To hear and be heard

From: Richmond Times Dispatch, VA - Sept 5, 2004

Families in limbo as state assesses coverage of children's hearing

BY TAMMIE SMITH
TIMES-DISPATCH STAFF WRITER

Sep 5, 2004

When the family's health insurer refused to pay for hearing aids for Mark and Danielle Fink's young son and daughter, Danielle Fink prodded the company for a reason.

She said she was told hearing aids "are not deemed necessary."

"Surely," Fink responded, such a policy was "written by individuals who hear birds chirping, dogs barking, oncoming cars, even bees buzzing without medical devices such as hearing aids.

"My children's hearing loss was from birth and not at all preventable."

Fink's frustration is shared by other parents of hearing-impaired children whose health plans do not cover hearing aids. Most private plans in Virginia do not cover the devices as part of standard benefits, according to a survey by the State Corporation Commission in April 2003.

The survey, done for an advisory panel studying the issue, polled 60 firms that write most of the accident and sickness policies in the state. Only two companies said they provided hearing-aid coverage like that proposed in a bill in this past General Assembly session. Six made such coverage available through an optional group rider.

The proposed legislation would have required private health plans to pay up to $1,400 per hearing aid every 36 months for children 5 and younger when the devices are prescribed by li- censed audiologists. Health insurers opposed that bill and another one that would have covered hearing aids for children up to age 18.

The latter bill was defeated. The first bill had the votes to pass, said Judith Castleman, lobbyist for the Speech-Language-Hearing Association of Virginia. But the association agreed to a plan that would delay a vote while state health-policy officials worked out a compromise that avoided mandated coverage.

"The administration was willing to work on this and study just how many kids fall between the cracks. . . . We were willing to wait and see," Castleman said.

One suggestion was to create a pot of money to help those children whose families cannot afford to buy hearing aids but who make too much to qualify for Medicaid, which does cover hearing aids for children.

The Virginia Department for the Deaf and Hard of Hearing is collecting information on public and private options, said Leslie Hutcheson Prince, the agency's policy and planning manager.

"A lot of times if you appeal to your insurance company, you can get hearing aids for children covered. That is one of the things I had not realized," she said.

For some families, help is available from organizations such as the Central Virginia Lions Hearing Aid Bank, which collects and refurbishes used hearing aids and provides them free or at low cost to people who qualify. Some also can qualify for aid from agencies that provide low-interest loans to purchase hearing-assistance technology.

Fink looked into some of those options but did not qualify because of her family's income. They are nowhere near destitute, she said.

But she said she is not making an issue of the insurance just for her children's sake.

"We have been very blessed. I am not looking for a handout," said Fink, who lives in Chesterfield County.

Without hearing aids, her children have about 50 percent hearing. The last set of hearing aids for Cameron, 10, and Michael, 12, bought three years ago cost $12,000 and were high-end digital models that do a good job of screening out background noise, so the children can function in regular classrooms.

The other mainstreaming option was clunkier - their teachers would have to wear a microphone, and the children would have to wear special microphone receivers and hearing aids.

"My husband's grandmother helped us with the costs," Fink said.

But not all families are as fortunate, she said. When she tells people the devices are not covered by many insurance plans, most people seem surprised.

"When I see the shock in other people, I feel I have to do something about it," she said. "It may not be for me personally."

Experts agree that recognizing deafness and hearing problems early in life is critical because that is when children learn language.

"Kids can be fitted with hearing aids as young as 4 weeks old," said Prince, the official in the Department for the Deaf and Hard of Hearing. "If they are 18 months before they get their first hearing aid, you have lost critical language-development time."

In California, lawmakers recently passed legislation that would require health plans to pay up to $1,000 for hearing aids for children younger than 18. Maryland also mandates some hearing-aid coverage for minors.

"The successes are small and steady," said Maureen Thompson, director of private-health-plans advocacy for the American Speech-Language-Hearing Association based in Rockville, Md.

"Health plans are always going to oppose mandates. Advocates have been banging on the doors of health plans for years," she said.

But health-plan lobbyists argue that mandates could backfire by driving up health-care costs.

In the Virginia survey, companies were asked how much premiums would go up if hearing-aid coverage became mandatory. They quoted estimates of 27 cents to $1.87 per month on policies purchased individually and 35 cents to $3 per policy bought in a group. The state advisory panel cited higher insurance costs in its decision to oppose legislation mandating coverage.

"Health insurance is a safety net and serves a very valuable purpose," said Joy Lombard, director of policy for the Virginia Association for Health Plans. "It cannot be everything to all people or nobody would ever be able to afford it. I think the real question is why these devices are so expensive."

Lombard's group also cites the lack of regulation of hearing-aid sales as a reason why mandating coverage is not a good idea. Prices range from as low as $300 to several thousand dollars.

If Virginia were to mandate $1,400 in coverage, Lombard said, prices probably would rise to meet that minimum, making hearing aids less affordable for people who do not have hearing-aid coverage or who are uninsured.

"Even if you get coverage, it's not going to cover every kid," added Prince, pointing out that mandates do not apply to self-insured health plans.

Those arguments don't deter Fink. When Virginia lawmakers convene next year, she intends to be there.

"I feel like I was meant to do something with this," she said. "I feel like we have been blessed in so many other ways that this is how to give back."

Contact Tammie Smith at (804) 649-6572 or tlsmith@timesdispatch.com

© 2004, Media General, Inc. All Rights Reserved