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hmmm.

so, when looking up the hearing aid insurance info online this morning, I came across this.

Basically, it seems to say that if your health plan claims to cover prosthetic devices, but excludes hearing aids, then they're in violation of the ADA.

From my health plan:

Covered in full after a $10 copayment per visit:
- Durable medical and prosthetic equipment (including ostomy supplies)


and later on:

The Plan does not provide coverage for:
...
- hearing aids.


They also cover "Vision hardware for special conditions" - but not hearing aids.

As near as I understand it, the criteria by which the ADA determines discrimination is if the difference between what they cover and what they don't is the nature of the thing covered rather than its severity. i.e., if they cover artificial limbs, they should cover artificial ears. If they cover vision hardware for special conditions, they should cover hearing hardware for special conditions. They can put a spending cap on it (as long as it's comparable to the cap they have on other similar things), but they can't deny it entirely.

tikva can probably tell me if I'm way off base here, but it's awfully tempting to go after them. Could save me a few grand when these guys finally can't be repaired anymore...

Comments

( 3 comments — Leave a comment )
tikva
Feb. 25th, 2002 07:30 pm (UTC)
I'm gonna check up on it at work tomorrow. I suspect the ADA would mainly come into play here if they, say, denied all coverage to deaf people (or blind people, or people with MS, or whatever). But I'll consult with Andy and get back to you. Remind me. :)
tikva
Feb. 26th, 2002 02:20 pm (UTC)
Follow-up
I conferred with Andy the ADA God, and we came to the following conclusion:

Your insurance company is not doing anything illegal as far as I can tell. Differential coverage is legal as long as it is based on "sound actuarial data" (and if you think your insurance company is going to let you in on their trade secrets, I've got a surprise for you). The most common case of differential coverage exists with people with mental illnesses - often a plan will offer, say, $1 million in lifetime coverage for people with physical disabilities and only $25K in lifetime coverage for people with psychiatric disabilities, because crazy people cost more than cripples. :) Likewise, while individual prostheses may be more expensive than are individual hearing aids, far more people need hearing aids than prostheses, so hearing aids are more expensive for an insurance company to cover. And they probably have "sound actuarial data" to back that up.

Now, if your employer refused to cover your medical insurance because of your hearing impairment, and they were happily covering everyone else's medical insurance, that'd be different. But the plan is simply outlining things it will or will not cover. It could just as easily refuse to cover, say, Norplant, or orthotics, but it's choosing to be an asshole about hearing aids instead.

In other words, it's a bitch, but it's not illegal, unfortunately.

Let me know if I can clarify anything or if you have other questions.
jnanacandra
Feb. 26th, 2002 03:51 pm (UTC)
Re: Follow-up
*sigh* oh well. but thanks for the info :)
( 3 comments — Leave a comment )

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