Anthem Denied Hearing Aids? Here's How to Appeal

Anthem, the Elevance Health company administering Blue Cross Blue Shield plans in 14 states, routinely denies hearing aid coverage for adults — and the reason is straightforward: most commercial health insurance plans, including many Anthem plans, explicitly exclude hearing aids for adults as a standard benefit. But that doesn't mean your denial is final. Pediatric mandates, plan-specific riders, medical necessity arguments, and state law protections may give you a real path to appeal.

Why Insurers Deny Hearing Aid Claims

The most common denial reason is a plan exclusion. Hearing aids for adults are not required as an essential health benefit under the Affordable Care Act, and many Anthem employer-sponsored plans explicitly exclude them. If your Summary Plan Description lists hearing aids as non-covered, you're starting from a difficult position — but not an impossible one.

For children, the situation is more favorable. The ACA's pediatric essential health benefit requirements include hearing services, and most states where Anthem operates have enacted pediatric hearing aid mandates requiring coverage for children. Anthem's denial of hearing aids for a covered child is more likely a claim error or documentation failure than a legitimate coverage decision — and it is highly appealable.

Even for adults, Anthem denials sometimes rest on grounds beyond a flat exclusion. Anthem's Coverage Policy Bulletin (CPB) on hearing devices distinguishes between conventional hearing aids (typically excluded under most commercial plans) and surgically implanted devices. Cochlear implants are covered under Anthem's medical benefit — not the hearing benefit — and require Prior Authorization Denied: How to Appeal" class="auto-link">prior authorization based on candidacy criteria: documented profound bilateral sensorineural hearing loss, poor word recognition scores (typically below 50% in the ear to be implanted), and evaluation by a cochlear implant center. Bone-anchored hearing aids (BAHAs) are also covered as durable medical equipment under specific criteria.

Anthem may also deny based on the type of device selected, a finding that the device exceeds the plan's allowable benefit, or missing audiological documentation. ICD-10 codes relevant to hearing loss include H90.3 (sensorineural hearing loss, bilateral), H91.90 (unspecified hearing loss), and H90.6 (mixed conductive and sensorineural hearing loss, bilateral).

How to Appeal

Step 1: Review Your Denial Letter and Plan Documents

Identify whether Anthem denied based on a plan exclusion, medical necessity, or criteria failure. Request Anthem's Coverage Policy Bulletin for hearing devices at anthem.com/provider/policies and the specific clinical criteria applied to your case.

Step 2: Identify the Correct Benefit Category

Cochlear implants and BAHAs appeal under Anthem's medical benefit, not the hearing benefit. Conventional hearing aids appeal under the hearing benefit or a plan rider. Misrouting your appeal to the wrong department is a common reason for second denials.

Step 3: File a First-Level Internal Appeal Within 180 Days

For pediatric denials, cite the applicable state mandate and attach your child's audiologist's documentation. For cochlear implant denials, submit audiology evaluations and ENT candidacy documentation that meets Anthem's CPB criteria directly. Under ERISA (29 U.S.C. § 1133), you have the right to a full and fair review of any adverse benefit determination.

Step 4: Obtain Comprehensive Audiological Documentation

Your audiologist's report should include: pure-tone audiogram with air and bone conduction thresholds, speech discrimination and word recognition scores, functional impact assessment, and clinical rationale for the specific device recommended. Vague reports that don't use Anthem's criterion language are the single most common reason otherwise valid appeals fail.

Step 5: Request Expedited Review for Children

When hearing loss is affecting speech development and educational outcomes, request expedited review. Under the ACA (42 U.S.C. § 300gg-19), insurers must process urgent appeals within 72 hours. Pediatric hearing loss impairing language acquisition qualifies as an urgent situation.

Step 6: File a Second-Level Internal Appeal If Denied

Request a reviewer with audiology or ENT specialty experience. Under ERISA, you have the right to know the credentials of the reviewing clinician — if the reviewer is not a hearing specialist, document this for your External Independent Review: Complete Guide" class="auto-link">external review submission.

What to Include in Your Appeal

• Complete audiological evaluation including pure-tone audiogram, speech discrimination scores, and functional impact on daily activities
• Audiologist's or ENT's letter of medical necessity explaining why the specific device is clinically required
• For children: documentation of impact on speech development, language acquisition, and educational performance, plus citation of the applicable state pediatric hearing aid mandate
• For cochlear implant appeals: documentation meeting Anthem's candidacy criteria — profound bilateral hearing loss, poor word recognition scores below 50%, ENT or cochlear implant center evaluation
• ICD-10 codes for the hearing diagnosis and any comorbid conditions that create urgency (cognitive decline, cardiovascular effects of hearing loss)

Fight Back With ClaimBack

A hearing aid denial from Anthem feels final — but it rarely is, especially for children. Pediatric hearing aid mandates exist in every state where Anthem operates, and denials that violate those mandates are among the most straightforward to overturn. Even adult cochlear implant and BAHA denials can be successfully challenged when documentation clearly supports candidacy. ClaimBack generates a professional appeal letter in 3 minutes, referencing Anthem's CPB criteria and your state's specific legal protections. Start your free claim analysis → Free analysis · No credit card required · Takes 3 minutes

Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal