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http://www.contracostatimes.com/health/ci_7896838
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.
Byrne-Haber noted, however, that when she and her clients prevail, 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 foundation patients as well as 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 mind-set 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.
Four-fifths of the students at the Redwood City school have cochlear implants, Sussman said. "And many of them because of (Byrne-Haber's) work," she added.
The surgically implanted devices restore hearing, even in the deaf. When put in early enough -- optimally from ages 6 months to 18 months -- 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 announced Oct. 19 that it would cover the dual procedure.
Victories 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.
Byrne-Haber said she also has persuaded more than 30 companies that self-insure employees to add cochlear implants to their coverage, including Sun Microsystems and Apple Inc.
"They covered zero cochlear implants before that," she said.
Although much of the foundation's work focuses on securing implants for infants, the advocacy program also aids hearing-impaired adults facing insurance denials.
For Dr. Laurie Naimin, 75, a retired Palo Alto physician, the advocacy work of the Let Them Hear 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," Naimin said. "I resigned myself to struggling with poor hearing the rest of my life." Naimin said he was normally self-assured, but his poor hearing sapped his self-confidence in groups.
In 2004, after his audiologist suggested a cochlear implant, he received insurance approval for one in his right ear, which was implanted that year.
"I felt much more relaxed in groups," Naimin said. "My wife and family noticed I wasn't shouting at them," he added with a smile.
But Naimin was still nearly deaf in his left ear. When he requested a cochlear implant for that ear, his insurer, Blue Shield of California, denied it on three occasions.
And three times, Byrne-Haber and her team appealed the decisions, citing numerous benefits of the dual devices.
"With one implant, it's like having only one eye -- you have no depth perception," Byrne-Haber said.
Much of Byrne-Haber's work has focused on getting coverage for one implant, but she increasingly has focused on persuading insurers to cover the bilateral treatment for improving the quality of life for recipients, as well as supporting optimal language and social development in children using cochlear implants.
Rachelle Cunningham, an Aetna spokeswoman, said the insurer decided in October to cover bilateral cochlear implants after reviewing new clinical evidence of their effectiveness.
Byrne-Haber said she 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 other insurers, Byrne-Haber based the threatened lawsuit against Aetna on allegations of fraud for denying the treatment, because the insurer consistently approved it after appeals.
Cunningham said Aetna's decision was based solely on an assessment on the dual implants from the Institute of Hearing Research. "I know (Byrne-Haber) would like to take credit," Cunningham said.
"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 she warned Aetna of the pending litigation, and three months before its long-scheduled policy review this month.
And with Naimin's surgery date looming, Byrne-Haber called Blue Shield Dec. 11, warning the insurer of an upcoming news article describing Naimin's inability to secure insurance coverage for his second implant. His surgery had been scheduled for months for Dec. 17.
The day after Byrne-Haber called Blue Shield, she said, Blue Shield authorized the surgery, after four months of appeals. Elise Anderson, a Blue Shield spokeswoman, said medical privacy laws prevented her from discussing why the insurer approved it Dec. 12.
Byrne-Haber was ebullient about the authorization, and she cited a 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."
Naimin was equally ebullient about 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."
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.
Byrne-Haber noted, however, that when she and her clients prevail, 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 foundation patients as well as 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 mind-set 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.
Four-fifths of the students at the Redwood City school have cochlear implants, Sussman said. "And many of them because of (Byrne-Haber's) work," she added.
The surgically implanted devices restore hearing, even in the deaf. When put in early enough -- optimally from ages 6 months to 18 months -- 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 announced Oct. 19 that it would cover the dual procedure.
Victories 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.
Byrne-Haber said she also has persuaded more than 30 companies that self-insure employees to add cochlear implants to their coverage, including Sun Microsystems and Apple Inc.
"They covered zero cochlear implants before that," she said.
Although much of the foundation's work focuses on securing implants for infants, the advocacy program also aids hearing-impaired adults facing insurance denials.
For Dr. Laurie Naimin, 75, a retired Palo Alto physician, the advocacy work of the Let Them Hear 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," Naimin said. "I resigned myself to struggling with poor hearing the rest of my life." Naimin said he was normally self-assured, but his poor hearing sapped his self-confidence in groups.
In 2004, after his audiologist suggested a cochlear implant, he received insurance approval for one in his right ear, which was implanted that year.
"I felt much more relaxed in groups," Naimin said. "My wife and family noticed I wasn't shouting at them," he added with a smile.
But Naimin was still nearly deaf in his left ear. When he requested a cochlear implant for that ear, his insurer, Blue Shield of California, denied it on three occasions.
And three times, Byrne-Haber and her team appealed the decisions, citing numerous benefits of the dual devices.
"With one implant, it's like having only one eye -- you have no depth perception," Byrne-Haber said.
Much of Byrne-Haber's work has focused on getting coverage for one implant, but she increasingly has focused on persuading insurers to cover the bilateral treatment for improving the quality of life for recipients, as well as supporting optimal language and social development in children using cochlear implants.
Rachelle Cunningham, an Aetna spokeswoman, said the insurer decided in October to cover bilateral cochlear implants after reviewing new clinical evidence of their effectiveness.
Byrne-Haber said she 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 other insurers, Byrne-Haber based the threatened lawsuit against Aetna on allegations of fraud for denying the treatment, because the insurer consistently approved it after appeals.
Cunningham said Aetna's decision was based solely on an assessment on the dual implants from the Institute of Hearing Research. "I know (Byrne-Haber) would like to take credit," Cunningham said.
"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 she warned Aetna of the pending litigation, and three months before its long-scheduled policy review this month.
And with Naimin's surgery date looming, Byrne-Haber called Blue Shield Dec. 11, warning the insurer of an upcoming news article describing Naimin's inability to secure insurance coverage for his second implant. His surgery had been scheduled for months for Dec. 17.
The day after Byrne-Haber called Blue Shield, she said, Blue Shield authorized the surgery, after four months of appeals. Elise Anderson, a Blue Shield spokeswoman, said medical privacy laws prevented her from discussing why the insurer approved it Dec. 12.
Byrne-Haber was ebullient about the authorization, and she cited a 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."
Naimin was equally ebullient about 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."