Is Ear Molding covered by Insurance?
By Nicholas Bastidas
Many patients call our NYC and Long island offices asking if ear molding is covered by insurance? The answer is mostly yes and “it depends”. The majority of insurance carriers recognize ear deformities as congenital problems and therefore will likely cover the cost associated with the procedure. Most do not even require what’s known as pre-determination, which is approval prior to undergoing the procedure.
Examples of insurances that cover ear molding are: Aetna, BCBS, Cigna, Fidelis, UHC, Healthfirst, Affinity, Magnacare, Northwell-direct and Oxford.
What we find to be most important in obtaining coverage is having your baby placed on your insurance within the first 30 days of life. As long as your baby is on the plan by then your insurance will accept our submitted CPT codes. Usually this requires sending the birth certificate to the insurance company. You do not need to wait for the baby to be on the plan before beginning ear molding. Best results are obtained within the first 3 weeks of life and you should not delay the treatment. Some patients may be asked to sign a waiver, which basically dictates that if you don’t put the baby on the plan in 30 days, then you may be responsible for paying for the cost of ear molding.
Also it is important that your doctor is IN-NETWORK with your insurance company. Many doctors who do ear molding are out-of-network but claim to “participate” or “will work” with your insurance. If the insurance company denies it you may be on the hook for thousands of dollars. In addition, if covered – you may be responsible for your out of network deductible which may end up costing you a small fortune. It’s always better to confirm with your doctor is they are in-network or par with your particular insurance plan.
In some some cases I find that some insurance companies will want to see pictures prior to giving approval. For these insurance companies often we will arrange a telehealth visit and have you send photos so we can help expedite the approval process without delaying your child’s ear molding treatment. Once approved we can arrange to have you seen at either our Manhattan or Nassau county office where we can immediately place the ear molds, often the same day. Insurance also covers the followup visits which are usually 2 weeks from he day that we place the ear molds.
If you have any questions please contact us or call to schedule an appointment
516-497-7900
