Friday, June 17, 2011

X-rated post!!! Beware - I'm fuming!

We got a copy of our insurance benefits coverage today. That was great because I was going to request one anyway. I wanted to see how our insurance policy handled Cochlear Implants. Interestingly, I found they cover it AND consider it a prosthetic device and not a hearing aid. That made me happy because I figure that I can use that information in an appeals letter (which the insurance lady suggested I write). What has gotten my goat though, is they consider a PENILE IMPLANT a covered prosthetic device!!!! While I sympathize with men who need assistance to perform in the bedroom - some for very good reasons, I'm sure - I cannot fathom how their need  for SEX is more important than my need to hear! (Men, I'm sorry - I "get it" because I am married to a man, but seriously....? A penile implant is a prosthetic device but a device screwed into the side of my head is not?)

I wrote the following two letters to our insurance company:

First letter:

Medicare has revised how they classify this surgery and how this device differs from traditional hearing aids. Please see these Web sites for information:

http://www.audiologyonline.com/news/news_detail.asp?news_id=1922

http://www.asha.org/Publications/leader/2011/110315/Middle-Ear-Implants-and-Osseointegrated-Implants.htm

Traditional hearing aids conduct sound through air using the auditory nerve. I have no functioning auditory nerve on the right side. I’ve tried traditional CROS hearing aids with no success. They amplify sound and send it to the good ear. Unfortunately, they amplify all sounds, including rustling of papers, typing on keyboards, etc. Those noises are very annoying and drown out conversations. I also have Meniere’s disease and only one functioning balance nerve. I suffer from bouts of vertigo.

Without this surgery and the associated device, I will be forced to continue living life struggling to be a part of everyday activities. Currently, I lose portions of conversations in group settings, such as staff meetings, because if I cannot look directly at someone to try and “see” what they’re saying I often miss what is being said. This has caused complications on my job since if I miss something, I don’t always know that I have. Consequently, I have missed important things in meetings that have negatively impacted my perceived performance. In fact, I have been written up for this and put on probation of sorts.

The Osseointegrated Auditory Implant (commonly referred to as the BAHA system) works on bone conduction instead of air conduction. The system works on a titanium screw and mount being inserted into a bone in the skull behind the ear. After the bone has fully integrated the hardware, an external processor is clipped onto the mount and sound is transferred through the bone, creating the sensation of “hearing” in the affected ear. This is a prosthetic in the truest sense of the word. A hearing aid amplifies through the hearing nerve, increasing the ability for the nerve to process the sound. This system simulates hearing but without the processor, there is nothing to transmit the sound waves through the bone.

With this system, I could do the following, which would improve the quality of my life:

• Hear sirens before the emergency vehicles are upon me
• Be able to hear where sound is coming from
• Be able to participate in group conversations without constantly twisting my head back and forth to try and catch everything
• Be able to walk and carry on a conversation with someone without losing my balance due to moving my head to hear and then back to see where I was going
• Be able to walk and talk with someone without having to make sure that person is on my ‘good side’
• Be able to talk on the telephone and still hear someone trying to tell me something that I might need to hear regarding that telephone conversation (right now, they are both canceled out because I can’t process both conversations with one ear)
• Be able to hear people in the car, especially if I’m driving, because they’re sitting on my bad side
• Quit asking people to please repeat themselves because I can’t hear or understand what they’ve just said
• Have the television at a normal volume level instead of an increased volume level

I would greatly appreciate this device being considered as a medical device instead of a hearing aid. As you can tell, a hearing aid is much less invasive and much less complicated than an auditory implant into the skull. There is no way I can afford to have this surgery or hope to have a more somewhat normal life if this is not approved as a medical device instead of a hearing aid.
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That letter didn't help any and the lady I've been dealing with at the insurance company suggested that I write a letter to the appeals department. She said she tried everything that she could think of to get this covered or to get it listed as something other than a 'hearing aid'.

Second letter:


Attention Appeals Department:

I am writing to ask that you reconsider the coverage for the Bone Anchored Hearing Solution (even though it’s called an “aid” it is really a prosthesis). Many insurance companies fall in line with what Medicare and Medicaid cover and they completely fund this procedure. I understand from reading the benefits book that insurance covers prosthetics, including but not limited to arms, legs, eyes, breast prosthetics, PENILE IMPLANTS, and Cochlear implants. I find it extremely disturbing that a man can get an implant for something so he can have SEX but I am denied the opportunity to hear because the device I need to hear is not considered an implant. That is truly sad. I would like to compare side-by-side the Cochlear Implant and the BAHA.

BAHA SOLUTION
  • Uses direct bone conduction for the treatment of hearing loss
  • Surgically implanted in the bone under the skin behind the ear
  • Externally, consists of a sound processor that picks up sound vibrations
  • Internally, consists of a small titanium implant secured in the bone behind the ear and transfers sound vibrations through the bone to the functioning cochlea
  • Requirements for this device: single-sided deafness in individuals who do not have a functioning auditory nerve and who have not benefitted from other kinds of hearing aids
  • Costs associated with BAHA: Less than $50,000 including the external processor (Via Christi's charge currently is less than $39,000)

COCHLEAR IMPLANT

  • Uses electrical stimulation of the hairs of the cochlea for the treatment of hearing loss
  • Surgically implanted in the bone under the skin behind the ear
  • Externally, consists of one or more microphones, a speech processor, and a transmitter
  • Internally, consists of a receiver and stimulator secured in bone beneath the skin which converts the signals into electric impulses and sends them through the cables wound throughout the cochlea
  • Requirements for this device: functioning auditory nerve; not benefitting from other KINDS of hearing aids(that use air for sound conduction), including the latest models of high power hearing instruments and FM systems
  • Costs associated with Cochlear Implant:  Including only the post-operative cost, including the programming of the device, usually 5-6 visits during the first three months - from $50,000 to $100,000 (Warranties for the devices are $300-$400 per year)

These two devices - although different in physical structure - perform the same function:

They provide an alternate pathway for the conduction of sound. Neither of these devices are "hearing aids" but rather they are substitutes - like an artificial limb - for the real function of "hearing." As a person without a functioning auditory nerve, I believe that I am being unfairly denied the full coverage benefit that someone who does have a functioning auditory nerve receives. It is not my fault that my auditory nerve was destroyed by Meniere's Disease. In addition, while I sympathize with men who require a penile implant so they can resume sexual activity, I cannot fathom how their problems result in "prosthetic coverage" whereas my lack of hearing and having a somewhat normal conversation with someone does not warrant "prosthetic coverage."

I would greatly appreciate this coverage being re-evaluated and the Bone Anchored Hearing Solution be placed in the same category as the Cochlear Implant. Waiting until I am 65 to be covered by Medicare seems like such an unfair option.
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I sure hope this works or I wasted money on a perm. LOL - love the curls again, though!

6 comments:

Bouncin' Barb said...

Good luck with this Teresa! I'm certainly praying it goes through for you.

SkippyMom said...

Your points are so incredibly valid I can't believe they wouldn't approve this.

Wishing you luck and sending the best thoughts that this goes through soon sweetheart.

Jo-Anne Rambling said...

Every time I read about the problems you are having getting the cost of you hearing device covered I get mad.
I hope the letter helps the fact that a penile implant is covered really pisses me off...........

romance-of-roses said...

Well I think it's horrible and sad that they won't cover you for something that is so important and necessary, yes this also pisses me off.
Prayers and good wishes go your way.
Hugs...Lu

Pat said...

Does this just prove that it's a man's world?

Good luck to you! You made a valid argument!

Green Girl in Wisconsin said...

I'm stewed and steamed to read this! Oh my gosh. PLEASE let common sense prevail and grant you hearing!