Cochlear Implant
Healthcare considers cochlear implants a medically necessary prosthetic for adults aged 18 years and older with bilateral sensorineural hearing impairment who meet both of the following criteria:
Member has bilateral severe to profound sensorineural hearing loss determined by a pure tone average of 70 dB or greater at 500 Hz, 1000 Hz, and 2000 Hz; and Member has limited benefit from appropriately fitted binaural hearing aids. Limited benefit from amplification is defined by test scores of 40 percent correct or less in best-aided listening condition on open-set sentence discrimination (e.g., CID sentences, Hearing in Noise Test sentences (HINT)).
Healthcare considers cochlear implants a medically necessary prosthetic for children 12 to 18 months of age or older (use of Clarion is covered in children 18 months of age or older, and use of Nucleus is covered in children 12 months of age or older) with bilateral sensorineural hearing impairment who meet all of the following criteria:
Child has profound, bilateral sensorineural hearing loss with thresholds of 90 dB or greater at 1000 Hz; and Child has limited benefit from appropriately fitted binaural hearing aids. For children 5 years of age or younger, limited benefit is defined as lack of progress in the development of simple auditory skills in conjunction with appropriate amplification and participation in intensive aural habilitation over a 3 to 6 month period. For children older than 5 years of age, limited benefit is defined as less than 20 percent correct on open-set sentence discrimination (e.g., Multi-syllabic Lexical Neighborhood Test (MLNT) or Lexical Neighborhood Test (LNT), depending on the child's cognitive ability and linguistic skills); and A 3- to 6-month hearing aid trial has been undertaken by a child without previous experience with hearing aids. Note: When there is radiological evidence of cochlear ossification, this requirement may be waived at Aetna's discretion.
The following additional medical necessity criteria must also be met for coverage of cochlear implants in adults and children:
The member must have no medical contraindications to cochlear implantation (e.g., cochlear aplasia, active middle ear infection); and
The member must have had an assessment by an audiologist and from an otolaryngologist experienced in this procedure indicating the likelihood of success with this device; and Candidates must be enrolled in an educational program that supports listening and speaking with aided hearing; and
Arrangements for appropriate follow-up care including the long-term speech therapy required to take full advantage of this device, must be assured. (Note: Particular plans may place limits on benefits for speech therapy services. Please consult plan documents for details.)
of course I am still learning like Wendy is 
due the IL, NJ, and SD states are hard to get approve.. I decline one of them due the rule is not apply to them. So hope that information I just gave you example is good enough. I could find the rules from your wal mart's health insurance if the information is open public. I will tell you the next advice you can do before you waste your time.
