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.