2024 Federal BCBS (Standard and Basic) Plans Now Require Prior Authorization

The Academy is aware of changes made to hearing aid coverage for certain federal employee (retired and active) Blue Cross Blue Shield (BCBS) Plans. As of January 1, 2024, for Standard and Basic Plans, hearing aids will require prior authorization and will not be covered with a post-service review. Blue Focus will continue to not cover hearing aids. For further details on this, see the Federal Employee Program Updates to Prior Authorization Requirements and Benefits | Blue Cross and Blue Shield of Illinois (bcbsil.com). 

Per BCBS guidance on the topic, coverage is predicated on pure-tone average (PTA) greater than 40 dB. Anecdotally, we have learned that some audiologists have been successful in receiving prior authorization for patients who do not meet the PTA by providing documentation as to why the PTA alone was not reflective of the patient’s hearing loss and/or completing a peer-to-peer review with BCBS. The above 40 dB PTA requirement appears to be applicable for new hearing aid users OR for patients for whom it has been 3-5 years since their last HA fitting.

The process to obtain prior authorization seems to be variable, including state-to-state. Pre-authorizations have been obtained through Availity and/or by faxing the pre-authorization form and supporting documentation to BCBS. 

The Academy has requested further clarity on this new policy, including better guidance about the process for obtaining pre-authorization, and also is pursuing reconsideration of greater than 40dB to meet medical necessity requirements for coverage. We will provide additional updates when available.