Commission of Deaf, DeafBlind, and Hard of Hearing Minnesotans


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Q and A: Hearing Aid Law for Kids in Minnesota

Effective August 1, 2007 the state of Minnesota requires insurance companies that provide coverage in Minnesota to add hearing aids for children birth through 18 who were born with or have an acquired loss to their benefit set when the policy is issued or renewed. The Minnesota Commission Serving Deaf and Hard of Hearing People (MCDHH) has received many questions from parents, teachers and audiologists. The following are the most commonly asked questions about the new law.

What is the number and language of the statute?
Who is covered?
How often can I purchase aids?
What do I do first?
I have a fully-insured plan and believe that I am covered by the statute. What do I do next?
OK, my doctor has authorized the purchase of hearing aids- what should I do next?
I have a full-insured plan and should have coverage. What if my insurance carrier resists or delays providing coverage?
The law does not cover us because we have a self-insured plan. Is there anything that I can do?
Hearing Aid Appeals Packets – PDF and WORD for Download
In the future we would like to try to get coverage expanded for all children.
More questions?

What is the number and language of the statute?

[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. [EFFECTIVE DATE.] This section is effective August 1, 2007, and applies to policies, contracts, and certificates issued or renewed on or after that date.

Who is covered?

Children who are covered by fully-insured plans that are born with a congenital malformation that causes hearing loss and/or an acquired hearing loss.

How often can I purchase aids?

One hearing aid for each ear once every three years from birth through 18.

What do I do first?

Don’t purchase aids without authorization from your insurance company.
Determine what kind of health insurance you have: self-insured or fully-insured. This law covers only fully-insured plans. You can find out if your plan is fully-insured or self-insured by contacting your insurance carrier or the Human Resources department at your place of employment. If you talk to your insurance carrier instead of HR, be sure and get the full name, phone and extension number of the insurance representative in case you or the Department of Commerce or the Department of Health need to follow up.

I have a fully-insured plan and believe that I am covered by the statute. What do I do next?

Call your insurance carrier and ask them if you are covered. The procedure will be different for different insurance companies, but the following will probably need to happen before authorization for your child’s aids is given:

An audiologist that is covered by your insurance company should conduct a test and verify that there is a hearing loss and that hearing aids are part of the recommended treatment. The audiologist will make a recommendation for the type of aids needed.

Next you need to get a diagnosis from your family physician or an Otolaryngologist (ENT) that your child’s hearing loss was caused by a congenital malformation.

If your child was identified through Universal Newborn Hearing Screening, you may not need to get the verification by the ENT. Your medical home, or family physician may be authorized to make the determination based on the information he or she has received from the screening at the hospital and the follow up from the audiologist.

OK, my doctor has authorized the purchase of hearing aids- what should I do next?

Different health plans will have different rules. Some insurance companies may try to contain costs by negotiating contracts with different hearing aid manufacturers. Your audiologist will recommend the aid that will help your child.

I have a full-insured plan and should have coverage. What if my insurance carrier resists or delays providing coverage?

Always get the name, title and phone number/extension of the person you talk to at your insurance company document what they said and provide that to the team.

Contact the Consumer Response Team (651-296-2488 or 1800-657-3602) at the Minnesota Department of Commerce or the Complaint Process at the Managed Care Systems through the Minnesota Department of Health for HMOs (651) 282-5600 or 1-800-657-3916. Provide them with the name of your insurance company or HMO

The law does not cover us because we have a self-insured plan. Is there anything that I can do?

Yes! Advocate for your child. The Department of Human Services Deaf and Hard of Hearing Services Division has put together an appeals packet with sample letters and documents that you can use to make your case to your company to try to provide coverage.

PDF http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs_id_048039.pdf

WORD Hearing Aid Appeals Information Packet by DHS-DHHSD [757.00KB]

We also have parent advocates who can work with you to make your case to your insurance carrier. Contact your employer to explain why they should add this coverage to the policy plan. Your employer makes the final decision.

Your insurance company is required to have a dispute resolution process. Some parents have successfully advocated for their children even when they don’t have a law in place.

In the future we would like to try to get coverage expanded for all children.

MCDHH will try to track the number of children who are not covered by the law and work with insurance companies to provide coverage. Please contact us and let us know if you fall into these categories. We are trying to keep track of all advocacy efforts.