EqualityCare inquiry

I sent an inquiry to the Wyoming EqualityCare about their coverage for cochlear implants last Friday... Today I got a response from them.

Dear Client,

This correspondence is in response to your recent Ask EqualityCare submission. Wyoming EqualityCare records indicate that the prior authorization for cochlear implants was denied as the client is able to communicate through speech. In order for a prior authorization to be approved for clients over the age of 21, the client must be unable to communicate through speech or other means to make their medical or basic needs known. The documentation that was submitted to Wyoming EqualityCare states that this is not the case. If you believe this is incorrect, please contact Rocky Mountain Ear Center.

If you have any additional questions, please contact ACS Client Relations at ------------

Sincerely,

ACS, Inc.

Client Relations

I have forwarded this email on to Advanced Bionics. This is just not right at all, how can they factor in how well one communicates, despite how badly they hear? Even FDA guidelines doesn't factor in communication skills, just hearing loss and how POORLY the person hears speech with hearing aids. This is an outrage!

Medicaid's reasoning...

Just got a reply back from Rocky Mountain Ear Center on why Medicaid/Wyoming EqualityCare denied the cochlear implant.
"Equality care is stating that DOES NOT MEET CRITERIA: PATIENT ABLE TO COMMUNICATE THRU SPEECH."

Um... how messed up is that? So I have good speech and I communicate orally, that doesn't mean I shouldn't get an implant. If only they could actually SEE how I function with the little hearing I've got in the right ear. I can't even understand my own MOTHER without facing her. I have to lipread everyone in order to make sense of what they're saying, I need subtitles/captions on at all times, I need all the visual support I can get! I can barely use the phone these days, and always struggle to make sense of what my own mother is saying over the phone. She constantly has to repeat what she says on the phone for me to get it. I'm astounded over their reasoning, I really am. So I got lucky with having good speech, thanks to the deaf school and a dedicated speech therapist working with me on my speech. I'm lucky I can still communicate via speech, but I need all the visual support I can get when it comes to understanding what the other person is saying. And if I'm out at a restaurant or noisy situation, communication is pretty much... zip, even with lipreading I just can't understand crap. I can only lipread if I can hear what is being said, and I can hear if I can SEE what is being said, so I'm screwed either way. Come on Equality Care, seriously. That's a really stupid reason to deny the cochlear implant to someone who has 1 fully deaf ear and 1 that has about oh 20% hearing and can barely get by with a powerful hearing aid. Golly.

Rocky Mountain asked me if I wanted OMS Insurance or Advanced Bionics to do the appealing. I told her to send the information on to Advanced Bionics. We'll see how things go. Seriously.. just... wow.

Denied...

Medicaid has denied the cochlear implant request. Rocky Mountain Cochlear Implant Center will send the information on to OMS Insurance Support, and OMS will appeal, and hopefully work their magic. I might even get in contact with the Let Them Hear Foundation and see if they can be of any support as well.

Edit: LTHF is currently not accepting any appeal requests, so I'll just have to rely on OMS at this time. That's fine with me though. Also contacted Advanced Bionic's insurance support as well, to see if they could be of any help.

now I'm a bit torn...

With the news of the new Cochlear Nucleus 5 device now out on the market, I read up on the info for the new device... and now I'm a bit torn as to which implant I would choose for myself. For the last few years I've been thinking Advanced Bionic's Harmony, for sure! I like the design of their BTE processor, and of the speech processing strategies they offer. But now with the new Nucleus 5 out, just the thinner BTE processor appeals to me. The thinner internal implant is nice too, and the processor is also made of titanium and such. Hm. I don't know! I've already shot off a couple of emails, and have requested an information packet from Cochlear about the Nucleus 5. And I plan on comparing Nucleus 5 with Harmony, and I will continue to talk to various CI users online and so on. I still have a while before I actually get implanted. I know both companies are excellent, and their products work well, so I can't go wrong with either one really.

I have an appointment on the 15th (next Tuesday) with a new local doctor. The person who takes care of the insurance approval process at Rocky Mountain Ear Center, she told me I needed to have a primary doctor (that has referred me to them) and such before she can even turn in the paperwork to get the pre-authorization from Medicaid. Well, gee! I haven't had a primary doctor in years, and really, no one actually referred me to Rocky Mountain Ear Center. A former school district audiologist told me they were an excellent center to work with if I should go down the implant path. And I did my research online, looking at the different centers available in Colorado (and even Boys Town in Nebraska), when I decided on Rocky Mountain Ear Center. Anyway, I made a couple of calls via internet relay and got an appointment set up. Turns out my stepdad's daughter used to go to school with the doctor I'll be seeing on Tuesday, so it's good to know that he's a good person and all.

Hopefully after that appointment, the Ear Center can finish filling out the paperwork for Medicaid and we can get going with the process, that is if Medicaid approves.


Also, my mom gave me more of my audiology reports from when I was in school. Excellent! I haven't closely looked at them yet, but I will soon enough. I'm just happy to have them now, in my file box.


EDIT: Ok, I think I'm still set on picking Harmony, regardless. Did a little more browsing and comparing of both devices on the manufacturers' websites, and I know I'll be happy with Harmony. I'm sure Nucleus is an excellent device, but it's going to be Harmony for me. Nothing against Cochlear. I'll still continue to follow the news and whatnot though.

Uuummm?

Um... My hearing aid's acting all weird. I'll turn it on or try to change settings and it'll beep, then silence.... then eventually sound will come around. But that's unusual for my hearing aid. Makes me wonder exactly what's going on with it. Is there something going on with the on/off and programs switch/button? Or is it just something internal? Hm. Just not sure if I'd want to contact the local audiologist... but what other choices do I have? Hm.

Wyoming Equalitycare

So I did some browsing around last night. I explored the Wyoming EqualityCare website so I could get a good idea of what I can use my card for in terms of medical/health care. Good for 1 preventive/cleaning dental visit, few cavity treatments, any tooth extractions, in patient and out patient hospital visits, some eye care stuff, up to 20 therapy sessions will be covered, etc. I also found the Rocky Mountain Ear Center, Dr. Kelsall and the audiologist Allison all in the list of providers on the website as well, so that's good to know.

Then I tried to see if I could find out anything about Wyoming Medicaid and cochlear implant coverage. This is what I found:

Wyoming Medicaid

Wyoming provides Medicaid benefits for cochlear implant services under its EqualityCare program according to FDA indications. Adults must be post-lingually deafened. Children may be pre-lingually deafened but must be over 12 months old. Coverage is limited to a one-processor system.
Source: http://www.cochlear.org/sys-tmpl/wyomingmedicaid/

Interesting. Of course, I have no idea how old this information is, but it still is a bit of information. I am still going to work on finding out absolutely for sure though on what Medicaid/EqualityCare covers when it comes to cochlear implants.

Oooo!

Email of the day: I have interpreters lined up for the community classes I'm taking at the college. Excellent! One will interpret the dog obedience classes, starting on Tuesday. She's interpreted for me before from 9th grade up, even for some college courses and such. She's an awesome person and I really like her. I'll have a different interpreter for the photography classes on Sundays starting Sept. 20th. Also another great interpreter too. And the college is paying for the interpreters as well. Perfect.

Mail of the day: I got my medicaid card. I wasn't expecting to see it so quickly. Just yesterday I got a letter from the DFS office stating that I am eligible for Medicaid, and then today the card arrived. Whoa. Already I've emailed Rocky Mountain Ear Center to inform them I just got the card, and of what I should do next.