CI surgery cost and insurance

dragon_image18 · 03-14-2008, 02:42 PM

Hi,

I am just trying to compare the out of pocket cost for CI surgery based on insurance companies and get a feel for what my out of pocket expenses will be.

I have Kaiser for my daughter and they say they cover bilateral CI surgeries. They will cover 90% of the cost. They gave me an estimate of $60,000 for each implant, so a bilateral would be $120,000. My cost would come out to be $12,000.

"The total cost of the implant, including the device, hospital fees, surgical fees, and programming for the first year is approximately $60,000."

Is this normal for all insurance companies? Can anyone with Kaiser give me some insight?

Insurance companies tend to be flaky about telling you total cost so it is hard for me to get a straight answer out of them.

***VamPyroX*** · 03-14-2008, 02:57 PM

Every insurance company varies... depending on the coverage.

While we may give you different answers, you may also want to try contacting other insurance companies.

john57 · 03-14-2008, 03:25 PM

Quote:

Originally Posted by dragon_image18

Hi,

I am just trying to compare the out of pocket cost for CI surgery based on insurance companies and get a feel for what my out of pocket expenses will be.

I have Kaiser for my daughter and they say they cover bilateral CI surgeries. They will cover 90% of the cost. They gave me an estimate of $60,000 for each implant, so a bilateral would be $120,000. My cost would come out to be $12,000.

"The total cost of the implant, including the device, hospital fees, surgical fees, and programming for the first year is approximately $60,000."

Is this normal for all insurance companies? Can anyone with Kaiser give me some insight?

Insurance companies tend to be flaky about telling you total cost so it is hard for me to get a straight answer out of them.

Sounds like you like you have Kaiser coinsurance plan instead of the HMO plan
You may have a maximum out of pocket limit that might help you but you need to call them to see if that would apply in your situation. $60,000 sounds
typical including programming. I know there are many people like myself that costs were much higher due to other factors not commonly run into.

Drew's Dad · 03-14-2008, 04:18 PM

Our total "provider charges" for bilateral cochlear implant surgery were $155,000 and change.

dragon_image18 · 03-14-2008, 04:37 PM

Just got off the phone with Kaiser. They assured us that our Max out of pocket will be $1,500. This lifts a huge weight off our shoulders.

Looks like we will want to do both ears this year to take advantage of this.

deafdyke · 03-14-2008, 08:05 PM

Oh that's awesome that the co-pay isn't going to be too too expensive.
I'm not anti-CI at ALL, but is it pretty much a given that your daughter isn't benifiting from HAs AT ALL? Just b/c the benifit from bilateral CIs really isn't drasticly different......the only advantages are sound localization abilty (and a lot of folks who are too deaf to hear speech can at least localize sound with HA)
and abilty to hear well in noise (and a LOT of folks have trouble with that)
On the other hand...........if you wait, the insurance company might be "oh if she needs it so bad, then how come you didn't opt for it in the first place? (I really think that a lot of insurance companies are going to become a little stricter abt canidacy for implants and allowing bilateral implants in the next few years)

Drew's Dad · 03-14-2008, 08:27 PM

Quote:

Originally Posted by deafdyke

On the other hand...........if you wait, the insurance company might be "oh if she needs it so bad, then how come you didn't opt for it in the first place? (I really think that a lot of insurance companies are going to become a little stricter abt canidacy for implants and allowing bilateral implants in the next few years)

This is a very good point, because they do argue this frequently.

Your other point is a good one too, but I am going to guess that because her hearing loss is due to the Connexin-26 gene that they are about as certain as can be that the loss is definite, and that the cochlea is likely fully formed and a good possibility exists for full insertion of the electrode array (barring any other issues that I am sure they are investigating with other testing, and the eventual MRI or C/T scan).

If there is a good bit of hearing going on with aids, that certainly would affect the decision on bilateral v. single, along with anything that the MRI or C/T shows.

rick48 · 03-14-2008, 08:43 PM

Quote:

Originally Posted by dragon_image18

Just got off the phone with Kaiser. They assured us that our Max out of pocket will be $1,500. This lifts a huge weight off our shoulders.

Looks like we will want to do both ears this year to take advantage of this.

Great news and a good start to the weekend!

R2D2 · 03-14-2008, 08:47 PM

I think in the blog it says that Kairi is hearing at 90db aided with hearing aids. It's quite hit and miss as to whether people can do well with HAs with that kind of loss. It's great that they are trying them out though!

dragon_image18 · 03-14-2008, 10:18 PM

The doctors have ruled out the hearing aids. Her response is very minimal and only at or above 90db. Fortunately no one along the process has questioned her need for the CI. She has Connexin 26 and is in perfect health to be a candidate for the CI. Everyone we have worked with has been happy to make sure that we get the CI.

Also, we requested CI as soon as we were sure that the hearing aids were not working. We obviously didn't want to make her have a CI surgery if it was 100% necessary.

shel90 · 03-14-2008, 10:25 PM

Quote:

Originally Posted by dragon_image18

The doctors have ruled out the hearing aids. Her response is very minimal and only at or above 90db. Fortunately no one along the process has questioned her need for the CI. She has Connexin 26 and is in perfect health to be a candidate for the CI. Everyone we have worked with has been happy to make sure that we get the CI.

Also, we requested CI as soon as we were sure that the hearing aids were not working. We obviously didn't want to make her have a CI surgery if it was 100% necessary.

How long did she use the hearing aids before the doctors ruled them out?

The reason I asked is cuz I have Connexin 26 too and was born with a bilateral severe profound hearing loss of 120 dB but yet, I was able to make good use of my hearing aids despite my severe hearing loss. The doctors told my mom that it would take at least 3 years of trainign with HAs and they were right. It seems like doctors nowadays have different criteras?

Just curious what are the doctor's definition of success with hearing aids? I consider myself a success with my HAs and so many people have a hard time believing me but probably cuz my definition of success is different from theirs.

Just curious.

BTW...cute little girl!

deafdyke · 03-14-2008, 10:38 PM

Well I was just saying what I said b/c it can be very difficult to tell how well a baby can hear. But on the other hand, there's still a significent percentage of dhh kids who don't benifit from hearing aids. From what you say, it sounds like your daughter is one of those kids. Nothing wrong at all with implanting a kid who clearly doesn't benifit from HAs. And yes, R2D2 that's one of the reasons why I'm not all gung-ho about CI......HAs are very hit or miss....Every hearing loss is very indivdual. Just b/c one person with a profound loss doesn't benifit from HA, it doesn't mean that another person might.
It's too bad that there isn't an ABR that can tell you how well a baby or nonverbal kid hears with hearing aids.
It really does sound like you're doing the right thing!

shel90 · 03-14-2008, 10:42 PM

Quote:

Originally Posted by deafdyke

Well I was just saying what I said b/c it can be very difficult to tell how well a baby can hear. But on the other hand, there's still a significent percentage of dhh kids who don't benifit from hearing aids. From what you say, it sounds like your daughter is one of those kids. Nothing wrong at all with implanting a kid who clearly doesn't benifit from HAs. And yes, R2D2 that's one of the reasons why I'm not all gung-ho about CI......HAs are very hit or miss....Every hearing loss is very indivdual. Just b/c one person with a profound loss doesn't benifit from HA, it doesn't mean that another person might.
It's too bad that there isn't an ABR that can tell you how well a baby or nonverbal kid hears with hearing aids.
It really does sound like you're doing the right thing!

U are right about it being a hit or miss thing. Even with my 120 dB hearing loss in both ears, hearing aids were a huge hit for me but a huge miss for my brother with the exact same hearing loss. It is sooo weird, isnt it? That could be why CIs sometimes work for some and dont work for others

R2D2 · 03-14-2008, 10:57 PM

Quote:

Originally Posted by shel90

Just curious what are the doctor's definition of success with hearing aids? I consider myself a success with my HAs and so many people have a hard time believing me but probably cuz my definition of success is different from theirs.

Just curious.

Definition of success - probably the ablility to respond to speech and to hear speech in the "speech banana" range. Environmental sounds only would not be considered successful.

My nephew was similar to your brother - he did not respond to hearing aids either and eventually they gave up and took them off and he signed only. I have a theory that those of us at profound levels of deafness who did well with HAs are successful not because HAs alone made us successful but because we are very good at combining other skills e.g, lipreading, context, body language together with the limited audition from the HAs. However, alone with HAs I'd be completely lost. I noticed that back when I use to struggle with the phone, if I got the caller's name then everything seemed to fall into place because of context. But I had a lot of trouble understanding their name so it always remained a struggle until now.

Many people just don't have the skills to do things like that. We just are all different.

shel90 · 03-14-2008, 10:59 PM

Quote:

Originally Posted by R2D2

Definition of success - probably the ablility to respond to speech and to hear speech in the "speech banana" range. Environmental sounds only would not be considered successful.

My nephew was similar to your brother - he did not respond to hearing aids either and eventually they gave up and took them off and he signed only. I have a theory that those of us at profound levels of deafness who did well with HAs are successful not because HAs alone made us successful but because we are very good at combining other skills e.g, lipreading, context, body language together with the limited audition from the HAs. However, alone with HAs I'd be completely lost. I noticed that back when I use to struggle with the phone, if I got the caller's name then everything seemed to fall into place because of context. But I had a lot of trouble understanding their name so it always remained a struggle until now.

Many people just don't have the skills to do things like that. We just are all different.

Geez, those doctors really define the term success for all of us? Man..no wonder.

Thanks.

jag · 03-15-2008, 05:34 AM

Quote:

Originally Posted by deafdyke

Well I was just saying what I said b/c it can be very difficult to tell how well a baby can hear. But on the other hand, there's still a significent percentage of dhh kids who don't benifit from hearing aids. From what you say, it sounds like your daughter is one of those kids. Nothing wrong at all with implanting a kid who clearly doesn't benifit from HAs. And yes, R2D2 that's one of the reasons why I'm not all gung-ho about CI......HAs are very hit or miss....Every hearing loss is very indivdual. Just b/c one person with a profound loss doesn't benifit from HA, it doesn't mean that another person might.
It's too bad that there isn't an ABR that can tell you how well a baby or nonverbal kid hears with hearing aids.
It really does sound like you're doing the right thing!

You know, I really don't get it when people have this thing about a profoundly deaf baby/child getting 'some' benefit from HA's.

Has your life in the mainstream environment been so great because you had benefit from the HA's, because you were able to lip read well enough to make sense of 'some' of what was heard through your heaing aides? I got 'decent' benefit from HA's and life was ok. But as time went on I found out how awful struggling with 'decent' benefit is as the hearing got worse. I never liked the HA's. They were to loud. My mind could not adjust to the loudness of every little bitty sound. You know what? with the technology in todays' implants I can now actually wear a hearing device and hear and understand quite well and not have to turn it down because of all the excess noise.

With today's better technology why should a profoundly deaf child have to struggle with miminal results and the stresses of having to speech read just because they got 'some' benefit from a normal HA? (notice I'm leaving those little ones with severe hearing loss out of this and when I was implanted I was in the lower severe range)

Why not let them get the CI, the worst that could happen is they would still have to struggle as they would have had to do with a HA. We'll have to agree to disagree. Hearing aides aren't all that they're cracked up to be.

vallee · 03-15-2008, 07:25 AM

Quote:

Originally Posted by dragon_image18

Just got off the phone with Kaiser. They assured us that our Max out of pocket will be $1,500. This lifts a huge weight off our shoulders.

Looks like we will want to do both ears this year to take advantage of this.

That is great news. My insurance was about the same. My out of pocket was 1300. Another point to ask your insurance about is - since you met your out of pocket cost, the rest of the year the insurance should pay 100% of everything from audie visits to other doctor appointments.

When making arrangements for payments, you have to arrange separated payments for the doctor and hositpal. Mine has been fantastic. I worked out payments very low.

vallee · 03-15-2008, 07:31 AM

Quote:

Originally Posted by Drew's Dad

Our total "provider charges" for bilateral cochlear implant surgery were $155,000 and change.

That was the range of my cost as well. Do children tend to have an easier time getting approval for CIs? My insurance fight was so stressful. I am thankful I did it just wish others didn't have too.

I have a questions for other with CIs, when you order parts for your CIs, do you contact the company, insurance, or your audie? I am not sure of how to do it.

AB users how long will the batteries last before you replace them - a year, less or more?

john57 · 03-15-2008, 12:25 PM

It can depend on the insurance policy you have. If you have Kaiser you can just call or send a a E-mail to your audie when you need a part replaced under warranty or if you need batteries. You may have a DME(durable medical equipment) rider on your policy that could offset some of the costs of supplies. Some other insurance companies may have a preferred provider for supplies that you must deal with in order to get any payment from the insurance companies.

Bear · 03-15-2008, 07:55 PM

Quote:

Originally Posted by vallee

That was the range of my cost as well. Do children tend to have an easier time getting approval for CIs? My insurance fight was so stressful. I am thankful I did it just wish others didn't have too.

I have a questions for other with CIs, when you order parts for your CIs, do you contact the company, insurance, or your audie? I am not sure of how to do it.

AB users how long will the batteries last before you replace them - a year, less or more?

I am an AB user and have had my batteries for a year. I seem to recall the audie telling me that they last up to 3 years before needing replacements. But I can tell you I have my implant done Sept of 2006 and actived in Sept same year and my batteries are still going strong over a year later.

Sceptre71 · 03-15-2008, 09:07 PM

What happens if the devices you need to wear,after the CI surgery,breaks down,gets damaged or etc?
How much are those to replace?Does insurance cover those?
I would imagine theyre very expensive.

sr171soars · 03-15-2008, 10:00 PM

Quote:

Originally Posted by Sceptre71

What happens if the devices you need to wear,after the CI surgery,breaks down,gets damaged or etc?
How much are those to replace?Does insurance cover those?
I would imagine theyre very expensive.

Good questions!

You are right the external device is expensive. I believe they are ~ $6,000.

For the internal device, I think it was at least ten years and it could be lifetime but I just can't recall. If it has to be replaced, Cochlear takes care of that.

For the external device, if with Cochlear, it will be three years manufacturer's warranty. After that, one can either get the company's extended warranty plan or get a third party. I am looking at that within the next year. I will probably opt for a third party just to cover the processor and controller. The rest I will handle via flex spending. Since I have two CIs since one is a backup, I will only get coverage on one and store the other except in emergencies to minimize my costs.

As far as I know, insurance doesn't get involved at least not in NC.

john57 · 03-16-2008, 01:41 AM

in addition Cochlear has a first time lost replacement during the first three years of the manufacturer's warranty.

03-14-2008, 02:42 PM	#1 (permalink)
dragon_image18 Registered User Join Date: Mar 2008 Location: Hillsboro, OR Posts: 22	CI surgery cost and insurance Hi, I am just trying to compare the out of pocket cost for CI surgery based on insurance companies and get a feel for what my out of pocket expenses will be. I have Kaiser for my daughter and they say they cover bilateral CI surgeries. They will cover 90% of the cost. They gave me an estimate of $60,000 for each implant, so a bilateral would be $120,000. My cost would come out to be $12,000. "The total cost of the implant, including the device, hospital fees, surgical fees, and programming for the first year is approximately $60,000." Is this normal for all insurance companies? Can anyone with Kaiser give me some insight? Insurance companies tend to be flaky about telling you total cost so it is hard for me to get a straight answer out of them. __________________ Kairi's Blog

03-14-2008, 02:57 PM	#2 (permalink)
*VamPyroX* bloody phreak from hell Join Date: Feb 2003 Location: Hell Posts: 27,867	Every insurance company varies... depending on the coverage. While we may give you different answers, you may also want to try contacting other insurance companies. __________________ Check out my city... CLICK HERE! (If you already visited yesterday, visit again today!)

03-14-2008, 04:18 PM	#4 (permalink)
Drew's Dad Drew Activated 6/28/2007 Join Date: Mar 2007 Posts: 225	Our total "provider charges" for bilateral cochlear implant surgery were $155,000 and change. __________________ Drew received simultaneous, bilateral cochlear implants at 8 months of age. Read his story here! Visit Drew on Facebook! Send Love and Start A Home Business - Send Cards with SendOutCards

03-14-2008, 04:37 PM	#5 (permalink)
dragon_image18 Registered User Join Date: Mar 2008 Location: Hillsboro, OR Posts: 22	Just got off the phone with Kaiser. They assured us that our Max out of pocket will be $1,500. This lifts a huge weight off our shoulders. Looks like we will want to do both ears this year to take advantage of this. __________________ Kairi's Blog

03-14-2008, 08:47 PM	#9 (permalink)
R2D2 Retired from All Deaf! Join Date: Dec 2005 Location: Australia Posts: 2,606	I think in the blog it says that Kairi is hearing at 90db aided with hearing aids. It's quite hit and miss as to whether people can do well with HAs with that kind of loss. It's great that they are trying them out though! __________________ Left ear implanted 9th June 2006 Activated 29th June 2006 Right ear implanted 31st August 2007 Activated 18th September Both Nucleus Freedom Cochlear implant myths

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03-14-2008, 08:05 PM	#6 (permalink)
deafdyke So NOT a Princess! Join Date: Mar 2003 Location: Trebekistan Posts: 6,685	Oh that's awesome that the co-pay isn't going to be too too expensive. I'm not anti-CI at ALL, but is it pretty much a given that your daughter isn't benifiting from HAs AT ALL? Just b/c the benifit from bilateral CIs really isn't drasticly different......the only advantages are sound localization abilty (and a lot of folks who are too deaf to hear speech can at least localize sound with HA) and abilty to hear well in noise (and a LOT of folks have trouble with that) On the other hand...........if you wait, the insurance company might be "oh if she needs it so bad, then how come you didn't opt for it in the first place? (I really think that a lot of insurance companies are going to become a little stricter abt canidacy for implants and allowing bilateral implants in the next few years)

03-14-2008, 10:18 PM	#10 (permalink)
dragon_image18 Registered User Join Date: Mar 2008 Location: Hillsboro, OR Posts: 22	The doctors have ruled out the hearing aids. Her response is very minimal and only at or above 90db. Fortunately no one along the process has questioned her need for the CI. She has Connexin 26 and is in perfect health to be a candidate for the CI. Everyone we have worked with has been happy to make sure that we get the CI. Also, we requested CI as soon as we were sure that the hearing aids were not working. We obviously didn't want to make her have a CI surgery if it was 100% necessary. __________________ Kairi's Blog

03-14-2008, 10:38 PM	#12 (permalink)
deafdyke So NOT a Princess! Join Date: Mar 2003 Location: Trebekistan Posts: 6,685	Well I was just saying what I said b/c it can be very difficult to tell how well a baby can hear. But on the other hand, there's still a significent percentage of dhh kids who don't benifit from hearing aids. From what you say, it sounds like your daughter is one of those kids. Nothing wrong at all with implanting a kid who clearly doesn't benifit from HAs. And yes, R2D2 that's one of the reasons why I'm not all gung-ho about CI......HAs are very hit or miss....Every hearing loss is very indivdual. Just b/c one person with a profound loss doesn't benifit from HA, it doesn't mean that another person might. It's too bad that there isn't an ABR that can tell you how well a baby or nonverbal kid hears with hearing aids. It really does sound like you're doing the right thing!

03-15-2008, 12:25 PM	#19 (permalink)
john57 Registered User Join Date: Jul 2007 Location: Colorado Posts: 155	It can depend on the insurance policy you have. If you have Kaiser you can just call or send a a E-mail to your audie when you need a part replaced under warranty or if you need batteries. You may have a DME(durable medical equipment) rider on your policy that could offset some of the costs of supplies. Some other insurance companies may have a preferred provider for supplies that you must deal with in order to get any payment from the insurance companies.

03-15-2008, 09:07 PM	#21 (permalink)
Sceptre71 Registered User Join Date: Mar 2008 Location: Kentucky Posts: 28	What happens if the devices you need to wear,after the CI surgery,breaks down,gets damaged or etc? How much are those to replace?Does insurance cover those? I would imagine theyre very expensive.

03-16-2008, 01:41 AM	#23 (permalink)
john57 Registered User Join Date: Jul 2007 Location: Colorado Posts: 155	in addition Cochlear has a first time lost replacement during the first three years of the manufacturer's warranty.

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