Diagnosis: Hearing Loss
Treatment: Increase in hearing aids and dispensing fees

The insurer denied increase in hearing aids and dispensing fees. The denial is overturned.

The patient is a female with a history of multiple medical problems including glaucoma, tinnitus, thoracic aortic ectasia, mitral valve insufficiency, chronic pain, osteoarthritis, bronchiectasis, and hearing loss for at least 5 years. Audiogram performed demonstrated severe sensorineural hearing loss. She had been previously been wearing hearing aid amplification. She underwent an evaluation with an Audiologist who recommended binaural hearing aid amplification. The health plan has denied coverage for an additional hearing aid. The subject under review is the medical necessity for increase in hearing aid and associated dispensing fees.

The health plan's determination is overturned.

The requested increase in hearing aid and dispensing fees is medically necessary for this patient. Binaural hearing aid amplification is necessary for this patient.

Based on the available records, for patients with bilateral sensorineural hearing loss, it is always in the best interest of the patient to use binaural hearing aid amplification for optimal benefit to improve hearing. There is improved speech intelligibility, improved perceived sound quality, and decreased effort for understanding speech with using binaural versus monaural hearing aid amplification.