That is the reason my insurance company, Univera, will most likely deny authorization to cover my other ear.
Nope, I am not giving up…not by all means. I don’t quit; its not an option. As far as I am concerned, surgery for December 2007 or January 2008 is still on. With Steph’s help, I am going to fight this tooth and nail.
Let the battles begin!!
“bilateral cochlear implants have not been medically proven to be effective”
translation: “our lawyers think we can avoid paying for this, and our shareholders like it that way”
Good luck,
Greg
Not a chance in heck, buddy. The bottom line is bilateral cochlear implants HAVE BEEN medically proven to be effective. Hundreds of other insurance companies say so!
The battles have commenced!
I think that it is an issue of necessity more than one of being effective. Bilateral CIs are effective, but is a second implant necessary? If you are functioning well with one, is the second implant really needed? Of course, my answer is that the second implant is needed. May your insurance surprise you and give the authorization without a battle.
Kare
I just love this “medically necessary” thing. When we were fighting with insurance early on and I was told this, I was so mad that I actually asked the lady at our insurance company to turn off her ears and then determine if she would consider the CI to be medically necessary! Seriously, why is it that medical treatment is determined by an isurance company instead of a doctor and his/her patient?
Our insurance company does provide coverage for bilateral – if you need a copy of the policy, please let me know. I actaully have heard that some insurance companies are putting age limits in their policies – I don’t know how they get away with it, but that is what I have heard. Also, I don’t know a lot about letthemhear.org, but I know that they have a 100% record of winning battles for CI coverage vs. insurance companies. Most of what I have researched is pediatric, but if we can help, please let us know! I have a ton of bilateral research that I could forward to you.
I’m in the middle of my first appeal with BlueCross for my bilateral implant. I have already gotten my first official denial letter, with the same old “not medically necessary” hooey. It might not be medically necessary, in the sense that I won’t DIE without it, but the safety of my kids and myself is still compromised, since I can’t hear enough with the one ear to get by very well. And, dadgummit…it’s pitiful only being able to pick up a word here and there…I still rely on lip reading for 99.7 percent of my communication, and still miss a lot….gr!
You fight, Sam! You know I’m in your corner!! 🙂
You will win, one way or another. Good luck!!!
Hello, I wanted to check the internet to see if there was someone else talking about this same topic. I should have known that there were a number of individuals having the same problem my family is experiencing. My son was born with a severe to profound hearing loss in both ears. He turned 1 on July 25, 2007. I have been fighting my insurance company for everything dealing with hearing. Initially, they denied his cochlea implant surgery and then agreed to pay for one ear only. I thought they decided they would not pay for bilaterial implants and one time, but I was told that they would only pay for one implant ever. I can’t believe it.
He is scheduled for surgery for one ear on September 11 and we are so excited, but I know my fight is on, so if anyone has any information that I can use, please let me know. One way or the other, my son will receive the other implant, even if I have to sell everything, take out my retirement money, etc., he will have it, but I am not going to lie down and just accept what the Insurance company is saying. They have a fight on their hands.
God bless you and thanks in advance if you can assist me.
Denene