rockin'robin
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JACKSONVILLE, Fla. -- Five-year-old Antonio Sarnelli, wearing his Santa hat, is ready for Christmas. But his parents say Antonio's wish list is not made up of toys; he wants a cochlear implant.
"This is what Antonio asked for Christmas. He said 'Pappy I want a second ear;' we are praying that he will receive that," said Emanuele Sarnelli.
Antonio is a typical 5-year-old, but he is deaf. Sarnelli said his son had a reaction to childhood vaccines and developed a series of ear infections that caused him to lose his hearing.
"We did not know he was deaf; for 2 1/2 years he was diagnosed as autistic," he said.
Tests would reveal it was a misdiagnosis.
"They found instead that Antonio was profoundly deaf in both ears," said his father.
Uninsured, the family and their doctors turned to Florida Medicaid for help. "They made us jump through a bunch of hoops to prove it was medically necessary," he added.
In 2009 Antonio had surgery to have a cochlear implant placed in one ear and his world changed. "It is like day and night," said Sarnelli.
Antonio is so excited about his ability to hear; his mother said he refuses to remove it at nights. "He does not want to take the implant off, first thing he wakes up and that's what he wants," said Forinda Sarnelli.
The family said Antonio's doctor wants him to have a second ear implant for clarity, balance and speech development. Sarnelli said they presented the evidence to their HMO, United Health care and it was denied, then they filed for a 'Fair Hearing ' with Medicaid and it was denied again. Why?
"They said they're only required to cover one implant," he said.
Sarnelli said the device would give his 5-year-old a better chance in a world where hearing is taken for granted. "We're not asking for anything else or anything above what the boy needs which is another implant," he said.
A spokesperson for Florida Medicaid, Shelisha Durden, gave this response, after receiving the family's permission to discuss the case:
Antonio Sarnelli is a Medicaid recipient enrolled in the Medicaid HMO United. United is required to cover all services that Medicaid covers. Antonio's treating physician recommended cochlear implantation, and in 2009, a unilateral cochlear implant was approved. In March 2009, the device was unilaterally implanted in his right ear."
On Jan. 15, Antonio's physician requested a second or bilateral implantation which was denied by United Health Care based on Medicaid coverage policy.
According to Medicaid policy, Medicaid reimburses for one cochlear implant in either ear, but not for bilateral cochlear implantation. The decision went through the appeal process at the plan level and subsequently, the recipient requested a Medicaid Fair Hearing. This case was presented at Fair Hearing.
The hearing decision is as follows:
"Based upon the foregoing Findings of Fact and Conclusions of Law, the appeal is denied. The agency's action is affirmed."
Under Medicaid policy, Sarnelli can file an appeal with ACHA and the District Court of Appeal.
He said he plans to do so but doesn't have the money for a legal battle, he would prefer the state to be more flexible in its policy.
5-Year-Old Wants Cochlear Implant for Christmas | Firstcoastnews.com | Local News
"This is what Antonio asked for Christmas. He said 'Pappy I want a second ear;' we are praying that he will receive that," said Emanuele Sarnelli.
Antonio is a typical 5-year-old, but he is deaf. Sarnelli said his son had a reaction to childhood vaccines and developed a series of ear infections that caused him to lose his hearing.
"We did not know he was deaf; for 2 1/2 years he was diagnosed as autistic," he said.
Tests would reveal it was a misdiagnosis.
"They found instead that Antonio was profoundly deaf in both ears," said his father.
Uninsured, the family and their doctors turned to Florida Medicaid for help. "They made us jump through a bunch of hoops to prove it was medically necessary," he added.
In 2009 Antonio had surgery to have a cochlear implant placed in one ear and his world changed. "It is like day and night," said Sarnelli.
Antonio is so excited about his ability to hear; his mother said he refuses to remove it at nights. "He does not want to take the implant off, first thing he wakes up and that's what he wants," said Forinda Sarnelli.
The family said Antonio's doctor wants him to have a second ear implant for clarity, balance and speech development. Sarnelli said they presented the evidence to their HMO, United Health care and it was denied, then they filed for a 'Fair Hearing ' with Medicaid and it was denied again. Why?
"They said they're only required to cover one implant," he said.
Sarnelli said the device would give his 5-year-old a better chance in a world where hearing is taken for granted. "We're not asking for anything else or anything above what the boy needs which is another implant," he said.
A spokesperson for Florida Medicaid, Shelisha Durden, gave this response, after receiving the family's permission to discuss the case:
Antonio Sarnelli is a Medicaid recipient enrolled in the Medicaid HMO United. United is required to cover all services that Medicaid covers. Antonio's treating physician recommended cochlear implantation, and in 2009, a unilateral cochlear implant was approved. In March 2009, the device was unilaterally implanted in his right ear."
On Jan. 15, Antonio's physician requested a second or bilateral implantation which was denied by United Health Care based on Medicaid coverage policy.
According to Medicaid policy, Medicaid reimburses for one cochlear implant in either ear, but not for bilateral cochlear implantation. The decision went through the appeal process at the plan level and subsequently, the recipient requested a Medicaid Fair Hearing. This case was presented at Fair Hearing.
The hearing decision is as follows:
"Based upon the foregoing Findings of Fact and Conclusions of Law, the appeal is denied. The agency's action is affirmed."
Under Medicaid policy, Sarnelli can file an appeal with ACHA and the District Court of Appeal.
He said he plans to do so but doesn't have the money for a legal battle, he would prefer the state to be more flexible in its policy.
5-Year-Old Wants Cochlear Implant for Christmas | Firstcoastnews.com | Local News
Hard time with sarcasm huh? 
