Why insurers pay for CIs and not hearing aids (long)

[Guest guest]

There are only two things that insurance companies care about. The first is

money, and the second is operating on the right side of what is minimally

required by the law. I've found that they really only care about operating

on the right side of the law once someone with a JD after their name has

drawn a very bright line in the sand and said " Here is clearly what the law

is. Go against it at your own very large financial risk. " Which takes you

back to rule #1 :-)

Here's the " logic " behind why insurers pay for CIs and not for hearing aids.

All people who qualify for cochlear implants by current FDA gudelines are

severely to profoundly deaf. As such, they qualify as " disabled " under

Federal ADA law. I don't want to get into a discussion about whether or not

THEY consider themselves disabled, or their parents / teachers / classmates

/ friends consider them disabled, for the purposes of this discussion just

accept at face value that a profound hearing loss is specifically listed in

federal code as a disability.

There are no other options available for cochlear implant candidates besides

a cochlear implant. So if the insurance company (or the employer, in the

case of self-insured plans) excludes cochlear implants they are making what

is referred to as a disability-based distinction (i.e. they are refusing to

provide any treatment for something that the federal goverment has

categorized as a disability). Disability-based distinctions are blatently

illegal under the ADA and the EEOC, and applies to all companies whether

self insured or not. I've successfully gotten both Apple Computer and UPS

to drop their illegal blanket exclusions in their health insurance contracts

against cochlear implants, and I am now challenging the same exclusion with

San State University.

Not all people who require hearing aids are disabled. Some are, some

aren't. Therefore, you can't use the same arguments to state that hearing

aid exclusions are illegal.

Hope that helps . . .

Sheri

>Message: 25

> Date: Tue, 20 Dec 2005 20:56:52 -0500

>

>Subject: Re: insurance

>

>I think it's very interesting that insurance companies generally cover

>cochlear implants (at least the first one - I think bilateral coverage

>is another thing altogether) but won't cover hearing aids. We talk so

>much about the importance of letting a family choose their method - it's

>unfortunate that insurance companies almost drive you in the direction

>of implants because they are covered. And I'm speaking as a parent of a

>child with an implant. It's so crazed - just doesn't make sense at all.

>

>Barbara

>

>Johanna Lynch wrote:

>

> > --- JillcWood@... wrote:

> >

> > <<Can you imagine? They would cover the surgery, the

> > hospital costs, the two surgeons, the consulting

> > surgeon, the anesthesiologist, the MRIs, CT scans and

> > every other thing you can imagine. But not a tiny

> > piece of plastic! >>

> >

> > I hope this doesn't anyone on the list, but our

> > insurance does not cover anything related to the

> > hearing aids (tests, molds, visits with audi, etc.)

> > just like a lot of us on the list. What burns me most

> > about our plan is that Viagra is covered. Please don't

> > take offense, it just makes no sense to not cover a

> > hearing aid. But that saves my husband's employer tons

> > of money so they won't budge.

> >

> > johanna