Thursday, July 5

"Is That It? I'll Just Pay Cash."

We got Drew's "Explanation of Benefits" for his bilateral, simultaneous cochlear implant operation in the mail on Tuesday. We had a little bet going on who would come closest to the total cost, but both Drew's Mom and I were way too low.

The total "Provider Charges" were a whopping $155,232.71! However, because our insurance company Anthem Blue Cross and Blue Shield evidently "gets it" regarding how important bilateral cochlear implants can be for a child (or adult), the total out-of-pocket cost to us is only $1,170.15.
As I constantly "meet" people from Spain, Sweeden, California, South America, and all over who are dealing with hearing loss, hearing aids or cochlear implants, one thing is clear. That is the fact that whether one has insurance that will cover their chosen "plan of attack" directly impacts how successful that plan will be.

We are the fortunate ones. Our insurance company (Anthem of Virginia) gave phone approval in under five minutes for a procedure that some families never get. (I'd like to thank those who have decided to cover this procedure, as it truly makes a difference for Drew. I'll never meet you, but if you happen to see this please know we feel you have done a great service to your customers.)

Some insurance companies (now the minority) don't cover cochlear implants at all. Other insurance companies claim that a second cochlear implant is experimental or not medically necessary, despite growing evidence that they do benefit the users.

Because most of us can't quite find it in the budget to write a check for $155,000, not obtaining insurance approval means that they won't be able to take advantage of the cochlear implant technology. Families often fight for months or years to get insurance approval, while precious weeks roll away. These vanishing months quickly close the window of time during which a young child can grasp the foundations of language, with it often closing before the appeals, court arguments and battles have concluded.

Make sure this does not happen to your child. If you have decided that a cochlear implant is best for your son or daughter, I want you to do two things:

#1 - Start the insurance approval process immediately. Don't wait. Don't assume. Request a copy of what is covered by your policy. Politely demand that your chosen surgeon or audiology team contact your insurance company right away for approval.

#2 - If you are having difficulty, contact the Let Them Hear Foundation. They help families battle insurance companies that deny cochlear implants (or a second implant) to those who need them. Perhaps you should contact them even if you don't foresee trouble, just to take advantage of their educational resources.

We are going to send our approval letter and explanation of benefits to the Let Them Hear Foundation so they can demonstrate to the other insurance companies that bilateral, simultaneous cochlear implants are being covered. I hope that in this way we will be able to help others "Turn on their ears".


Yana said...

These are excellent ideas, especially the last one!

Anonymous said...

You two are so "on top of things" that it never ceases to amaze me. We have worked with Let Them Hear and they are outstanding. Thank you so much for sending them your insurance documentation, Ethan might be one of those kiddos down the line that directly benefits from a move like this.

We would very much like to go bilateral, but are pretty sure our company will deny the procedure. We do have BCMH coverage however, so there is still a window of hope.

Did Drew hear any fireworks?

Drew's Mom said...

Thank you! We just want all children (and adults, too) to have the same opportunities as Drew. And it is a shame that some children are able to take advantage of technology that others are not simply because of health insurance. There is something seriously wrong with the American Health Insurance situation to allow this to happen.

I wish you luck with approval for bilateral. It may sound crazy, but we already see signs of Drew being able to localize sounds - and we are only on day 7. (Not to metion the affect on his balance, amazing, and I know a HUGE concern of yours). The things we have seen are truly AMAZING and would never, EVER have happened without a CI, or two!

Drew did not hear any fireworks, mainly because he goes to bed well before dark, let alone before fireworks! He did go to a parade and heard sirens, bands and horns honking. He was so tired he feel asleep midway through the parade! I have lots to share, but little time to make a post. Maybe tomorrow...

Jennifer said...

I'm still waiting on my coverage for Implant #2. Blue Cross of TN covers bilaterals for children 12 and under (which I think is awesome) but refuses coverage to adults since it's not "medically necessary". We're in our first round of appeals. Hopefully we won't have to bother LTH to make our appeal for us, but I am not opposed to going that route if I have to...I want to hear better and score higher on speech comprehension than just 16%! :)

Shiloh said...

I had no idea that bi-laterals were granted to some and not others...especially kids. We are in PA and for Isaac's 1st implant our primary insurance (South Central Preferred-it's a tiny company) covered 80% and medical assistance (Gateway) covered the rest. I didn't have to fight at all. We are really lucky I guess. My husband and I are talking about a 2nd implant for Isaac, but have not made any decisions yet. Interesting post.

Laurie said...

That price is about right. My surgeries were over $70,000 each. Everyone should have the opportunity to get their CI's without a long wait or cost. Especially children, who might miss that important "window" for language development, communication, etc. Thank you for sharing!

MB said...

You are so lucky! We have Anthem of Virginia and they have been nothing but a complete pain in the #$$.