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Thursday, November 1

Insurance Coverage for Therapy

Drew's Dad provided information regarding insurance coverage for cochlear implants in a post he wrote a few months ago. There are so many pieces to the cochlear implant insurance puzzle that I would like to provide some information on insurance coverage for therapy.

Those that are traveling or are going to travel the cochlear implant path should know that the individuals' success with his or her cochlear implant is achieved with hours of therapy. You must learn to listen and process sound before you can begin to talk and communicate. There is only so much the doctor and audiologist can do; without learning how to listen, the recipient is not going to have optimal success with his or her cochlear implant.

Many insurance companies have guidelines for therapy. Some insurance companies will provide services for a certain number of visits in a calendar year while others set a dollar maximum. For example, Anthem/Blue Cross Blue Shield of Virginia, our provider, has a $500 maximum for speech therapy in a year. With a one hour therapy session costing $189, we reached our maximum in less than three visits. Most families, including ours, and especially those with young children, do not have the means to financially pay for this necessary therapy.

There is hope. I have been "battling" the insurance company over therapy coverage for several months and finally have secured coverage for Drew's therapy sessions. There is a specific insurance billing code for "aural habilitiation following a cochlear implant." This code recognizes that cochlear implant recipients must have listening habilitation. And it recognizes that the therapy the recipient is receiving is NOT speech therapy, but rather therapy to learn to use their new found hearing.

If you are having issues with insurance coverage for therapy, I implore you not to give up! Many insurance companies deny coverage on the initial try because they know that some people will not take the time and energy to appeal. Many times making just one phone call can secure coverage. If not, you can always make a written appeal requesting coverage. And, you can utilize your physician and audiologist for medical documentation and support.

10 comments:

Laurie said...

Yes, auditory therapy is a MUST after CI surgery. I went for a year after my first CI and need to go back to learn to listen in noise.

My insurance company (AETNA) paid a certain portion for each visit. There was no maximum that I knew about but I had to pay my deductible (which was easily met with the CI surgery itself).

The deaf and hard of hearing people need people like Drew's dad to advocate and research for them. Thank you.

Hetha said...

We've had a tough time since our insurance company only covers 20 visits to speech per year, but we actually have BCMH and they have helped cover some of the costs this year. I'll definitely look into this code that you mention! Thanks so much for the information! This makes me wonder if there is a similar procedure to get fuller coverage for his other 2 therapies (PT and OT) which BCMH doesn't help cover!

I have a question for Drew's Mom about the pockets for bilaterals, could you guys drop me an email, or leave an email address at Ethan's World?

And a big thanks for your support during Ethan's surgery and recovery. It has meant a lot to me to hear from another ci parent who knows what we've been feeling.

Drew's Dad said...

hetha,

I just made my email available if you click on my profile. If Drew's Mom hasn't replied yet, feel free to email to my address and we'd be happy to help if we can.

Jennifer said...

I didn't have the auditory therapy with my first CI, but think I'll take advantage of it with the second one. I had such poor hearing at first that just picking up actual sounds was a challenge...let alone listening to anything! This time around, though, I expect to hear sounds...crazy though they may be...and I want to maximize my potential! :)

Kauan Tyler's Mom! said...

I guess we're very lucky here in California!! CCS covers 48 hours per six months of Auditory Verbal Therapy at UCLA. Also, for the bilateral surgery (Kauan was the first child to have a bilateral implant using CCS in California)we didn't have to pay for anything - nothing - which is wonderful!!!
Kauan is also going to JTC and he has a TOD coming to our house once a week - aside of working with the therapist at UCLA.
During this journey, I've learned that if you look and fight for your child's rights you will find the support you need. I think it's important to share with other parents about the CCS, because most of them don't know that bilateral implant is now availble through CCS.
:0)
I agree with Hetha, the support you guys are giving to us parents is amazing - thank you so much!!!
Iz and Kauan.

MB said...

We fight with Anthem of VA all the time. First they denied the MRI and then the genetic tests. Each time it just took a call from our doctor and they instantly approved it.

What about coverage under Early Intervention? I know for VA residents they have to cover up to $5k/year. I don't know how it works now that you don't live in VA, but you should ask if speech therapy would be covered under that clause until he turns 3.

Fon said...

Thanks for the information on topics.I was excited for this article.
Thank you again.

Insurance information for good ideas.

Sheri Byrne said...

You guys have been very good (and a little lucky) to get your insurer to cover what you've been fighting for without outside assistance. For those who need help, please visit http://advocacy.letthemhear.org

Sheri Byrne said...

Oh, and I hate to disappoint the CCS mom, but Kaun may not be the first -- the foundation got CCS to cover a bilateral implant for a little girl in northern California almost two years ago.

So, there are at least two, and here's hoping to many more in the future

Sheri

Drew's Mom said...

MB: We have Early Intervention in Ohio which provides up to one hour of service with a TOD per week. We didn't feel like that was enough therapy, so anything else is up to insurance or us.

Sheri: Thank you for posting "Let Them Hear's" website. I forgot to include that in my post. Many of our CI friends have had great help from this organization, and I forgot that it is not just for the surgery itself, but also therapy.

I think that Kauan's Mom was trying to say that Kauan is the first child in CA that has been approved for simultaneous implants. I agree - here's to many more gaining approval without a long fight!