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".