Application For a Bone Conduction Hearing Device

If you or a loved one is in need of a bone conduction hearing device/(BAHA), please submit the following information to Ear Community for consideration:

ALL information that is required below must be complete in order to be considered for the application process.
*  In order to be considered for this application process, the candidate must have Microtia and Atresia.

1.  Submit a letter (four to five paragraphs in length) about the child or adult (applicant) in need explaining why help is needed to obtain a bone conduction hearing device.
2.  Please include the applicant’s mailing address, phone number, and e-mail address at the bottom of your letter.
3.  Please include a picture of the applicant.
4.  Please indicate which ear is in need of a hearing device (Right, Left, or both)?
5.  Does the applicant currently wear a hearing device?  If so, please indicate which model and brand?  Is a soft band head band required?
6.  Do you currently see an audiologist?  If so, please provide your audiologist’s name and contact information?
7.  If you have insurance coverage, but have been denied insurance coverage for obtaining a (BAHA), please include a copy of the denial letter from your insurance provider.  Please also provide proof of income showing economic hardship.
8.  If you do not have insurance coverage and can not afford to purchase a (BAHA) out of pocket, please provide proof of economic hardship (a state document showing your income) and explain why you can not afford to purchase a bone conduction hearing device.  Families applying must truly be needy with low incomes and proof of low income.

*  Incomplete applications will not be considered.  If your application is incomplete and not considered, you may reapply the next calendar year.  Applications that are mailed that are short on postage will not be accepted from the post office.  

Mail the above information post marked to:

Heidi Jeffs
C/o:  Ear Community, Inc.
Hearing Device Applicant
517 14th Avenue North
Nampa, ID  83687
USA

*  While Ear Community is able to help many applicants in need, not all applicants can be selected due to the large number of applications being received.

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