Wednesday, August 27, 2008

Denied

We are on quite the journey! I prepared myself that we would probably have to file an appeal with our health insurance to cover simultaneous bilateral cochlear implants. I did not, however, think that they wouldn't even cover one! I have a plan. I know what we need to do, and will do it. She will have her surgery on September 26th and they will cover both of them that day. I will fight, I will advocate.

What I don't understand is the justification for denying the coverage: Sensorinueral hearing loss is not a medical condition. As for the simultaneous bilateral portion, that is because they claim that the treatment is not consistent with published clinical evidence. Bilateral CIs are unproven.

Not a medical condition? I just don't understand!

12 comments:

Laurie said...

Oh no! Sounds like you are not giving up! I would contact your doctor to advocate you. If you are going with Cochlear, they also have an excellent advocate program. Also, contact the "Let Them Hear Foundation" and they will be glad to give you advice and advocate for you as well.

Your insurance company needs to be educated. . . it's a matter of finding the right person to talk to that knows and understands this procedure!

Will think good thoughts for you!

leahlefler said...

I know there are letters and research posted on the listen-up.org website (and I'm sure yahoo's CI Circle has more) for bilateral effectiveness. Let Them Hear Foundation has some points to argue with insurance companies at

http://advocacy.letthemhear.org/ci-simultaneous-bilat.php

I wish you luck in your insurance fight!

Melanie said...

You go, strong mommy!

We were denied bilaterals the first time too. Have your CI audi send the insurance co a letter from the FDA stating the safety of bilaterals, and some of the MANY peer reviewed statistically valid articles on the efficacy of bilaterals. Our surgeon called the medical director of our insurance company too- maybe yours would? My husband and I also wrote a letter to the insurance co.

You surely have the right attitude-now you have to rally your team to advocate for Courtney.

Landon's Mom said...

Good luck and don't give up!! There is plenty of research on the internet proving the benefits of bilateral implants. It's also cheaper for them - one surgery, anesthesia, etc. I can't believe they wouldn't even approve one. Does it say anything in your policy about them? I have heard of a few people who were denied because the person looking at the request thought they were just hearing aids which are commonly not covered. You've definitely got the right attitude - don't accept no!

britni said...

I don't know what to say other than you guys are in our prayers! We love you and hope Miss Courtney gets the treatments she needs! Oh, can you tell Jeremy to quit growing! Kindergarten....really?! I feel so old! I love his little nervous, but excited grin too...too cute!

Lisa said...

I hate insurance companies. They don't know who they are picking a fight with. I'm glad some of your buddies have some good ideas for you and Bryan. I know some ins companies just deny out of hand, in the off chance you won't fight. I know you'll win this one. Go get 'em!

Dustin, Heather and Gavin said...

Hello
Kohler Family!
Insurance companies are A JOKE!!
With Gavin they wouldn't cover hearing aids because the Insurance company consider them to be COSMETIC! Like hearing aids are so cool and everyone is wearing them! I laughed at the lady who told me that! Then I asked her about the implant she told me they only cover one. She then told me her reason why they only cover one. She told me well you only need one ear to hear! I said excuse me! I asked her Do you like both of your ears? Cause personally I love both of mine! She then said Well u can petition if u like and told me how to do it! Which I will be fighting for the another implant if you learn any tips let me know.

I when to church that very next Sunday and was talking to a gentlemen who has a docoate of audiolgy and now he is a lawyer. I told him what my insurance company told me about the implant and hearing aids. He said you know Heather I'm so glad I wont be the only one burning in heck because of my career the insurance companies with be there right with me.
If they keep denying Keep your head up and keep Fighting them!! There are too many kids that go without getting the proper medial attention and technology that they need to hear with! It's because it is too expensive out of pocket! I dont know very many familes who can just fork out $6,000.00 on hearing aids and $80,000.00 One Cochlear Implant Sugery.

I'm in the same boat as you right now trying to figure out how to get the next implant paid for.

God Bless! I have a few resources you might be interested in? Let me Know
Dustin, Heather, and Gavin Frost

Mikki said...

Hi there! I am so sorry about the denial! But if you are anything like me as a mother you will do anything and everything to make this happen. Stay strong and confident! Stay ahead of the game! Don't give up! His surgery will happen! I will be praying for you guys!

Drew's Mom said...

Hi, I just found your blog through a couple of others...

My son Drew was implanted with simultaneous implant in June of last year. He will be two in September.

Please let us know if there is anything we can do to help. We have Anthem/BCBS of VA that approved his surgery. The EOB is on our blog.

Keep fighting - there are many, many companies that are now covering these, it just might take a bit of a fight. Our surgeon was able to talk over the phone with the doctor doing the medical review and after 15 minutes it was approved. Doing both implants in one surgery is actually much less expensive than two.

Best of luck!

Bill and Shelly said...

Keeping fighting. I would ask your doctor to contact the insurance company. While we did not have a fight with our insurance company, I know many who have and having the doctor talk to them made all the difference. Our doctor was ready to fight for us, if the need arose.
Best of luck and we look forward to hearing that the surgery is done and your daughter is well on her way to hearing.
Keep up the good work for your daughter.

Gma Donna said...

Oh Sweetie...I'm not sure if you are getting this but don't give up. I truly want to help. Just let me know how!!! I'm on it immediately!!! I promise. My heart breaks for baby Courtney. I just simply don't understand how she can be denied from the insurance. MAKES NO SENSE AT ALL! Again, please let me know what I can do to help. May God be with all of you.

Mikki said...

Our UHC plan covers CI's. We did not have any trouble getting Sophie's approval. We are only getting one done now. So we did not have to push for bilateral immediately. Are yall covered through you or your husbands benefits or an individual plan? I have UHC thru work and it is a 80/20 plan. It amazes me that some people can get approvals almost immediately and some are still waiting years to get theirs. I will be praying for you guys! Hang in there!!!