Thursday, December 4, 2008

update on little m's implant surgery

i keep meaning to post about this, but then, well, i don't. this may be a boring post, but here's what's up with little m's surgery these days...

a few weeks ago, matt and i went to palo alto to meet with amy b., an advocate from the let them hear foundation. one of the things that let them hear does is provide legal advocacy for families who are appealing insurance denials related to hearing loss. since little m's surgery was denied for october 31st (and our insurance said they will deny her until she is a year), amy is advocating on little m's behalf. 

she has been pretty realistic about the expectations we should have: little m's surgery will likely happen after she turns one. there is the slight chance that blue cross blue shield will approve her implant before then, but at this point it looks highly unlikely. we are appealing less for little m's sake (although it would be great if she could get implanted before april), and more for the fact that us appealing this decision will ultimately help other little ones who are in m's situation down the road. the more people who appeal to the insurance companies and are able to prove the positive results of early implantation, the sooner the fda and insurance companies will approve surgeries under one year.

when we first received the denial paperwork, there were about 15 reasons listed as to why her surgery was being denied. we had proof to back up every single one of reasons, all of which said that we had not showed that the surgery was medically necessary, except for the last one on the list: little m is not 12 months of age. at this point, the fda approves cochlear implants at 12 months or older. are these surgeries happening before that age? yes. there are kids who have gotten implants, covered by insurance, who are in situations similar to little m, for ci's before a year old. and, if we had $120,000 to pay upfront for her surgery, little m could have gotten implanted a month ago. but, we don't have that kind of money, to fight the insurance we go!

this is how amy said things would probably happen with our insurance: first, she filed our appeal (and sent them a big stack of little m's medical files plus and even fatter book full of photocopies of every single case let them hear has won, plus research showing the benefits of early implantation). amy says they'll deny our appeal after 30 days (that's how long the insurance company has). then, she'll re appeal. a second denial after 30 more days. then the case goes to matt's  board of pensions. who knows how long that will take. of course at that point, m will be about 9 months old. 

again, it is very very likely that she won't have her surgery until a year, and that this process is in vain for our own personal situation. our own appeal process will, hopefully, help other deaf babies in the future. i can't tell you how crushed i was the night we got the phone call denying us the surgery that we thought was 36 hours away. if this process somehow saves another family from this waiting game, and works to help little ones get implants earlier so their speech and language acquisition is easier and faster, then i think it's worth it.

so we expect surgery in april, but hope for something sooner....maybe in january?

1 comment:

  1. i am so glad you have an advocate who is able to work this through with you! i wish this did not have to be so difficult and laborious for you all BUT totally understand why the appeal process is so important. support and love from us to you...


Hi friends! This is where you talk back to me. :) Easy peasy: write your comment, then scroll down where it says "comment as" to identify yourself (if you want to just write your name click Name/URL or just click anonymous. xoxoxoxo