One of the first things I had to figure out about the prospect of a cochlear implant was whether insurance would even cover it. I had never really considered the possibility in the past, because for so long insurance would automatically reject people with only one deaf ear. A couple things have changed now.
In general, insurance companies are more willing to approve a single cochlear implant with hearing in the other ear. Frankly, I don’t think it would have been worth it to me, but because I was experiencing such dramatic fluctuations in my “good” ear, it seemed like a good thing to at least look into.
My doctor told me at the very first assessment that insurance might be a challenge. He said they would submit records and everything on their side, but that I should also reach out to them. As he described it, they are used to telling the doctor’s office no, but have more trouble when the actual patient is the one on the other end of the phone. I don’t know how much that actually plays into it, but I do think there’s something to be said for a patient speaking for themselves.
I should also point out that I got some help from the team at Cochlear America, even though I hadn’t yet decided what company I would use.
My first contact with the insurance company got a canned response listing requirements for consideration. It was very explicit that demonstrated binaural hearing loss was the first prerequisite, which was discouraging. They also asked for proof that traditional hearing aids wouldn’t be sufficient.
I can get behind that. There’s no sense in expensive, invasive surgery and hardware when there is an easier solution. But I was pretty concerned about the emphasis on binaural. Technically, my right ear is still considered “normal hearing” when I’m not having an episode.
Fortunately for me, it was quite easy after that. I went through additional hearing tests to determine hearing aid eligibility. Not surprisingly, my left ear had no improvement in any situation. I expected a lot more back and forth with the insurance company, but I actually never had to send them anything else. The determining factor was the hearing test results showing profound hearing loss in the left ear and major fluctuations in the right, especially since there is no telling when those fluctuations may become more permanent.
So I got a call one morning from the doctors office letting me know I was approved and we could schedule the surgery! A process I had prepared myself to take 6 months ended up taking only about 6 weeks.
If you are considering an implant, I would recommend asking your insurance what they cover and what kind of factors they consider. Each insurance is a little different in how they define what is “medically necessary,” and some companies are more more willing than others. Either way, definitely make sure your doctor is going to bat for you, but also do everything you can think of.
