Miss-Delectable
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Palo Alto Daily News
Sheri Byrne-Haber has a winning streak any lawyer would envy.
Since she launched a program in 2004 challenging health insurers' denials of a device that allows the deaf to hear, the East Palo Alto-based attorney has won every one of the 325 cases now completed. Hundreds more appeals are in the works, and the odds aren't in the insurance companies' favor.
When she and her clients prevail, however, Byrne-Haber noted they don't get a dime in reparation. All her clients get is the ability to hear.
"When we win, all we win are medical services," said Byrne-Haber, director of the insurance-advocacy program for the Let Them Hear Foundation in East Palo Alto. She and her legal team represent, at no charge, not just foundation patients, but hearing-impaired individuals nationwide denied treatment by their insurers.
She pioneered a unique approach in the world of health care advocacy: saber-rattling at insurers, threatening class-action lawsuits unless they cover the only means for restoring hearing for the deaf or severely hearing-impaired, called cochlear implants. Many of her clients are children, and she took up the mantle of challenging insurers after facing repeated obstacles years ago in securing treatment coverage for her hearing-impaired daughter, now 16.
"(Byrne-Haber) has been a pivotal person in changing the whole mindset of the insurance companies to support cochlear implants for children," said Kathy Sussman, executive director for the Jean Weingarten Peninsula Oral School for the Deaf in Redwood City.
The surgically implanted devices restore some hearing, even in the deaf. When put in early enough -- optimally between the sixth and 18th month of life -- children typically learn to speak and can carry on conversations. They often enter the mainstream educational system.
Since Byrne-Haber founded the program at the Let Them Hear Foundation, four out of five of the nation's largest insurers began covering cochlear implantation for both ears, called bilateral implants. The most recent policy change came from Aetna, which on Oct. 19 announced it would cover the dual procedure.
Wins by the Let Them Hear Foundation advocacy program resulted in the expansion of cochlear implants coverage in the insurance plans for more than 158 million people, according to Byrne-Haber.
For Dr. Laurie Naiman, a 75-year-old retired Palo Alto physician, the advocacy work of the foundation may soon close the book on his two-decade saga of hearing loss.
"I maybe heard 20 or 30 percent of what was said to me," Naiman said.
In 2004, after his audiologist suggested a cochlear implant, he received insurance approval for one in his right ear, which was implanted that year.
But Naiman was still nearly deaf in his left ear. When he requested a cochlear implant for that ear, his insurer, Blue Shield of California, on three occasions denied it.
And three times, Byrne-Haber and her team appealed the decisions, citing numerous benefits of the dual devices.
An Aetna spokeswoman, Rachelle Cunningham, said the insurer decided in October to cover bilateral cochlear implants after reviewing new clinical evidence of its effectiveness.
But Byrne-Haber believes Aetna's decision to cover the dual implants followed her threat to issue a class action lawsuit, after she and her staff of three lawyers won 28 consecutive appeals of Aetna's denial of bilateral cochlear implants.
Following a tactic she has used with the other insurers, Byrne-Haber based the threatened lawsuit against Aetna on allegations of fraud for denying the treatment, since the insurer consistently approved it following appeals.
"I know she'd like to take credit," Cunningham responded. But Aetna's decision, Cunningham stated, was based solely on an assessment on the dual implants from the Institute of Hearing Research.
"If Aetna's change in policy wasn't a result of our threatened lawsuit, then it is an extreme coincidence in timing," Byrne-Haber said, noting that the decision came weeks after Byrne-Haber warned Aetna of the pending litigation, and three months before its long-scheduled policy review in January 2008.
And with Naiman's surgery date looming, Byrne-Haber called Blue Shield on Tuesday, warning the insurer of an upcoming news article describing Naiman's inability to secure insurance coverage for his second implant. His surgery has been scheduled for months for today.
On Wednesday, she said, the Blue Shield authorized the surgery. Elise Anderson, a Blue Shield spokeswoman, said due to medical privacy laws, she couldn't discuss the reasons why the insurer approved it on Wednesday.
Byrne-Haber was ebullient over the authorization, and she cited her own hunch for the reasons behind the last-minute approval.
"Blue Shield personnel told me that the approval had nothing to do with the pending negative publicity," she said. "But once again, you can't help thinking that the timing is suspiciously coincident."
Naiman was equally ebullient over the approval, calling the timing "pretty close."
He also expressed his relief at securing Byrne-Haber's representation.
"I would never have thought to appeal it," Naimin said. "Most people think these policies are written in stone."
Too bad she doesn't help people fight insurance companies for hearing aids coverage.
Sheri Byrne-Haber has a winning streak any lawyer would envy.
Since she launched a program in 2004 challenging health insurers' denials of a device that allows the deaf to hear, the East Palo Alto-based attorney has won every one of the 325 cases now completed. Hundreds more appeals are in the works, and the odds aren't in the insurance companies' favor.
When she and her clients prevail, however, Byrne-Haber noted they don't get a dime in reparation. All her clients get is the ability to hear.
"When we win, all we win are medical services," said Byrne-Haber, director of the insurance-advocacy program for the Let Them Hear Foundation in East Palo Alto. She and her legal team represent, at no charge, not just foundation patients, but hearing-impaired individuals nationwide denied treatment by their insurers.
She pioneered a unique approach in the world of health care advocacy: saber-rattling at insurers, threatening class-action lawsuits unless they cover the only means for restoring hearing for the deaf or severely hearing-impaired, called cochlear implants. Many of her clients are children, and she took up the mantle of challenging insurers after facing repeated obstacles years ago in securing treatment coverage for her hearing-impaired daughter, now 16.
"(Byrne-Haber) has been a pivotal person in changing the whole mindset of the insurance companies to support cochlear implants for children," said Kathy Sussman, executive director for the Jean Weingarten Peninsula Oral School for the Deaf in Redwood City.
The surgically implanted devices restore some hearing, even in the deaf. When put in early enough -- optimally between the sixth and 18th month of life -- children typically learn to speak and can carry on conversations. They often enter the mainstream educational system.
Since Byrne-Haber founded the program at the Let Them Hear Foundation, four out of five of the nation's largest insurers began covering cochlear implantation for both ears, called bilateral implants. The most recent policy change came from Aetna, which on Oct. 19 announced it would cover the dual procedure.
Wins by the Let Them Hear Foundation advocacy program resulted in the expansion of cochlear implants coverage in the insurance plans for more than 158 million people, according to Byrne-Haber.
For Dr. Laurie Naiman, a 75-year-old retired Palo Alto physician, the advocacy work of the foundation may soon close the book on his two-decade saga of hearing loss.
"I maybe heard 20 or 30 percent of what was said to me," Naiman said.
In 2004, after his audiologist suggested a cochlear implant, he received insurance approval for one in his right ear, which was implanted that year.
But Naiman was still nearly deaf in his left ear. When he requested a cochlear implant for that ear, his insurer, Blue Shield of California, on three occasions denied it.
And three times, Byrne-Haber and her team appealed the decisions, citing numerous benefits of the dual devices.
An Aetna spokeswoman, Rachelle Cunningham, said the insurer decided in October to cover bilateral cochlear implants after reviewing new clinical evidence of its effectiveness.
But Byrne-Haber believes Aetna's decision to cover the dual implants followed her threat to issue a class action lawsuit, after she and her staff of three lawyers won 28 consecutive appeals of Aetna's denial of bilateral cochlear implants.
Following a tactic she has used with the other insurers, Byrne-Haber based the threatened lawsuit against Aetna on allegations of fraud for denying the treatment, since the insurer consistently approved it following appeals.
"I know she'd like to take credit," Cunningham responded. But Aetna's decision, Cunningham stated, was based solely on an assessment on the dual implants from the Institute of Hearing Research.
"If Aetna's change in policy wasn't a result of our threatened lawsuit, then it is an extreme coincidence in timing," Byrne-Haber said, noting that the decision came weeks after Byrne-Haber warned Aetna of the pending litigation, and three months before its long-scheduled policy review in January 2008.
And with Naiman's surgery date looming, Byrne-Haber called Blue Shield on Tuesday, warning the insurer of an upcoming news article describing Naiman's inability to secure insurance coverage for his second implant. His surgery has been scheduled for months for today.
On Wednesday, she said, the Blue Shield authorized the surgery. Elise Anderson, a Blue Shield spokeswoman, said due to medical privacy laws, she couldn't discuss the reasons why the insurer approved it on Wednesday.
Byrne-Haber was ebullient over the authorization, and she cited her own hunch for the reasons behind the last-minute approval.
"Blue Shield personnel told me that the approval had nothing to do with the pending negative publicity," she said. "But once again, you can't help thinking that the timing is suspiciously coincident."
Naiman was equally ebullient over the approval, calling the timing "pretty close."
He also expressed his relief at securing Byrne-Haber's representation.
"I would never have thought to appeal it," Naimin said. "Most people think these policies are written in stone."
Too bad she doesn't help people fight insurance companies for hearing aids coverage.
