I made an appointment with the neuro-otologist that has done cochlear implant surgeries for people with unilateral hearing loss in May 2014. He has been able to get insurance approval in the past for this a few times. He said that if he had my hearing loss, he would get a cochlear implant under the one condition that insurance paid for it.
The doctor wanted to have a couple audiologist appointments before submitting the surgery order. The clinic had scheduling problems and it took until October to get the second meeting done. This second meeting was to choose which of the three cochlear implant makers to use. Each of these three products are quite different.
Selecting a cochlear implant is an important decision. Since the internal implant has an electrode threaded through the cochlea - the plan is for it to be permanent and the implant only works with external components from the same company. Effectively it is a lifelong decision of getting locked into a company. Think of it as picking a smartphone platform of Apple, Android, or Windows Phone except:
- you don't get to try the smartphone first since the only way to try a cochlear implant is to have it implanted,
- you've never even used a smartphone before so you don't even know what to look for in a cochlear implant, and
- you never get to change your mind, even after a two year contract is over.
This makes for an interesting decision problem. I picked the Med-El cochlear implant but since the hardware is not actually ordered until shortly before surgery, I filed away that it would be worth taking another look at after getting insurance approval.
Lesson Learned: Take the device selection decision seriously but there is time to change your mind since they won't order it before insurance approves of surgery.
Two weeks after the doctor's order was submitted, insurance sent their rejection. While cochlear implants are covered for people with hearing loss in both ears, the insurance company simply cited the page of the policy indicating that cochlear implants are not covered for single sided deafness. I knew it wasn't going to be easy getting approved so I was expecting the first rejection.
A few weeks later, the doctor sent an appeal which was also rejected two weeks later. This was disappointing but I took the opportunity to write a research paper with a student on deciding between cochlear implants. The paper was accepted for the PICMET conference. I'll give away the punchline-after looking at all the factors carefully, I changed the device to be implanted from Med-El to Advanced Bionics.
Lesson Learned: Carefully weigh the options for which cochlear implant to pick.
The next step was a patient appeal. I had read through the academic literature earlier which made a compelling case for the cochlear implant as the best treatment option. I organized this and cited the literature in my three page patient appeal. That too was rejected.
The next stage was a second level patient appeal to the insurance panel. I prepared a stronger argument than my first appeal and included updated references. After submitting it, they said that I could present it in person to the panel if I wanted to do so. As a professor, I'm used to presenting technical material so I decided to make the presentation. Besides, it is very much in line with the kind of research that we do it in the Engineering and Technology Management Department at Portland State University.
The day before the panel presentation, I had an appointment at Costco's hearing center for a hearing test. It had been about 9 months since my last audiogram and I wanted to see how it had changed. They offer free tests and will also let you test a hearing aid while in the store. The answer was my hearing had stayed stable and I walked around a store with their most powerful hearing aid for an hour. The hearing aid did me no good. While their audiology practice may not measure up to the level of expertise that I saw elsewhere, the price (free!) was right and the timing was quick.
Lesson Learned: A visit to Costco could be a good way to get second, a third, or fourth opinion as the case may be.
I put together a PowerPoint presentation, brought copies of the printouts, and some copies of the relevant literature to the meeting. The meeting went very well. They asked questions that I was thoroughly prepared for - it felt like a really well prepared research presentation where the presenter knows the material so well they are eager for any kind of hard question.
After the panel presentation, one of the people said it was the best prepared appeal he had ever seen. Alas, he didn't have a vote and it too received a rejection.
While I was convinced it was the best option, it was clear that insurance wasn't going to approve it. At this point, it was more than a year after my originally scheduled surgery. After giving it a lot of thought and reviewing the insurance documents yet again, I decided to go back to the original plan of a bone conduction hearing aid. A full year later and I was back in the same position but at least I had given it a try and had a paper published.
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