Cochlear Insurance question

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Condor1970

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I have question about insurance coverage for cochlear implants. My doctor said he will most likely be able to get the insurance to pay for my daughters implant because she is post-lingual, and only 14yo.

If insurance is known for paying for implants pretty commonly now, do they also pay for the sound processors as well?
 
should be the whole package. the implant device itself, the surgery, the processors. But double-check with your insurance to be sure.
 
Oh I definitely will. We are really hoping to get the regular Nucleus 6 for the right ear which is totally deaf.

Then, a Nucleus Hybrid for the left, which still has about 20% residual hearing, but she only has about 30% speech recognition at 80db, so the HA won't be good enough.
 
Condor1970 said:
Oh I definitely will. We are really hoping to get the regular Nucleus 6 for the right ear which is totally deaf.

Then, a Nucleus Hybrid for the left, which still has about 20% residual hearing, but she only has about 30% speech recognition at 80db, so the HA won't be good enough.
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Just a word of advice... you MAY want to get the totally deaf ear implanted, and then trial a super power aid, just to see how the combo works.....People respond very individually to that set up...On the other hand, the left was her hearing ear until recently right? And the right ear has never heard normally right? If so, I'd opt for bilateral implants......her right ear may not respond as well since it has never heard normally...and then the left ear would be the strong ear.......
 
Condor1970 said:
I have question about insurance coverage for cochlear implants. My doctor said he will most likely be able to get the insurance to pay for my daughters implant because she is post-lingual, and only 14yo.

If insurance is known for paying for implants pretty commonly now, do they also pay for the sound processors as well?
Click to expand...

I had just one ear done with the N5 about 2.5 years ago. Insurance paid for everything needed. I received a large suitcase full of equipment from Cochlear. I'm considering getting my other ear done next year with the N6.

Good luck to you and your daughter.
 
Yes, I asked about a high power HA for the left, so when we did the audiogram, he tuned his machine to work like a high power HA at various frequencies needed. At 80db, she had only 30% word recognition, and at 90db only 40% max. We are getting her a high power HA for temporary use while they do surgery on the right implant first. This will at least give her something better than nothing in the left ear for school.
If she responds well in the left ear with the loaner HA, then I may consider getting her one. However, considering her lack of speech recognition, the doctor is already assumnig we will need to do a Hybrid Cochlear in the left. There's just so much high frequency loss, that she is having a horrible time understanding people. My wife can practically yell her high pitch voice into her ear, and she doesn't hear it. But my voice is much deeper, so I am about the only one in the family who can talk to her.

So, essentially she will end up getting a Bilateral Implant, with regular N6 on the right, and the N6 Hybrid on the left.

My only concern at this point is to pray that the Insurance Co. will do their part, and the Surgeon does his. We got a good ENT with a good rep, so my family feels pretty positive about all this, so far. Especially considering how my daughter has had such a tough time dealing with her Sudden Hearing Loss in her only good ear.
 
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Condor, what I know right now is..
The doctor will write and submit a letter to the insurance company explaining the extent of her hearing loss, which is usually good to get the CI covered. The initial coverage will cover the surgery and the first set of cochlear processors. Any processors you need to purchase in the future depends on your insurance coverage as well as warranty. Cochlear will replace 1 time, free of charge/no questions asked, the processors if lost, stolen or damaged... after that it depends on you and your insurance. This is just what I am finding out as I am going throught the process now as I am planning to get CI myself. Best thing to do is see the doctore and let them contact the insurance companies as some denie approval to individuals but will approve it with the doctor as they are better informed through that letter as I did call my insurance and they said they would only pay $1000... but my doctor said the insurance company will pay 100% minus any deductables. Since they work with our insurance company they are familiar with it and states I will possibly only be $30 out of pocket.
 
^^^ Yes, I am assuming the same. I called my insurance and asked about HA and CI coverage. Of course, all I got was the standard agent on the phone who says my policy normally does not cover it, as stated in the policy. My assumption is as you said above. After her appointment yesterday, the Doctor said he will get authorization from the insurance company to do this, and I can't do much of anything. All I can do now, is wait for him to get back, and let us know for certain if we are pre-authorized, before actually scheduling her surgery.
 
Condor1970 said:
^^^ Yes, I am assuming the same. I called my insurance and asked about HA and CI coverage. Of course, all I got was the standard agent on the phone who says my policy normally does not cover it, as stated in the policy. My assumption is as you said above. After her appointment yesterday, the Doctor said he will get authorization from the insurance company to do this, and I can't do much of anything. All I can do now, is wait for him to get back, and let us know for certain if we are pre-authorized, before actually scheduling her surgery.
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You can get pre-authorized by anyone, including yourself... what you need to know is....if they will cover the costs and how much as well as what is your out of pocket responsibility...
Doc can say they have the go ahead, but what is your financial responsibility of that go ahead? get all the information before you say yes.
 
I've talked to a few people who could not get the hybrid covered by their insurance, even though it is FDA approved, it was still considered experimental. As someone that had similar speech scores, I wouldn't personally bother with the hybrid and look at other options for her with just straight CI's. I'd consider the Advanced Bionics implant over Cochlear.

As for insurance covering the implants, it's rare that they will not cover the surgery, equipment and mappings after the fact. How much you will owe depends on what your deductible and out of pocket costs are on your plan.
 
Do your research on Cochlear, Advance Bionics and Med-El, as they all have their own issues. Who has the better warranty, who has the most issues, who have better options/accessories...ect.. To each their own, I like some of the options of others but I like the warranty coverage the most...that makes a big plus in my decision as things are costly enough.
 
sonocativo said:
Do your research on Cochlear, Advance Bionics and Med-El, as they all have their own issues. Who has the better warranty, who has the most issues, who have better options/accessories...ect.. To each their own, I like some of the options of others but I like the warranty coverage the most...that makes a big plus in my decision as things are costly enough.
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The only real difference in warranties is with the external processor. Where the warranty gives out, insurance kicks in. Some would consider the opportunity to upgrade sooner to be a good thing. With the Naida 3 year warranty, that is likely because AB will have a more aggressive processor release schedule compared to competitors. In 3 years, if your processor goes out on you then you have a greater chance of getting insurance coverage for an entirely new processor.
 
Insurance for hybrid?

Hi Condor,

Just wondering if your insurance has said they would pay for the Hybrid for your daughter?

I'm just in the early stages - I meet the criteria for a hybrid/EAS - but have not met with the doctor to discuss further.

Glad to read your daughters surgery went well - you all must be pretty excited for this!

misty
 
BleedingPurist said:
The only real difference in warranties is with the external processor. Where the warranty gives out, insurance kicks in. Some would consider the opportunity to upgrade sooner to be a good thing. With the Naida 3 year warranty, that is likely because AB will have a more aggressive processor release schedule compared to competitors. In 3 years, if your processor goes out on you then you have a greater chance of getting insurance coverage for an entirely new processor.
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Medicare and most insurances consider v the life span of the processor to be 5 years. but standard warranty is 3 years. They are required to cover it for 5 years free of charge if your have medicare.
 
UPDATE:

As you all know, my daughter had surgery a couple weeks ago for her right ear. She got the Cochlear CI24RE contour advance implant, and will be getting the N6 processor. I got her a good hearing aid for her left, as the hybrid cochlear is not necessary. She has a Kirkland 5.0, which is basically a Resound Verso. I like this combo for her, because Cochlear has the best reliability record and warranty. Also, they both will pair with the TV streamer and phone clip for her to be able to hear with both ears.

INSURANCE UPDATE:

This all started months ago, so bear with me.

Ok, here's the jist of it. My insurance plan initially said it specifically DOES NOT cover cochlear implants. This is primarily because the majority of us on the policy are engineers who work around loud equipment, and noise induced hearing loss is considered part of the job that we accept as an occupational hazard. If they had to cover cochlear implants for this policy they would probably go bankrupt very quickly, which actually makes sense, since just about every older engineer I work with has some hearing loss. So, my doctor called and tried to file for an appeal. The insurance company said he cannot file for an appeal, because there is nothing to appeal, since there is no provision for coverage, and all appeals for cochlear implants are simply ignored.

I wasn't very satisfied with that. So, I called my Union rep through my job, and said I really needed to file for an appeal, and wanted for the higher ups in the company to at least consider her case.

Well, they pointed me in the right direction of who to talk to at the insurance companies trust office. My union technically couldn't really get involved, since they are supposed to be separate from the insurance trust, so I had to do this all on my own without their involvement.

I was then told by a nice gal at the claims office who handles all the odd cases to go ahead and fax her information on my my daughters case including any letters from the doctor, myself, and also my daughters school went to bat for her as well, and wrote up some very nice letters explaining the serious nature of her situation. Basically, I got everyone I could to bombard the insurance office with paper work. Seriously, I just wanted them to have absolutely everything I could think of, since I don't have over $100,000 to pay for a cochlear implant. No piggy banks for me to break into on this one. I figure, I have had this policy for 17 years, and have invested hundreds of thousands of dollars in premiums, with little to no use. I really was hoping they would make an exception. Especially since my policy is the Primary policy for my family.

Anyway, after they got everything, they actually called me and agreed to allow me to sit in on the Board of Trustees monthly meeting to discuss with them the case. I showed up thinking there would be lots of other people with appeals. I was the only one. I sat at a big giant oval table with a whole bunch of investors who are the ones who basically control all the money. And they all were looking at ME. Not the most comfortable scenario, I must say. My wife was so nervous, she could not speak, so she made me do everything. Ha.

So, I just layed it all out, and told them what was going on, and how important this was. They had a bunch of lawyers, a dictation transcriptionist, and also some cameras for other investors to watch the meeting from offices around the country. Including some major investor who was listening in on the meeting while driving in his car somewhere up in Alaska. Weird.

Anyway, after my little 5 minute presentation, they asked me a few questions, and I answered them truthfully and very straight forward. No B.S.

They made it clear to me that our insurance policy is a notarized legal document, and it specifically says they do not cover cochlear implants under any circumstances. The way it is, they cannot legally make exceptions, even if they wanted to. The only way they could provide coverage is if they actually rewrite the insurance policy to allow for coverage, get it written up, and legally notarized to do so. which of course is a HUGE deal.

Anyway, they said they may consider bringing up the subject of coverage for this at the annual Board of Trustees meeting, and if they see fit, then they may amend the policy for coverage. Basically, that told me not to hold my breathe.

Well, I waited until the end of February after their meeting. I got an official annual policy change letter in the mail telling me about all the policy amendments that are to be made for the year. This includes changes in coverage, dependents, etc. all the legal stuff. Well, there was nothing that talked about cochlear implants. So, I called the insurance office, and asked directly if they had any provisions written up for the 2015 year for coverage of cochlear implants. They did some research, called me back a day later, and said NO!!!

Well, not to be deterred, my wife and I kind of saw this coming, so we had actually signed up for additional insurance under her name from her job, and added my daughter to her policy a couple months earlier, hoping it would kick in quick enough to at least provide "SOME" coverage. Well, it did, but only a percentage. I could still see some pretty sizable bills coming my way. So much for the college fund. LOL.

Anyway, we scheduled her surgery, none the less, and figured whatever the outcome, my daughter needs this, and we will figure out how to pay the bills.


One week before her surgery.....

I get a call from MY insurance company saying that the Board of Trustees was very impressed by my presentation, and is very understanding of the need for minors to get cochlear implants who have suffered from Sudden Sensorineural Hearing Loss. For some reason, they decided to issue an amendment to the policy, and they literally stopped a court notarization proceeding in order to re-write the policy, and change it to cover minors to get coverage for cochlear implants. So, if you're an 80 year old retired engineer who is going deaf, well... you're probably not going to get CI coverage. Frankly, if I make it to 80, I'll simply be glad to be alive. I probably won't want to hear my wife nag me by then anyway. ;) Anyway, they called me to let me know one week before her surgery, that she is fully covered.

So, I went and had a nice whiskey, sat outside on my deck, cried tears of joy for a while, and thanked God.

In the end, my daughter ended up with DOUBLE coverage for her surgery and implant equipment. I have no idea what any extra bills I will need to pay, but I am very happy that I will probably not have to mortgage my house. The best part is, my insurance policy covers thousands of other people through my union, and since the policy has literally been amended to include everyone, they all get coverage now for there children, if they should ever need this. I am very happy I was able to make a bit of a difference.
 
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I'm glad the insurance worked out for you!!

For others that may find themselves in a similar situation, I would suggest getting a private plan for whomever needs the surgery, and then drop the plan when you are done. You will likely have to cover mapping appointments so keep the plan for a year because you will go fairly often during that year. You can sign up for a private plan through an insurance company any time during the year (I'm not talking about an exchange plan--those are different). Individual coverage isn't all that expensive, and WAY less expensive then covering a CI surgery.
 
I wish you all the best. I would encourage your whole family to start taking Sign Language classes too.
 
Glad it all worked out in your daughter's favor Condor! Glad they were willing to amend the policy for minors.
 
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