Insurance caps


I’m curious if anyone else has experienced a similar insurance hell that I’m currently trying to navigate. I have BCBS of TX, yet live in MI. I purchased Quattro’s in December, insurance was billed 6500, I paid 4000 out of pocket and was told I would be reimbursed after insurance covers whatever it is they will cover. My BCBS of TX benefit supposedly covered 7000 for two hearing aids every 3 years. This is where the problem comes in. BCBS of MI apparently caps hearing aid coverage at 2500 for two hearing aids. Again, I have BCBS of TX, yet live in MI. I’ve been fighting with Accolade, a contract company BCBS employs to handle their membership claims with no real help. I’ve now finally reached someone higher in my company that coordinates member benefits to see if they can help figure out a solution to my problem. I’m not sure if BCBS of MI actually supersedes my TX benefit, or if my benefit is only good in TX, or if maybe I’ll have to drive to OH to exercise my full benefit. Next week I’ll be downgrading my Quattro 9’s to something more affordable while this insurance debacle continues to drive me closer to insanity. Has anyone had a similar insurance problem, and/or any insurance problems they were successful in overcoming?

Another frustrating part of this problem, I had knee surgery in 2018 so all of my deductible and co-insurance responsibilities were covered in 2018, which means these hearing aids technically should’ve been completely covered with no out of pocket expense. If I’m forced to change providers and start a completely new purchase, say in OH to exercise my full benefits(?), I’m going to have to pay my 2019 deductible and co-insurance again, which will probably total around $2000 for the latest and greatest hearing aids. ugh!

If I can never access my full 7000 benefit, I’m now trying to figure out if I should just skip the latest tech and insurance headaches and just head to Costco. If I stick with my current audiologist (and BCBS MI cap) and downgrade to Quattro 7’s I’ll be out of pocket 2700 yet Costco hearing aids would be around 2500. I can’t believe there’s a huge difference between Costco’s top resound HA and the Quattro 7’s. My audiologist is extremely nice and accommodating, but the conversations I’ve had with Costco have also been great. Think Costco’s warranty is also 4 years instead of 3 with audiologist. ugh!!!



I moved out of Texas and was told that my insurance that I purchased while living in Texas as no good and it was canceled on us. And I have never had insurance that would pay a dime for hearing aids or even hearing test



I am SOOO counting my blessings right now!



Good luck to you my friend…

BCBS has decided to arbitrarily put a value on hearing aids for the benefit of their own bottom line. I absolutely detest BCBS. They are by far the worst to deal with where hearing aid claims are concerned, and completely misrepresent what the coverage is to the subscribers, and when we call to get verification. It is the biggest insurer in the nation squabbling over pennies. They suck.


  1. As far as resolving insurance issues: The only way I’ve had any success is to dig into what the policy says. Either that or get a lawyer to do it for you, but that could get expensive. 2)I’d probably just go to Costco,


Sorry for your insurance issues. I have BCBS in North Carolina. I am in FL but my employer is headquartered in NC. Anyway any time I have ever called them to ask what my benefit is for hearing aids I am told it is zip, nada, too bad so sad.
I know different employers can contract for different plans, and apparently yours at least has a plan with some level of benefit.
I’m about to start a trial on some Phonak M90s. But if I buy it’s all on me. $6400. This is why my current aids are 10 years old.
I know this doesn’t help you, but count your blessings and keep working with them. If your insurance is through your employer get them involved. They should have folks trained to advocate for you.



As for having exhausted your deductible so you can take advantage of the hearing aids being covered without the deductible, I was in a similar situation in 2016 when I exhausted my deductible toward the end of the year and figured it was time to take advantage of the situation of spring for a new pair of premium hearing aids,.

My HDHP insurance covers 95% of the hearing costs after my deductibles if I went with in-network providers but only 70% for out-of-network providers. There’s no cap on how much I can spend, but there’s a clause that says the price has to be reasonable.

So I bought a pair of OPN 1 for $6,200 and paid $300 (my 5%) and my audi billed my insurance company for the rest. Although my audi was not an in-network provider, she agreed to bill me only 5% as if she was in-network. to keep my business. Then she’ll accept whatever the insurance company is willing to pay her, hopefully the 70% of the bill, which was $4340. In the end my insurance only agreed to pay her $3400 (55%) but she accepted it anyway.

It was a little gut wrenching to me because this happened in December and if my audi wouldn’t accept what the insurance had to pay, I’d have to return the hearing aids to her and find an in-network provider last minute before my exhausted deductible expires by year end and I wasn’t sure if there was enough time or not.