What Audiologists Need to Know About Blue Cross Blue Shield Wyoming Hearing Aid Prior Authorization Issues

July 9, 2024

Starting in January 2024, the Blue Cross Blue Shield Federal Employee Program (BCBS FEP) started requiring prior authorization for all air-conduction hearing aids. The process for prior authorization was left up to each individual BCBS company to determine and manage. Because each BCBS company has developed a different process and requires different information for authorization, providers must go to their local BCBS company for information on prior authorization.

Issues With Denials and Prior Authorization Processes

This month, ASHA members began reporting denials of prior authorizations for air-conduction hearing aids from Blue Cross Blue Shield Wyoming (BCBSWY). BCBSWY is requiring audiologists to list a U.S. Food and Drug Administration (FDA) 510(k) number on their authorization request. The requirement is listed on the BCBSWY website.

According to FDA regulations, both legacy non-wireless air-conduction hearing aid devices (21CFR874.3300) and wireless air-conduction hearing aid devices (21CFR874.3305) are exempt from the premarket notification process, which includes obtaining a 510(k) number. Since these devices are exempt from premarket notifications, audiologists are unable to provide a 510(k) number for authorization, making it impossible to receive approval for air-conduction hearing aids through BCBSWY under its current requirements.

What ASHA Is Doing

ASHA has asked BCBSWY to remove this requirement, citing the regulations and offering alternative options. Common practice is to submit the name and model of the hearing aid and the name of the manufacturer on an authorization request along with the prescription from an audiologist. ASHA is awaiting a reply from BCBSWY to determine whether it will change its requirements and how it will handle the denied claims.

Resources

Questions?

If you have questions or are experiencing issues with the prior authorization process at your local BCBS company, please contact ASHA’s health care and education policy team at reimbursement@asha.org.