Bad News - Denied for CI

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Phi4Sius

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So I've been denied claiming "too much speech recognition". That's horse***.

Time to fight.

For those who have been denied, what have you done? How did you appeal? What steps did you take to bring down the insurance company?

Okay, I was just kidding on the last one, but in all seriousness, how did you do it?
 
My friend has been denied too as she was borderline (southampton speech recognition was 60%, national was 50% She was 59% the Primary Care Trust said no), she has to wait another 6 months for repeat tests. She got progressive hearing loss.

If you have too much speech recognition therefore the HA is doing the job well for you at the moment.

Whats was the % of your speech recognition?

I am sorry you have been denied and i cannot give you any advice.
 
WITHOUT HA! wow!!

Well to be honest I am not surprised you were turned down.

I guess you'll have to be patient until your speech recognition had dropped.

I am sorry you are disappointed.
 
Try going to different CI center/surgeon
That's what I'm going to do when my fiance and I get married I'd be under his insurance that approves 2nd ci without any question, I'll go to Baltimore to get my right ear implanted (hopkins center) that's 2 hours from here, I'm guessing 2-3 years from now
 
According to my acceptance letter for CI candiacy aged 10, I was very borderline, according to the letter my speech recognition or something was at 75db 100% with HA's. I will check about that again just to make sure. But after a lenghty time of waiting I was accepted for ci surgery. My hearing loss was over 115 at most frequencies.


No wonder you got turned down for surgery, you have too much hearing unaided. You're one of the lucky ones to have hearing unaided
 
Phi4Sius said:
So I've been denied claiming "too much speech recognition". That's horse***.

Time to fight.

For those who have been denied, what have you done? How did you appeal? What steps did you take to bring down the insurance company?

Okay, I was just kidding on the last one, but in all seriousness, how did you do it?
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What requirements does this insurance have? Maybe you can find a different insurance with more lax requirements. Several of us have said that itll be almost impossible to get a CI when you already hear similar to what others with CI hear. But you can try telling insurance you want a CI in your *dead* ear that hears nothing, 0%! They might be assuming you want a CI in the good ear! Youve told me you want to hear in both ears, tell insurance that. Point out that while you hear great in your good ear, you want to hear in the bad ear and to improve being able to tell direction of sound.

overthepond said:
WITHOUT HA! wow!!

Well to be honest I am not surprised you were turned down.

I guess you'll have to be patient until your speech recognition had dropped.

I am sorry you are disappointed.
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Most insurance and CI centers put an upper limit of 40% to 50% speech aided and a minimum of severe-profound hearing loss(that's 70db minimum sloping to nothing) to hear 72% speech unaided is absolutely amazing and shows you have a very large amount of residual, functional hearing(at least in the good ear) I was tested and scored only 4% speech unaided at 105db. This means I am pretty much deaf and hear pratically nothing unaided.

SkullChick said:
Try going to different CI center/surgeon
That's what I'm going to do when my fiance and I get married I'd be under his insurance that approves 2nd ci without any question, I'll go to Baltimore to get my right ear implanted (hopkins center) that's 2 hours from here, I'm guessing 2-3 years from now
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Well good luck with your 2nd CI. Didn't you mention that your hearing loss is progressive and you have almost no residual hearing left and basically just experience vibrotactile sensations with HA now? I would get a CI myself if I lost as much hearing as you did and if my CI gave me really good results, id try to get a 2nd.
 
No offense, but I probably would turn you down if I were the surgeon......
 
I scored absolutely 0% without HAs. My scores were better only with HAs. I'm thinking 72% in Phi's case unaided is just too high for a CI, so this is no surprise to me. Do you have a progressive loss and expect your scores to go down later? If so, then you might be a good candidate at that time.
 
Phi4Sius said:
overthepond- Speech recognition is 72% without my HA in my good ear.
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since you have that much hearing unaided, I would not even want a CI. A CI is for the last resort. I had 1% in right ear and 17% in left. Hearing aids are useless. If you hearing is progressive then you should qualify in a few years.
 
To be clear, I'm trying to get a hearing aid for my left ear, which has been dead since I was 4 years old. I've never been able to localize sound.

According to FDA cochlear implant candidacy criteria on this web site, my left ear meets the criteria no problem. Absolutely NOWHERE does it state any language whatsoever in relation to a "good ear".

The Cochlear Implant Journey: Candidacy, Expectations, and Aural Rehabilitation | August 2006 | The Hearing Industry Resource

I don't understand what their obsession with a good ear is - what good does it do to rely on the hearing in my good ear when the other ear is what I'm trying to get the implant for and it's totally dead?

I emailed them back and awaiting a response.
 
okay I get it now. They are using your good ear as a reason to deny your implant. Aww. Just thinking I thought they do not want to implant someone with good hearing in one ear. You can appeal your denial. Your dr office will file the claim. Check with the CI brand you want to use, they always have programs to help fight insurance.
 
P4S,

Sorry to hear you were denied from being a candidate for a CI.

Unfortunately, they were correct. If one is getting a CI within the framework of insurance, then they apply guidelines to determine whether one is a candidate. This is mainly because of the cost factors. If a person had one decent ear and could be aided with a HA to get along in life, then that is better than spending up to $100k to provide a benefit that is marginal at best comparatively speaking. That is why both ears are considered in respect to CIs. This is another way of saying if both ears meet the guidelines then they get the best bang for their bucks.

If one has the means to go ahead and get a CI outright without insurance, then there is no reason why one couldn't get one in this situation. Of course, not many are in a situation where the means was not a problem.
 
Phi4Sius said:
To be clear, I'm trying to get a hearing aid for my left ear, which has been dead since I was 4 years old. I've never been able to localize sound.

According to FDA cochlear implant candidacy criteria on this web site, my left ear meets the criteria no problem. Absolutely NOWHERE does it state any language whatsoever in relation to a "good ear".

The Cochlear Implant Journey: Candidacy, Expectations, and Aural Rehabilitation | August 2006 | The Hearing Industry Resource

I don't understand what their obsession with a good ear is - what good does it do to rely on the hearing in my good ear when the other ear is what I'm trying to get the implant for and it's totally dead?

I emailed them back and awaiting a response.
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definitely contact your implant center and manufacturer to see what help they may be able to offer. There is also an organization called Let Them hear assocaition or foundation that specializes in appeals of denials and has an amazing track record of success.
good luck,
Rick
 
I think they are doing some trials with CI's and unilateral losses. Can you look into that? I know you aren't really "unilateral", but maybe they help or point you in the right direction.
 
I've emailed AB and my doctor multiple times. I'm sure I won't hear back from them until after the weekend.

I'll keep everyone posted. :)
 
Phi4Sius you are not right in the head....My advice, go get more deaf so you can qualify for the CI.. As Vallee stated it is a last resort..

You can hear well with whatever ear and that is why you are denied .. FDA set those rules years ago..

Be glad you can hear that well with your aided ear !!!
 
Phi4Sius said:
overthepond- Speech recognition is 72% without my HA in my good ear.
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If you have 72% speech recognition without a HA in your good ear, surely you can not have a severe/profound hearing loss in that ear, as you claim you have!
 
Phi4Sius said:
So I've been denied claiming "too much speech recognition". That's horse***.

Time to fight.

For those who have been denied, what have you done? How did you appeal? What steps did you take to bring down the insurance company?

Okay, I was just kidding on the last one, but in all seriousness, how did you do it?
Click to expand...

I also understand why you want your deaf ear to improve your communication skills. i would hate for my deaf ear to go unused too. but don't be taking money away from people who really need it. spend it out of your pocket, because you can live without CI, people like me can't.
 
djchur: If you have 72% speech recognition without a HA in your good ear, surely you can not have a severe/profound hearing loss in that ear, as you claim you have!
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If you don't believe me, here is MY official audiogram:

http://i828.photobucket.com/albums/zz201/phi4sius/audiogram1a.jpg

Quite honestly, you can go to hell. I don't really care what you think. You can think I'm lying all to hell if you want to, but it doesn't change my condition.

Lighthouse77: I also understand why you want your deaf ear to improve your communication skills. i would hate for my deaf ear to go unused too. but don't be taking money away from people who really need it. spend it out of your pocket, because you can live without CI, people like me can't.
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If I had the money, I'd gladly spend it out of pocket to avoid having to go through this BS of fighting with insurance and I'd probably be able to have my surgery done this or next weekend. But, I don't so I HAVE to go through insurance.

Southfella: Phi4Sius you are not right in the head....My advice, go get more deaf so you can qualify for the CI.. As Vallee stated it is a last resort..

You can hear well with whatever ear and that is why you are denied .. FDA set those rules years ago..

Be glad you can hear that well with your aided ear !!!
Click to expand...

I'm not right in the head? EXCUSE me? I've lived with this my whole life - since I was 4 years old (I'm 29 now) - and there's finally a treatment for it and I intend to take full advantage of it. You want to get hostile, go ahead. I certainly didn't do anything to you.
 
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