Getting fitted for cochlear implants is a major decision, one that requires much contemplation for both lifestyle and financial conditions. These devices are not inexpensive, but they can change someone’s life for the better. The cochlear implant is designed to help the wearer hear sounds much louder and clearer than they do without electronic assistance. Once the device is fitted, it replaces the damaged components of the cochlear or inner ear that are no longer working effectively.
People sometimes confuse a cochlear implant with a typical hearing aid. While it operates in much the same capacity, an implant can amplify and clarify sound much more dramatically as it sends sound stimuli directly to the brain so that the wearer may hear sounds more accurately.
Cochlear implants can benefit any number of people with a significant amount of hearing loss in both ears or one ear, particularly when hearing aids are insufficient to correct these problems. The most common implant scenario is having them placed in both ears for equal response to distinguish between sounds in any direction.
Children and adults can have cochlear implants put in and the majority of them report better hearing, clearer communication skills, an ability to focus in loud environments, hear other parties on the telephone, listen to music, and have the confidence and peace of mind that comes with improved hearing of everything around them.
Getting cochlear implants can greatly enhance your hearing and your life, but everyone reacts differently to having them put in. Some people are better candidates than others due to the length of time their hearing has been poor, the severity of the hearing loss, the amount of damage in the cochlear area, and additional medical factors.
Cochlear implantation can be very costly and, while any potential candidate must decide whether having them fitted will benefit the quality of their life, they must also factor in the financial impact it will have on their wallet. Since cochlear implants are considered medically necessary for individuals who are suffering significant hearing loss, the majority of insurance companies will cover the costs associated with implanting the devices.
As of 2004, cochlear implants are covered by nearly 90% of private health plans as well as coverage offered by Medicare, Medicaid, and the Veteran’s Administration. Before any surgery is performed, cochlear implantation professionals will contact your provider to get the necessary approvals to allow for the procedure to move forward, so your costs are minimal. However, even with insurance coverage you may still incur some out of pocket expenses.
Review Your Policy
Before you go for any consultation, you should read your policy in full. This is always a shrewd move anyway because knowing what your plan covers and excludes will also help you make better medical choices across the board. In this instance, however, while most plans do cover cochlear implantation, your policy may still have some exclusions or limitations to what the company will approve and which devices or procedures could be denied.
Contact your provider and ask them for a copy of your plan if you don’t already have one in your possession. You can also call your insurance company and ask them about your benefits, the extent of coverage, and out of pocket expenditures that are your responsibility for this type of procedure.
Dealing with Insurance
As you start down the road towards having any unilateral or bilateral implant procedures, you will be working with your doctor, your cochlear implant center, and your insurance provider every step of the way. This relationship can get complicated and it can be slow moving as well.
Your care provider will need to get in touch with your insurance company in order to obtain approval to have the surgery. That begins with your doctor submitting a predetermination letter describing your diagnosis, treatments, and necessary procedures. This letter is usually submitted with supporting documentation which can include any test results, doctor’s notes, and other paperwork to explain why a cochlear implant is required.
Once all of that information is received, the insurance company will review the case and issue a decision that will either authorize the treatment and procedures that your care provider has recommended or a denial of same. If you are denied, the insurance company will not pay for any of the cost associated with your cochlear implant.
Receiving a Denial
Although most insurance plans cover cochlear implants, you could still receive a denial of your claim. If this happens, the first thing you want to do is find out the exact reason why you were denied. Get as specific a response as you can and request a written letter explaining the company’s justification for opposing your care provider’s proposed course of action.
You have the right as a paying insured customer to file an appeal and have that appeal heard. Obtaining your denial in writing can better prepare you to make a strong case to the appeals board who will hear your case. You may also contact your cochlear implant facility and your doctor to help you craft an effective denial so that when you present your case it is detailed and precise.
Coverage for Additional Services
Depending on the severity of your condition, you may require rehabilitative therapies in addition to the cochlear implants. These typically include speech-language and aural rehabilitation services to assist in detecting and understanding speech, auditory training, and communication reconditioning. Most patients will need to be trained in how to use and care for the implants.
These services may or may not also be covered by your insurance. If they are included as part of your coverage, then you could still reach the maximum limit for rehabilitative services, in which case you may need to appeal the insurance company’s denial of further services.
Cochlear Implant Maintenance
Even if your insurance provider covers cochlear implants, it may not cover repair or replacement of the device or any components within. In many cases, the devices come with a warranty in the event your insurance plan does not cover the costs that come with maintenance and repair.
Reading your policy will alert you to the extent of coverage in this area. Even if the plan doesn’t cover repair or replacement of the device, you may have durable medical equipment coverage that could apply in the event something goes wrong and it is no longer operating properly.