department of Labor – Employees Benefits Security Administration (EBSA) regulates all self-insured
employers and also has information about the Affordable Care Act and how it adds many protections related to
employment-based group health plans for you and your family: 1-866-444-3272
US Department of Labor Health Reform: https://www.dol.gov/ebsa/healthreform/consumer.html
Sample Letters
HOW TO WRITE AN APPEAL LETTER TO YOUR INSURANCE COMPANY
Some words of advice in writing a concise appeal letter from Katalin Goencz, director of MedBillsAssist, a
claims assistance company in Stamford, Connecticut and Rebecca Stephenson, president and CEO of
VersaClaim, a claims assistance and patient advocacy business in Austin, Texas:
When you write an appeal letter, be sure to include your address, name, insurance identification number, date
of birth for the person whose claim was denied, date the services were provided and the health insurance claim
number, Goencz says.
"The first sentence should state that you are appealing the claim denial, and the body of the letter should
explain why the medical bills should be paid," Goencz says. "Put in a closing sentence demanding payment, and
include supporting documentation."
Save emotional rants for understanding friends, and stick to the facts.
"[Insurers] don't want to know about your grief and how sick you've been," Stephenson says.
Send by certified mail to get notification that the packet was received, she adds.
There are several resources found online with tips on writing a letter to your insurance company. Listed below
are just a few to get you started. (NOTE: If these links are no longer available or you want to see other
websites, just type “how to write an appeal letter to insurance company” or something similar to that in your
preferred search engine).
State of Washington How to Appeal: https://www.insurance.wa.gov/your-insurance/health-
insurance/appeal/how-to-appeal/
State of Washington Denial Reasons and Appeal Example: https://www.insurance.wa.gov/your-
insurance/health-insurance/appeal/denial-reasons-and-appeal-example/
Insure Dot Com Sample Appeal Letter: http://www.insure.com/health-insurance/claim-denial-appeal.html
Writing Winning Insurance Appeal Letters by Susan Agrawal (PDF):
http://www.cdkl5.com/UserFiles/files/example%20ins%20appeal%20letter.pdf
Health Law Advocates Guide to Appeals (PDF):
http://www.healthlawadvocates.org/tools/documents/files/HLA-Guide-to-Appeals-2-15-13.pdf
Insurance Dot Com How to Appeal a Health Insurance Claim Denial - and win:
http://www.insurance.com/health-insurance/coverage/appeal-a-health-insurance-claim-denial.html
The above links contain generic letters. To give you a better idea of what parents have written to their
insurance company pertaining to the denial of hearing aids, you will find two sample letters on the next two
pages. The first letter is directed to the parent’s insurance company; the second to their Human Resources
Department to encourage the company to add hearing aid benefits.
TO THE INSURANCE COMPANY
Date
Name and Position Title
Name of Insurance Company
Street Address or Post Office Box
City, State, Zip Code
Re: Your Child’s Name
Policy/Member Number
Dear Name:
This letter is in reference to your denial letter dated [date]; this letter serves as my request for an appeal process
on behalf of my son.
[Child’s name] was born on [date]. Before leaving the hospital, he was given a hearing test and failed. Finally
at 4 months, he was diagnosed with a [type of hearing loss your child has] by [audiologist’s name] at [hospital
or clinic]. Enclosed is the actual data – [child’s name] ABR (auditory brainstem response) and OAE
(otoacoustic emission). It shows what he can and cannot hear. Also, I have enclosed an audiogram on which I
have highlighted the frequencies he can’t hear and some statistical information as to what a person with [type of
hearing loss your child has] would encounter without hearing aids.
The type of hearing loss my son has is permanent and if untreated will adversely affect [child’s name] ability to
speak language. He is not a candidate for any type of corrective surgery or for a cochlear implant. Hearing aids
are the only “medical solution” to his disability at this date and time. The request for hearing aids is not one for
cosmetic improvement, but is medically necessary and would drastically help my son to not only hear, but also
be a “normal” child. Without the hearing aids [child’s name] will not hear correctly, therefore will not learn
correctly. Without hearing aids [child’s name] will be in special learning classes, speech therapy, etc. He will
be unable to communicate clearly with friends and family. Research also indicates the potential for cognitive
delays if treatment is not provided.
I learned that [insurance company name] covers prosthetics and leg braces if a child was born needing them. I
was quite surprised to learn you are selective in what types of disabilities you are willing to cover when paying
for services and items. I believe it is unjust that [name of insurance company] will not cover a medically
needed item, in this case – hearing aids, ear molds and hearing evaluations for a child with congenital hearing
loss.
It would be a serious travesty, if you deny a [age of your child] child the chance of hearing.
Thank you for your prompt attention to this matter. I look forward to your return response.
Sincerely,
Your signature
Enclosures
Cc:
TO THE EMPLOYER or HUMAN RESOURCES (BENEFITS) DEPARTMENT
Date
Company Name
Human Resources
Address or Post Office Box
City, State, Zip Code
Re: Hearing Aid Coverage
Name of Person [or To Whom It May Concern]:
I would like [company name] to add hearing aid coverage as a benefit to all of the health plans that are offered
to employees. This would benefit employees who have children born with a hearing loss. Our kids need hearing
aids so they reach their full potential and become responsible, contributing citizens and effective members of
the workforce.
Up until 2003, many Minnesota insurance companies denied coverage for hearing aids as “cosmetic
improvements”. The Minnesota legislature passed a bill requiring insurance companies to cover the cost of
hearing aids for children with congenital hearing loss. The law, Minn. Stat. 62Q.675, which was revised in
2007, requires the insurance company to provide (with applicable, but not special, co-pay deductible) new
hearing aid(s) once every three years until the child is 18 years old.
I have attached a copy of the law, as well other supporting documents which show the importance of hearing
aids for children. Because [company name] is self-insured for its employees, this legislation does not impact
our plan. However, in my research, I have found other self-insured companies in the State of Minnesota that
have hearing aid coverage on their health plans and I hope our company will join them in covering hearing aids
for children.
Approximately two to three of every 1,000 children in the United States are born deaf or hard-of-hearing. So it
is unlikely that the [company name]’s self-insured plan would be greatly impacted by adding this coverage.
As the sponsor of a self-insured plan, [company name] can control, in many cases, which benefits its insurance
plan will provide. While I do not believe this should be simply a matter of dollars and cents, I understand that
nothing is free. Therefore, I urge you to look at the enclosed studies and other pertinent information regarding
the potential cost savings in speech therapy, as well as society’s cost savings in K-12 education and social
services that our company would obtain from providing hearing aid coverage.
When taking this decision into consideration, please keep in mind that my child did not have a choice about
their hearing loss. Please let me know if there is any additional information you feel you need to help make this
decision. Adding hearing aid coverage to [company name]’s health care plans would not only benefit my child,
it would also benefit other company employees who have children who have a hearing loss.
Your consideration in this matter would be greatly appreciated.
Kindest regards,
Signature
Enclosures
Cc:
Supporting Documents
TESTIMONY FROM DR. ROBERT MARGOLIS,
PROFESSOR OF AUDIOLOGY,
DEPARTMENT OF OTOLARYNGOLOGY,
UNIVERSITY OF MINNESOTA
23 FEBRUARY 2003
NOTE: This testimony was given prior to passing Minnesota Statute 62Q.675
One of the most dramatic changes in public health in recent years is the establishment of universal newborn
hearing screening in birthing hospitals throughout the US. Ten years ago only very sick babies were screened
for hearing loss at birth. Today 32 states have legislative mandates that require all babies to be screened for
hearing loss in the nursery. In Minnesota, over 90% of the 65,000 babies born each year are screened for
hearing loss in the hospital, a tremendous accomplishment for a state without a legislative mandate. This has
occurred because of broad support led by funding from the Lions 5M Hearing Foundation, the US Maternal and
Child Health Bureau, the Centers for Disease Control and tireless efforts by professionals, parents, and state
officials.
A change in health policy of this magnitude does not occur without a strong justification. The justification is
that there is incontrovertible evidence that early identification of and intervention for congenital hearing loss
prevents or reduces permanent, lifelong consequences of untreated hearing loss including developmental delays
in speech and language, diminished school achievement, diminished employability and career opportunities,
and limitations on social development and opportunities.
In addition to prevention of serious permanent consequences of untreated hearing loss, early intervention
significantly decreases the cost of education and rehabilitation of hearing-impaired children. The cost of special
education for hearing impaired children is three times the cost of regular education. The cost of education in a
residential program like our State Academy for the Deaf in Faribault is eight times that of regular education.
Early intervention moves children from more expensive educational program to less expensive programs.
Permanent congenital hearing loss is a chronic disease that when left untreated, results in serious permanent
impairment.
Please consider the experience of learning at the time your baby is born that the child has permanent hearing
loss. The good news is that a treatment is available. If the appropriate treatment is surgery, your health
insurance will pay for it. If the treatment is medication, your health insurance will pay for it. But for the
overwhelming majority of people with permanent hearing loss, the only appropriate treatment is hearing aids.
But your health insurance won’t pay for hearing aids unless you are lucky enough to be a state employee or you
qualify for medical assistance or you are a member of a small minority who have hearing aid coverage in
commercial health plans. If the treatment is one thing it is covered. If it is another, no matter how effective, it is
not covered. This is not responsible or fair health policy.
The Joint Committee on Infant Hearing 2000 position statement, supported by the American Academy of
Pediatrics, the American Academy of Audiology, and many other professional health agencies, recommends
intervention for permanent congenital hearing loss by 6 month of age. The current lack of access to appropriate
treatment is the most significant obstacle to achieving this goal.
All health plans should pay for hearing aids when they are the appropriate treatment for significant childhood
hearing loss. This makes sense medically; it makes good sense economically, and it makes sense morally.
JOHN TRACY CLINIC’S AUDIOGRAM OF FAMILIAR SOUNDS
EFFECTS OF HEARING LOSS ON DEVELOPMENT
From the American Speech-Language-Hearing (ASHA) website: American Speech-Language-Hearing
Association Effects of Hearing Loss on Development: http://www.asha.org/public/hearing/disorders/effects.htm
It is well recognized that hearing is critical to speech and language development, communication, and learning.
Children with listening difficulties due to hearing loss or auditory processing problems continue to be an
underidentified and underserved population.
The earlier hearing loss occurs in a child's life, the more serious the effects on the child's development.
Similarly, the earlier the problem is identified and intervention begun, the less serious the ultimate impact.
There are four major ways in which hearing loss affects children:
1. It causes delay in the development of receptive and expressive communication skills (speech and
language).
2. The language deficit causes learning problems that result in reduced academic achievement.
3. Communication difficulties often lead to social isolation and poor self-concept.
4. It may have an impact on vocational choices.
Specific Effects
Vocabulary
Vocabulary develops more slowly in children who have hearing loss.
Children with hearing loss learn concrete words like cat, jump, five, and red more easily than abstract
words like before, after, equal to, and jealous. They also have difficulty with function words like the, an,
are, and a.
The gap between the vocabulary of children with normal hearing and those with hearing loss widens
with age. Children with hearing loss do not catch up without intervention.
Children with hearing loss have difficulty understanding words with multiple meanings. For example,
the word bank can mean the edge of a stream or a place where we put money.
Sentence Structure
Children with hearing loss comprehend and produce shorter and simpler sentences than children with
normal hearing.
Children with hearing loss often have difficulty understanding and writing complex sentences, such as
those with relative clauses ("The teacher whom I have for math was sick today.") or passive voice ("The
ball was thrown by Mary.")
Children with hearing loss often cannot hear word endings such as -s or -ed. This leads to
misunderstandings and misuse of verb tense, pluralization, nonagreement of subject and verb, and
possessives.
Speaking
Children with hearing loss often cannot hear quiet speech sounds such as "s," "sh," "f," "t," and "k" and
therefore do not include them in their speech. Thus, speech may be difficult to understand.
Children with hearing loss may not hear their own voices when they speak. They may speak too loudly
or not loud enough. They may have a speaking pitch that is too high. They may sound like they are
mumbling because of poor stress, poor inflection, or poor rate of speaking.
Academic Achievement
Children with hearing loss have difficulty with all areas of academic achievement, especially reading
and mathematical concepts.
Children with mild to moderate hearing losses, on average, achieve one to four grade levels lower than
their peers with normal hearing, unless appropriate management occurs.
Children with severe to profound hearing loss usually achieve skills no higher than the third- or fourth-
grade level, unless appropriate educational intervention occurs early.
The gap in academic achievement between children with normal hearing and those with hearing loss
usually widens as they progress through school.
The level of achievement is related to parental involvement and the quantity, quality, and timing of the
support services children receive.
Social Functioning
Children with severe to profound hearing losses often report feeling isolated, without friends, and
unhappy in school, particularly when their socialization with other children with hearing loss is limited.
These social problems appear to be more frequent in children with a mild or moderate hearing losses
than in those with a severe to profound loss.
What You Can Do
Recent research indicates that children identified with a hearing loss who begin services early may be able to
develop language (spoken and/or signed) on a par with their hearing peers. If a hearing loss is detected in your
child, early family-centered intervention is recommended to promote language (speech and/or signed depending
on family choices) and cognitive development. An audiologist, as part of an interdisciplinary team of
professionals, will evaluate your child and suggest the most appropriate audiologic intervention program.
DEGREES OF HEARING LOSS
Seattle Children’s Hospital
Seattle Children's Hospital-Research-Foundation Facts About Newborn Hearing Loss:
http://www.seattlechildrens.org/classes-community/community-programs/newborn-hearing-screening/about-
hearing-loss/
Websites
SOME WEBSITES TO GET YOU STARTED:
There are many other websites that provide valuable information for you to share with others – these are just a
few that parents and professionals have recommended. In addition to the home page, we have included some
links within that website. Please note that there are many (many!) more places to visit on these websites – we
leave it to you to explore each website thoroughly!
BEGINNINGS
Beginnings Home Page: http://ncbegin.org/
Beginnings Early Diagnosis & Intervention: http://ncbegin.org/the-importance-of-early-diagnosisintervention/
Beginnings Hearing Aids: http://ncbegin.org/hearing-aids/
Beginnings Developmental Benefits: http://ncbegin.org/developmental-benefits/
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CENTERS FOR DISEASE CONTROL AND PREVENTION
Centers for Disease Control and Prevention Hearing Loss in Children Home Page:
http://www.cdc.gov/ncbddd/hearingloss/index.html
Centers for Disease Control and Prevention Facts: http://www.cdc.gov/ncbddd/hearingloss/facts.html
Centers for Disease Control and Prevention Free Materials:
http://www.cdc.gov/ncbddd/hearingloss/freematerials.html
******************************************************************************************
MY BABY’S HEARING (BOYS TOWN NATIONAL RESEARCH HOSPITAL)
Boys Town National Research Hospital My Baby's Hearing: http://www.babyhearing.org/
Boys Town Research Hospital Next Steps: http://www.babyhearing.org/nextsteps.asp
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SUPPORTING SUCCESS FOR CHILDREN WITH HEARING LOSS
Supporting Success for Children with Hearing Loss Home Page: http://successforkidswithhearingloss.com/
Supporting Success for Children with Hearing Loss Language in Caught Not Taught:
http://successforkidswithhearingloss.com/speech-language/
Supporting Success for Children with Hearing Loss 12 Speech and Language Considerations:
http://successforkidswithhearingloss.com/12-considerations-speech-language/
