Thursday, November 12, 2009

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.

15 comments:

PinkLAM said...

Ugh, that must be so frustrating! They just don't get it.Good luck with the appeal!

Charlotte said...

Urgh thats absurd! I have good speech too But cannot understand speech without lipreading. The ENT said "as you got good speech i think you'll do well with the implant"..... We are rooting for you, good luck with the appeal.

Charlotte said...

Urgh thats absurd! I have good speech too But cannot understand speech without lipreading. The ENT said "as you got good speech i think you'll do well with the implant"..... We are rooting for you, good luck with the appeal.

sara said...

So stupid. I was denied SSI for that reasoning, but it doesn't make sense to deny a CI if you for someone who meets the medical hearing loss criteria!

MHobratschk said...

First, federal law requires they give you the denial in writing. Telephone is unacceptable. Second, the reason the gave is definitely an appealable issue. They have to give you a written copy of their cochlear implant policy, which sounds like it goes beyond FDA criteria. Also make sure to meet their appeal deadline.
AB and Cochlear can handle basic appeals like this just fine, so you're in good hands with either one. If it gets more complicated, feel free to contact me with any Qs.

Meghan said...

it was Rocky Mountain Ear Center that have gotten the denial. I did request for a copy of the denial if there is a letter, and asked if there was anything I should do or if Advanced Bionics could take care of the appeal on their own easily. I'm still quite clueless on how the process works, but I'm willing to learn so I can advocate for myself.

Foxnewscritic said...

Meghan, you got good advice last night in the Hearing Journey chat.

Another option: Move to another state and apply through their Medicaid. Move to the right state, and you'll also get a better CI center, too. NY is pretty good.

Meghan said...

I don't even remember all the advice from the chat last night. and there is no way I can afford to move out of state, much less another town right now. And Rocky Mountain Cochlear Implant Center is actually a pretty good CI center.

suddensilence said...

I just have to chime in here and say how ridiculous this denial is. I've never heard of speech quality being part of the cochlear implant approval process. If that were the case, I would have been denied because I could speak well and speak clearly, and I was TOTALLY DEAF in both ears.

In a way, it's almost good news because this should be easy to appeal. The only thing they should be considering is the amount of hearing loss you have.

I'm glad you're not giving up, and I hope AB can help you get quick resolution and an approval. You deserve it...you've been working so hard to get your CI!

~ Wendi

ROBERT said...

I got bacterial spinal meningitis last Chrismas eve, as a result was deaf in both ears. I got my first implant in May. The second implant I was turned down because the Insurance co. said it was "experimental". AB sent them plenty of backup showing it was not experimental. So the Insurance company on the next turn down did not even hint on the word experimental they jump to I can hear with one implant I don't need a second.
We are still appealing.
Of cause they don't address the problem that with my left implant while I am driving (which I do alot of) if someone is talking to me from the passeger seat, I need to turn my head away from the road so I can listen and read lips. Or that in my business of commercial pool renovations I need to walk along the top edge of empty pools, walking like I am drunk because I don't have good balance with one ear.

Meghan said...

insurance companies, ugh!

Alice said...

I'm very sorry you were denied. Let AB and the center go to work on this abd have faith. With good speech and lipreading skills, you are an excellent CI candidate. Good luck. I have a feeling this will turn out in your favor.

http://www.cihear.net

Meghan said...

Thanks Alice. I've just been forwarding stuff on to Advance Bionics and such. I'm sure they can get this turned around. It's just frustrating, since EC has indeed covered implants in the past, so... they must have changed or added to their criteria since then, I have no idea.

myspace.com/itsmewanda said...

Will someone tell me what happened?
We live in Wy. waiting for the approval of a Cochlear ear implant from Medicaide.
My husband went totally deaf after wearing aides for 35 years. he will be devasted if he can't have an the implant.....

myspace.com/itsmewanda said...

It seems like when you lose your hearing it is so hard.You can't communicate with hearing people or deaf people....