A nine month old little girl in New York was scheduled for her cochlear implant surgery, but was later denied coverage by Anthem Blue Cross Blue Shield because she was under one year old. Their doctor submitted a letter explaining the need, and they tried to get help from the Let Them Hear Foundation, but nothing had worked. The family had their final appeal with the insurance company later that day and a family friend posted a plea for help on CI Circle:
We saw her cry for help and emailed her, explaining that Drew had successful bilateral cochlear implant surgery at just under nine months while covered by Anthem. We sent to her a copy of Drew's approval of coverage letter and "Explanation of Benefits" from Anthem in the hopes that it would help the little girl in New York. We later got this response:
I've heard there are studies supporting implantation under 12 months. Does anyone happen to know those studies offhand. I was hoping to put a few things together for them to take with them to their appeal this afternoon.
I'm happy to report that my husband's co-worker and his wife won their appeal with Anthem, so their daughter will be able to have her surgery as planned on Friday. Thanks for all your help and advice.It feels great that Drew was able to help that girl, even though we don't know her or her family. If you or someone you know is denied insurance coverage for cochlear implants, don't give up! Please let us know if we (and Drew) can help you.
...I think Drew's EOB really made the difference. Thank you!
6 comments:
Most people at our hospital just use state Medical Assistance, since insurance companies don't typically cover CIs. That's what we use; it'll cover all his equipment needs to. It covers the hearing aid kids, too. *shrug*
added: I don't want to assume that all states have medical assistance/medicaid available for this, but I think it's an oft looked-over resource.
Thanks for the comments, jeannette!
I agree that it's important for people to know that Medicaid is out there, but on the other hand many people do not qualify financially.
Persons who make more money than Medicaid permits are in trouble if they don't have insurance that will cover CI's. They would have to pay around $60,000+ out-of-pocket for one CI, which very few can afford.
well, I think in the case of our state, it's not a financial requirement, rather a situational one (making even more looked-over). One qualifies by merely being deaf, a child, and insurance that does not cover. h
Wow, that is great that your state provides those resources.
I know Missouri provides for free hearing aids for residents, which is wonderful.
We found a program that gave loaner hearing aids (and therapy)when Drew was wearing them, but if it were not for that we would have had to purchase them for about $7,000.
This would have been especially difficult to swallow since he used them for less than a year due to his getting his CI's.
I think that's great!! Earlier seems to be better, if you ask me...they recover better from the surgery, they get the benefits more quickly. I'm so glad that I didn't have to break ground like you've been doing...but I appreciate that you've done it, so others will benefit from your work! :)
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