Hearing impairment is a reduction in the ability to perceive sound. Hearing impairments can vary from slight to profound and are generally classified as conductive hearing loss, sensorineural hearing loss or mixed hearing loss.

DELAWARE MANDATE (18 Del. C. §3357; 18 Del. C. §3571A): Effective Date: 2009   

(b) Every individual health insurance contract, including each policy or contract issued by a health service corporation, which is delivered, issued for delivery, or renewed in this State on or after January 1, 2009, shall provide coverage of up to $ 1000 per individual hearing aid, per ear, every 3 years, for children less than 24 years of age, covered as a dependent by the policy holder.

Hearing Aids

Prescribed U.S. Food and Drug Administration (FDA)-approved hearing aids are eligible for payment (per the FDA, hearing aids marketed for use by the general public should have FDA approval). Any hearing aid that is not FDA approved will be denied as non-covered.

Assistive Listening Devices

Assistive listening devices are used to improve speech intelligibility by reducing the degrading effects of distance and background noise. These devices are functionally similar to a personal sound amplifier system. These devices do not replace the function of the middle ear, cochlea or auditory nerve.  Therefore, they are not considered as prosthetic devices and are non-covered.

Middle Ear Implant

Bone Anchored Hearing Devices (BAHA), may be considered medically necessary as prosthetic devices when the following indications and criteria are met:

The BAHA is indicated for conductive or mixed hearing loss. This includes at least ONE of the following:

• Congenital or surgically induced malformation (e.g., atresia) of the external ear, ear canal, or middle ear, or
• Infection of the ear canal resulting in chronic draining ears, or
• Fixation of the ossicles (middle ear bones), or
• Single sided deafness due to: (allow stimulation of the functioning cochlea)
  • Viral infections; or
  • Meniere’s Disease; or
  • Trauma; or
  • Measles; or
  • Sudden deafness; or
  • Acoustic Neuroma; or
  • Tumors of the external canal and/or tympanic cavity; or
  • Dermatitis of the external canal; or
  • Severe chronic external otitis or otitis media, and
• There must be a functioning cochlea or cranial nerve VIII for the BAHA to work; and
• The following audiologic criteria must be met:
  • A pure tone average (PTA)  bone-conduction threshold measured at 0.5, 1, 2, and 3 kHz of better than or equal to 45 dB (OBC and BP100 devices), 55 dB (Intenso device) or 65 dB (Cordele II device).

For bilateral implantation, patients should meet the above audiologic criteria, and have a symmetrically conductive or mixed hearing loss as defined by a difference between left and right side bone conduction threshold of less than 10 dB on average measured at 0.5, 1, 2 and 3 kHz, or less than 15 dB at individual frequencies.

One (1) headband per year may be considered medically necessary. More than one (1) headband per year will be denied as not medically necessary.

Quantity level limits or quantity of supplies that exceed the frequency guidelines listed on the policy will be denied as not medically necessary.

BAHA for any other indication than listed above is considered not medically necessary.

An implantable bone-conduction (bone-anchored) hearing aid may be considered medically necessary:

• As an alternative to an air-conduction CROS hearing aid in patients 5 years of age and older with single-sided sensorineural deafness and normal hearing in the other ear; and
• The pure tone average air conduction threshold of the normal ear should be better than 20 dB measured at 0.5, 1, 2, and 3 kHz.

Other uses of bone-conduction (bone-anchored) hearing aids, including use in patients with bilateral sensorineural hearing loss, are considered experimental/investigational and, therefore, non-covered because the safety and and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Partially implantable magnetic bone-conduction hearing systems using magnetic coupling for acoustic transmission (e.g., Otomag Alpha 1 and BAHA Attract) are considered experimental/investigational and, therefore, non-covered because the safety and and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Auditory Brainstem Implant

Unilateral use of an auditory brainstem implant (using surface electrodes on the cochlear nuclei) may be considered medically necessary in patients with neurofibromatosis type II, 12 years of age or older, who are rendered deaf due to bilateral resection of neurofibromas of the auditory nerve. 

An auditory brainstem implant is considered experimental/investigational, and, therefore, non-covered for any other condition than listed above, including non-neurofibromatosis type 2 indications because the safety and and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Bilateral use of an auditory brainstem implant is considered experimental/investigational, and, therefore, non-covered because the safety and and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

One (1) headband per year may be considered medically necessary. More than one (1) headband per year will be denied as not medically necessary.

Processor replacement may be considered medically necessary one (1) per five (5) years. Processor replacement greater than one (1) per five (5) years will be denied as not medically necessary. 

Quantity level limits or quantities of supplies that exceed the frequency guidelines listed on the policy will be denied as not medically necessary.

Audiological Testing

Audiological testing is eligible as a diagnostic procedure, when not screening in nature.

Audiological testing performed without a physician evaluation and an order for thetesting are deemed to be screening in nature, and is considered not medically necessary.

Aural Rehabilitation

An audiologist performs the primary evaluation of the status of an aural rehabilitation program under the direction of physicians or speech-language pathologists within their scope of practice.

The speech-language pathologist is typically responsible for evaluating the client’s receptive and expressive communication skills and providing the services to anchor improvement.