Michael Moore's Movie "Sicko" Raises Concerns about Insurance Issues

Hear Again said:
Jillio,

I agree. :) I also have strong opinions about insurance companies. I know a deafblind CI user who has Usher's and can't get a second CI because Medicare won't cover it. He's been trying to find funding for the past 6 years. I was fortunate enough to have Medicaid cover my bilateral. However, my audi told me that if it were not for the fact that I had Medicaid coverage, I would not have received a second CI.
Click to expand...

Yeah, I find it objectionalbe when the ability to receive any form of health care is based on income, and subsequently, insurance benefits. If CI is a procedure made available to some who qualify for implantation and wish to be implanted, then it should be available to all.
 
R2D2 said:
That's interesting. I've enjoyed some of Michael Moore's past movies (like bowling for Collumbine) and I'm sure that he'd have a lot to say about insurers! It must be very hard for people in the US who don't have any or adequate health insurance and I believe the number of people in that category is quite significant.
Click to expand...

The last statistics I saw were obtained by a sociology professor I know. Those statistic found that 52% of Americans to not have adequate health care coverage, and of that 52%, over 40% was completely uninsured. It is truly a sad state of affairs.
 
Hear Again said:
deafdyke,

When I asked my CI audi about body aids, she told me they weren't available here in the U.S. and that if one needed repair, it would need to be sent to Europe. From what I understand, Lloyd's is the only place you can purchase a body aid online:

Order Body Aid Hearing Aids Online with LloydHearingAid.com

As far as frequency transpositional aids are concerned, I also asked my audi about them and was told that it can take some time for people to adjust to them and that the adjustment isn't always an easy one to make. If truth be told, I wanted to try frequency transpositional aids before opting for a CI, but my CI audi explained that the adjustment process would be too difficult for me as a totally blind person (especially in regards to being able to interpret environmental sounds like traffic).
Click to expand...

I find the audi's comments a bit paradoxical. CI also requires some time for adjustment, and the adjustment is not always an easy, nor a successful one.
 
Some deaf organizations in Ontario, Canada are making claims that 97% of deaf and HoH children from the age of 0 to 5 are implanted.

Yes, 97%
 
So what's the criteria for implanting the children at Canadian hospitals? Can the Canadian Deaf organizations back up this assertion? 97 percent seems rather high especially when you consider that the majority of deaf and HOH children benefit from hearing aids thus they don't qualify for CIs.

According to the Canadian Audiology site, CI canidacy appears to be similar to the American criteria. I guess the criteria is too lax in the USA as well. As far as I can tell the criteria for Canadian candidacy hasn't changed.
 
jillio said:
I find the audi's comments a bit paradoxical. CI also requires some time for adjustment, and the adjustment is not always an easy, nor a successful one.
Click to expand...

Jillio,

I agree with you. However, my audi thought my chances for success with a CI were quite good given the fact I've had over 20 years of auditory memory. Aside from that, I doubt Medicaid or Medicare would have paid for transpositional aids.

In regards to my own impressions about my possible success with a CI, I was a little worried about the fact that I would be unable to rely on visual clues to help me understand what I was hearing with my CI. Interestingly enough, I found the transition to be easier than I thought.

My audi and I had a discussion several months after my first CI was activated in which she asked me what I attributed my success to. We both agreed that my blindness played a positive role for several reasons:

1.) All I had to rely on was the input I received from my CI.

2.) I couldn't rely on lipreading or other visual clues to help me understand what I was hearing with my CI.

3.) As someone who was born blind, I already knew how to use my hearing for mobility and activities of daily living, so learning how to hear with my CI came naturally.
 
Last edited:
Banjo said:
Some deaf organizations in Ontario, Canada are making claims that 97% of deaf and HoH children from the age of 0 to 5 are implanted.

Yes, 97%
Click to expand...

I reckon 97% of profoundly deaf children only, sounds about right. I've heard in Australia that it's about 90% of profoundly deaf children. This probably reflects upon the fact that 90%+ parents of deaf children are hearing.

HOH children would not be implanted in socialised medical settings as the emphasis is on budget contraints and value for money. Since hoh people get similar results in hearing aids at lower hearing losses there would be no strong argument to implant them medically.
 
jillio said:
The last statistics I saw were obtained by a sociology professor I know. Those statistic found that 52% of Americans to not have adequate health care coverage, and of that 52%, over 40% was completely uninsured. It is truly a sad state of affairs.
Click to expand...

Wow that is not good. I hope Moore's movie improves the awareness of this situation and the will to do something about it. :(
 
Actually no. I want to correct that. I think that there is a population which is buying into the hype about CIs. I don't think EVERYONE is buying into that. But there does seem to be a population that sees the CI as the latest "gotta have" technology. Like I remmy from DeafNotes a mom with twin boys who had profound losses and were good aid users, who got implanted! She did say that the surgeon who implanted her boys said that he was now implanting a lot of people with lots of residual hearing. I know of a guy on a list who can hear 80% with aids, and still is looking into implantation.
I think that implantation centers should have uniform criteria for implantation. As it is now, it does seem like you can almost "shop" for a doctor to implant you based on kind of arbitrary guidelines. Also, as everyone knows response to hearing technology is VERY indivdualistic. I'm 100% a-OK with implanting people who get really poor speech perception with hearing aids.....Like people who get below 40%-45% speech perception with powerful aids, shouldn't be hassled if they want to opt for implantation. Same goes with people with severe recruitment, or tintiutas. However since response to hearing technology is so indivdualistic, I really think that its worth it for people with significent residual hearing to experiment and play around with different technologies before taking the plunge for CI
However it's very hard to tell. I remmmy an article at Hearing Exchange a few years ago that said that only a small percentage of those eligable for implantation, HAD been implanted.
I still think they should tighten eligbilty a bit, just so only those who really really need it (and that's including those with a lot of residual hearing, but who don't have good speech perception with aids) can get implanted.
I think too that they might be becoming a little more strinigent b/c it may seem that costs are spiraling out of control.
 
deafdyke said:
Actually no. I want to correct that. I think that there is a population which is buying into the hype about CIs. I don't think EVERYONE is buying into that. But there does seem to be a population that sees the CI as the latest "gotta have" technology. Like I remmy from DeafNotes a mom with twin boys who had profound losses and were good aid users, who got implanted! She did say that the surgeon who implanted her boys said that he was now implanting a lot of people with lots of residual hearing. I know of a guy on a list who can hear 80% with aids, and still is looking into implantation.
I think that implantation centers should have uniform criteria for implantation. As it is now, it does seem like you can almost "shop" for a doctor to implant you based on kind of arbitrary guidelines. Also, as everyone knows response to hearing technology is VERY indivdualistic. I'm 100% a-OK with implanting people who get really poor speech perception with hearing aids.....Like people who get below 40%-45% speech perception with powerful aids, shouldn't be hassled if they want to opt for implantation. Same goes with people with severe recruitment, or tintiutas. However since response to hearing technology is so indivdualistic, I really think that its worth it for people with significent residual hearing to experiment and play around with different technologies before taking the plunge for CI
However it's very hard to tell. I remmmy an article at Hearing Exchange a few years ago that said that only a small percentage of those eligable for implantation, HAD been implanted.
I still think they should tighten eligbilty a bit, just so only those who really really need it (and that's including those with a lot of residual hearing, but who don't have good speech perception with aids) can get implanted.
I think too that they might be becoming a little more strinigent b/c it may seem that costs are spiraling out of control.
Click to expand...


I remember reading somewhere that a CI center had to close due to spiraling costs.
 
I heard that one of the CI centers in Portland Oregon will be closing soon -- if it hasn't already.

I know some smaller CI centers tend to have a high turnover rate for audis. Even large CI centers like the one I attend only perform 6-7 CIs per year -- a much smaller number than I would have expected.

My CI audi told me hospitals lose a significant amount of money with each CI that is performed. Additionally, CI centers lose money when they accept CI candidates with Medicaid coverage since Medicaid only pays 15%-20% of the total cost of surgery.
 
Insurance companies rarely approve anything outside of FDA criteria for implantation without a very large fight. So someone with 80 % with aids is going to have a hard time getting an insurance company to pay for his surgery, unless he can write a very large check himself, he is not going to get the surgery

Only 8 % of the people who are eligible for CIs in the US actually have them. I have never seen this # published anywhere, but it is quite easy to calculate -- 500,000 qualify under FDA guidelines, but only 40,000 Americans have been implanted.

Sheri

deafdyke said:
Actually no. I want to correct that. I think that there is a population which is buying into the hype about CIs. I don't think EVERYONE is buying into that. But there does seem to be a population that sees the CI as the latest "gotta have" technology. Like I remmy from DeafNotes a mom with twin boys who had profound losses and were good aid users, who got implanted! She did say that the surgeon who implanted her boys said that he was now implanting a lot of people with lots of residual hearing. I know of a guy on a list who can hear 80% with aids, and still is looking into implantation.
I think that implantation centers should have uniform criteria for implantation. As it is now, it does seem like you can almost "shop" for a doctor to implant you based on kind of arbitrary guidelines. Also, as everyone knows response to hearing technology is VERY indivdualistic. I'm 100% a-OK with implanting people who get really poor speech perception with hearing aids.....Like people who get below 40%-45% speech perception with powerful aids, shouldn't be hassled if they want to opt for implantation. Same goes with people with severe recruitment, or tintiutas. However since response to hearing technology is so indivdualistic, I really think that its worth it for people with significent residual hearing to experiment and play around with different technologies before taking the plunge for CI
However it's very hard to tell. I remmmy an article at Hearing Exchange a few years ago that said that only a small percentage of those eligable for implantation, HAD been implanted.
I still think they should tighten eligbilty a bit, just so only those who really really need it (and that's including those with a lot of residual hearing, but who don't have good speech perception with aids) can get implanted.
I think too that they might be becoming a little more strinigent b/c it may seem that costs are spiraling out of control.
Click to expand...
 
Both of these are true. I heard about the center in Portland, there is a second one in Georgia that I know shut down because they were losing something on the order of $20,000 every time they did an implant surgery due to extremely low Medicaid/Medicare reimbursement.

In addition, there are states where you just can't get a cochlear implant because of the cost of setting up a center where one doesn't exist. People in Wyoming go to Colorado or Utah, people in Montana go to Seattle, people in New Orleans are going to Dallas or Birmingham because they just haven't been able to get audiology services fully functioning again after Katrina. I've also heard that Hawaii doesn't have a resident CI surgeon, one flies over from HEI in Los Angeles once a month to do specialized otology surgery including CIs.

Sheri

Hear Again said:
I heard that one of the CI centers in Portland Oregon will be closing soon -- if it hasn't already.

I know some smaller CI centers tend to have a high turnover rate for audis. Even large CI centers like the one I attend only perform 6-7 CIs per year -- a much smaller number than I would have expected.

My CI audi told me hospitals lose a significant amount of money with each CI that is performed. Additionally, CI centers lose money when they accept CI candidates with Medicaid coverage since Medicaid only pays 15%-20% of the total cost of surgery.
Click to expand...
 
I think it is 97 % of the children who are candidates are implanted in Ontario. The had some extremely interesting study results which were presented in the CI conference in Charlotte last April regarding the differences between simultaneous bilateral implantation and sequential bilateral implantation

Binaural processing in children using bilateral co...[Neuroreport. 2007] - PubMed Result

Sheri

Banjo said:
Some deaf organizations in Ontario, Canada are making claims that 97% of deaf and HoH children from the age of 0 to 5 are implanted.

Yes, 97%
Click to expand...
 
On the hearing aid issue, I agree with you. If I had a child with a 70 dB bilateral hearing loss, and my options were buying a $6000 pair of hearing aids every four years that weren't reimbursed that I couldn't afford (which means my child might not get any treatment at all) and surgery which the state (if I didn't have private insurance) or my private insurance would pay for, I might lean more towards the surgery solution because that might be the only financially viable solution available to me.

Unfortunately, the track record for insurers covering hearing aids is downright awful. This poll is about 6 years out of date, but I haven't seen any improvement, and if anything, things have gotten worse

Hearing Aid Insurance Poll

35 % of responders were either doing without aids or doing with worse aids than they needed because of lack of funding, and only 15 % had full coverage from private insurance.

BTW, the cost of covering a CI for every person who gets one annually works out to less than $1.25 per insured American per year. It really is a "low incidence" surgery, despite the high cost.

Sheri

deafdyke said:
On the other hand Sherri, I do think that if insurance companies covered HAs just as they did with CI, they might see a small downturn in implantations, and thus costs. Back in the old days it was really cost effective for insurance companies to cover CI b/c only a small percentage of deaf folks benifited from it. So the costs could be absorbed relatively easily. But now that more and more people are trying to get implanted, the costs are rising. I do think some people are beleieving the hype. Like I've heard of kids who get a lot of benifit from HA, being evaluated for CI! (which is INSANE) I have to say that there are too many people who think "Oh its the latest technology! I GOTTA have it!"
Its good that you're fighting for the ones who REALLY need it. There IS a population which really honestly needs bilateral implantation. Bilateral implantation is still relatively new, and the population that NEEDS it, is relatively small.
Click to expand...
 
It is my personal position that anyone who qualifies for one implant under the strict interpretation of FDA criteria, should qualify for two. Therefore, my answer is that anyone who wants a second one should get a second one, unless there is some significant reason why they don't qualify on the second side -- ossification, severe cochlear malformation, absent 8th nerve, etc. "Too much residual hearing" wouldn't be a valid reason -- if they have *that* much residual hearing on the unimplanted side, they shouldn't have qualified for implantation on the first side under FDA criteria to begin with.

Most insurance companies I am working with right now are using audiograms with CI alone and CI+HA results to determine whether or not the second side is "medically necessary" If the CI+HA open set speech recognition results really aren't any better than CI alone, then the HA isn't adding much (if anything) and the second CI is warranted. None of the insurance companies I have convinced to cover bilateral implantation are squawking about doing simultaneous bilaterals in children over 12 months with 90 dB losses or greater, or adults with sudden severe-profound bilateral loss -- it actually saves them about $22K in surgery and rehabilitation costs when they approve simultaneous bilaterals over sequential bilaterals.

Early results from the study from Toronto I cited in an earlier response shows that simultaneous bilateral implantation has advantages over sequential bilateral cochlear implantation. Other studies additionally state that the optimum gap between sequential bilateral implantation surgeries is less than eight years, but I know at least two patients who've had 15+ years between the two implant surgeries and gotten really good results on the second side. These are both individuals who received their first implant at a relatively early age and have much better technology on the second side.

Besides the standard arguments about being able to localize sound and the 7 dB improvement in S/N ratio for hearing speech in noise, bilateral implantation means never having to guess which ear is better. Several studies have clearly shown that ENTs have no reliable criteria in most cases for determining which is the better ear to do the initial implant in -- it does not depend on etiology, which ear had more residual hearing, or whether the person is left or right handed (assuming that the ear that was implanted matches their dominant hand).

Keep in mind, I'm just the lawyer for our advocacy program, not the person making the final determination about who qualifies for a second implant and who doesn't for our clinic.

Sheri

deafskeptic said:
By what criteria do you think that that people should get bilaterals, DD and LTHFAdvocate? I'm interested in your input from both of you. If I recall correctly only a few deaf people can get implanted yet you maintain that the criteria is too lax, DD.
Click to expand...
 
Too much residual hearing" wouldn't be a valid reason -- if they have *that* much residual hearing on the unimplanted side, they shouldn't have qualified for implantation on the first side under FDA criteria to begin with.
Click to expand...
On the other hand Sheri, what about cases where the person has a "dead" ear, but gets a lot of benifit being aided on the other side?
Do you think there might be a bit of a downturn in implantation, if insurance cos covered hearing aids?
I'm totally not against it. In fact I am VERY supportive of them in the right circumstances.... but I do think that the "gotta have latest technology" group,
I really think that bilateral CIs are probaly going to remain relatively rare. After all, relatively few Americans have really really superb insurance that covers bilateral implantation. Also a lot of people tend to have uneven losses or whatever. I know too that its very indivdualistic....there are people who LOVE the HA/CI combo, and then there are people who love CI/CI combo. Hell, there are even people who still love plain ol' analog aids!
Good on you for pointing out that its 97% of canidates. Not all dhh kids are eligable for implantation, and in countries with socialized medience it's very difficult to qualify off the bat.
 
I for one an very happy to have the latest 'trendy' technology. It's 1000x's better then the HA's that should have benedfited me alot more then they did. I hope that many people can take advantage of the latest 'trendy' technology, even if only on one side of the head. I'm happy that my dr's persued the 'trendy' technology for me and I heard 69% in the nice quiet booth on sentence recognition before implantation.

There's alot to be said about the 'trendy' technologies advantage over the HA's. Why would I want to use a cumbersome body aide (which was never offered and which I'd concider a PITA) or powerful HA that only created distorted sound over the 'trendy' technology which gives me clarity of speech, those who stuggle with their HA"s and hearing/speking 'thinking' they are getting great benefit from the HA's won't "know' what they are missing without getting the 'trendy' new technology.

To me being hoh with a CI is much better then being hoh with a HA. I'll take the new 'trendy' technology any day.
 
Back
Top