Did I just hear 'principal punch'?

Had a quick hearing test with the CI audiologist today. She was making her trip through Wyoming to meet with clients for mappings and such, and agreed to do a quick hearing test with me. Originally I was to go to Cheyenne tomorrow, but then I found out she was coming HERE the day before. So I went to the special education services building and was directed to the audiology office. The school audiologist is excited that I'm working on getting the implant. He made a copy of my Medicare and Medicaid cards for the CI audiologist since she wanted to take the copy back to her office to add to my file. The CI audie and I went into the soundbooth. Took her a few minutes to get her laptop up and running. She pulled up a program and we got started. It was just a quick test, not a full-out test with beeps and tones. Just sentences. And these were difficult sentences, oh my goodness! And there were different voices being used too (male and female). I understood the female voices better than the male's for the most part. I got maybe 2 full sentences right on, but all the rest were a bunch of mumble-mumble-WORD-mumble blah blah blah blah what?

One sentence said something about personal touch like "I'm going to add some personal touch" or something like that. I could've swore it said "principal punch." Anyway, we did 2 different rounds of sentences. First round, I got 7%, second round, 21%. Well, I definitely meet Medicare's criteria for cochlear implant coverage! CI Audie and I talked some more, trying to work out a plan of some sorts. We're going to shoot for a March/April surgery date for the cochlear implant. I'd rather do it sooner, but I'd have to travel to Denver, and with the holidays and winter coming up, I decided it'd be better to wait until early Spring.

When the audie gets back to Denver, she'll speak with the surgeon and see if we can schedule the initial visit with the surgeon and the pre-op into one appointment, so I wouldn't have to make two separate trips. She also mentioned she was planning to come back here sometime in April, so if we could do the surgery in March, then I could see the audie when she comes here for activation. It would be great if this happened, but we'll see what happens.

My Medicare coverage starts up next month, and they will cover 80% of the implant, and Wyoming Medicaid will cover the remaining 20%. Late last week, the audie had heard that Medicaid wasn't covering implants for adults anymore, but that applies to Colorado. Wyoming Medicaid is still covering them (I confirmed this via email with someone from Wyoming Medicaid's office on Monday and got the update "covered services" manual as well).  Seems like everything's all falling into place for me, finally. I've been working at this for years, since I was in high school. I'm glad I can finally progress with the implant. I'm still going to do the left ear alone, and I'm definitely choosing Advanced Bionic's device as well. Hopefully by spring next year the new Neptune processor will be available. Audie told me I should be able to get 2 processors, so if that's the case, I'd like to have the Harmony for everyday general use, and the Neptune for back up and for being in wet situations (I do have some very young nephews who do like to splash and squirt water guns).

Audie told me I should be hearing from someone from the CI Center's office within the next few days or so, to get things more set in stone/planned out basically.

And now for hearing aid stuff... I see my hearing aid audie later this afternoon to have a new earmold made for the right ear. I don't think the current earmold fits as well anymore. Been more than a year, so it's about time for a new one anyway. Should be fun! Two different audiologists in one day.

Dilemma

After calling EqualityCare to discuss coverage for hearing aids, basically if I wanted to get a new hearing aid nowadays to replace my old one, I should have just requested the Otion Sumo hearing aid instead of Phonak sending back a replacement. So now I'm trying to get in contact with the audiology office again, and see if we can work something out. It wasn't a repair to my old hearing aid, it was fully replaced with a new Supero. Yes, it works, but sometimes I just wonder if another hearing aid might be better. So I'll call the office again in about half an hour or so (when they get done with lunch) and see if something can be worked out. My original Supero was already 6 years old when Telecoil went busted (and apparently Phonak couldn't fix it), so EqualityCare would have covered a new hearing aid to replace the old one (they will cover new hearing aids after the old one has been used for 5 years and the warranty has expired). The replacement Supero is technically a whole new hearing aid, right?


EDIT: called audiology back.. it's still the same old Supero, just has new parts. The way the audiologist said it this morning, I got confused. Mentioned that I would like to at least trial an Oticon hearing aid, yada yada. Yeah. Got that straightened out.

So frustrating

A few weeks back, I sent an inquiry to the Wyoming EqualityCare office about their criteria for cochlear implant coverage. Today I've gotten a response. Since I sent in the inquiry, they've removed the "no communicating" bit from their criteria. Great!

But... I have to have scored 40% or worse in order for Medicaid to cover the implant for me. I've scored somewhere a bit over 50% with the right ear (0% for left ear). Ugh! Advanced Bionics insurance reimbursement already knows of this. I'm waiting on a response from Allison Biever to see if there's something else we could do. I am so incredibly frustrated right now. I do know there is still the CNI Cochlear Implant Assistance's program, and I may have to go that route afterall. I want to see what Allison has to say first.

Medicaid's Criteria

Advanced Bionic's insurance reimbursement just caught this contradiction with Medicaid's cochlear implant for adults coverage criteria.
The first criteria states: "patient must have post lingual deafness" so patient need to have developed speech before becoming deaf.
But then later on, it states "patient must have no means of communicating." Contradicting, isn't it?

Hopefully Advanced Bionics will be able to get a hold of someone at the Medicaid office and let them know of this "error" and that they get it fixed. I'm surprised I didn't catch this sooner. Wow.

Difficulties

So, I guess Wyoming EqualityCare is being difficult with the appeal case. The person at Advanced Bionics working on my appeal case is resubmitting everything. She's requesting for copies of my medical records and another letter from Rocky Mountain Ear Center so she can send that in. I've already resent the copy of the denial letter so she could use it as well. So frustrating! Hopefully this time we actually get somewhere with the appeal, and actually get an answer!

Oy!

Turns out Medicaid didn't get the stuff Advanced Bionics insurance reimbursement sent to them, so AB is having to resend the stuff. They're sending it via Fed-Ex and someone at Medicaid will have to actually sign to receive it. Oy!

Internet relay called the local audie's office and made an appoinment for next Wednesday to get a new earmold made. And I asked if they knew Medicaid covered this sort of thing, and nope they don't. I figured as much, but I figured it couldn't hurt to ask. No big deal.

Also bought a Dry & Store unit off someone on eBay.. I figured it was about time I had one. Maybe if I used it for my hearing aid, and it cleaned my hearing aid and earmold, I wouldn't have as many ear irritation issues. Wyoming is pretty dry, so moisture in the hearing aid isn't much of a problem.. but it couldn't hurt to have a Dry & Store as I do occasionally get moisture in the earmold tubing just from wearing the hearing aid all day, etc. And it'll be useful for whenever I get the implant too.

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.

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.

Crazyness

I emailed the person who is in charge of lining up interpreters and any other assistance one might need when taking classes at the college, informing him I was registering for a couple of community classes and would like to have an interpreter. His response? "You should contact (insert 2 names)!" Um, say what? So then I emailed another interpreter and told her of what was going on, and she got back to me, saying she had spoken with another interpreter. They both told me I did the right thing by emailing the college person, and that the one interpreter was confused over his response to me. Today, I got another email from the college person, and finally an interpreter is being lined up. I do have to sign a contract, and had to confirm which courses I was taking for him. Not a problem. I'm registering for Dog Obedience (my dog Bryan, boy he could really learn some manners!) and Introduction to Digital Photography. Now, I'm sure I'd fly through the photography class with no problems, but I thought it'd be fun to take. Gives me something to do on Sundays for about a month or so. And the dog obedience, that should be an interesting experience.

Still waiting to hear about medicaid. Since I did qualify for SSI, I should be able to get medicaid. But as to whether or not medicaid will cover cochlear implants, I don't know yet but I'll find out somehow. Seems like the auditory rehab is already taken cared of for whenever I do get the implant. Excellent! I am quite anxious to get things rolling, but of course, I have to be patient, and wait to get all the information in the mail and whatnot.