Michael Moore's Movie "Sicko" Raises Concerns about Insurance Issues

[Hear Again]

Insurance companies rarely approve anything outside of FDA criteria for implantation without a very large fight. So someone with 80 % with aids is going to have a hard time getting an insurance company to pay for his surgery, unless he can write a very large check himself, he is not going to get the surgery

This is true. I know one CI user who was evaluated for a CI and received 53% speech understanding with HAs for sentences in quiet. Instead of naming her a CI candidate, her surgeon opted not to implant her for fear of insurance denying her claim even though she was only 3% above the limit for speech discrimination percentages. (As it turned out, this person was re-evaluated 6 months later and received a CI because her hearing dropped significantly during that period of time.)

 

[jag]

This is true. I know one CI user who was evaluated for a CI and received 53% speech understanding with HAs for sentences in quiet. Instead of naming her a CI candidate, her surgeon opted not to implant her for fear of insurance denying her claim even though she was only 3% above the limit for speech discrimination percentages. (As it turned out, this person was re-evaluated 6 months later and received a CI because her hearing dropped significantly during that period of time.)

53%? I was told at my evaluation that the gov. programs (and thus insurance companies) had set the number at 60% and this was only about 14 months ago? Has that since changed?

 

[deafdyke]

or powerful HA that only created distorted sound over the 'trendy' technology which gives me clarity of speech, those who stuggle with their HA"s and hearing/speking 'thinking' they are getting great benefit from the HA's won't "know' what they are missing without getting the 'trendy' new technology.

jag, that's not the way it is for EVERYONE. Lots of people, including people with severe and profound losses get a lot of really significent benifit from HAs.
I definitly think if a person has really poor speech discrimation scores, despite having a lot of residual hearing, they should be implanted. That said, I think that the ambigious canidates can and should really hardcore experiment with alternative hearing technologies before going under the knife.
Some "almost hoh" severe and profound folks might find that they can hear better with a body worn aid, then with a BTE. Sort of like the way hoh people can hear with ITEs but can't get maximum amplification benifit, the way they could with BTEs.
You're definitly not one of those "gotta have the latest technology" types......but there does seem to be a subpopulation sort of like with cellphones, that's into the "gotta have the latest technology." I really do believe that's hurting the cause for folks who really honestly need it. It's like "Oh no! I can't hear in noise! Oh no.......hearing with hearing aids is imperfect!

 

[Hear Again]

I for one an very happy to have the latest 'trendy' technology. It's 1000x's better then the HA's that should have benedfited me alot more then they did. I hope that many people can take advantage of the latest 'trendy' technology, even if only on one side of the head. I'm happy that my dr's persued the 'trendy' technology for me and I heard 69% in the nice quiet booth on sentence recognition before implantation.

There's alot to be said about the 'trendy' technologies advantage over the HA's. Why would I want to use a cumbersome body aide (which was never offered and which I'd concider a PITA) or powerful HA that only created distorted sound over the 'trendy' technology which gives me clarity of speech, those who stuggle with their HA"s and hearing/speking 'thinking' they are getting great benefit from the HA's won't "know' what they are missing without getting the 'trendy' new technology.

To me being hoh with a CI is much better then being hoh with a HA. I'll take the new 'trendy' technology any day.

For 6 out of the 10 years I had severe-profound hearing loss, I spent 100% of my time connected to various microphones and cables just so I could hear. I used a Comtek FM system connected to my HAs with direct audio input. In addition to the stereo DAI cord, I had a "boom" microphone plugged into my Comtek receiver so I could point it at someone and hear them. I also had a lapel microphone that I used for class lectures and group discussions. In addition to the "boom" and lapel mics, I also had an environmental microphone which allowed me to hear environmental sounds. I must have looked so silly with all of those microphones and cables attached to me and I wouldn't doubt it if some people actually felt sorry for me because of how much equipment I had to carry in order to hear.

When my hearing loss reached the point where the Comtek could no longer help me, I still continued to wear it so that I could hear environmental sounds better.

When I think back upon those days, I almost feel silly because of how much I tried to hang onto the last bit of residual hearing I had. It wasn't until an audi who fitted me with my first pair of BTEs said to me, "You have very, very little residual hearing left. How much are you *really* hearing with your Comtek?" that I realized just how little I was hearing.

I didn't seriously consider getting a CI until 3 audis (my former HA audi, my university audi and the audi who fitted me with my first pair of HAs) encouraged me to do so insisting that I would be an excellent candidate. My CI application spent close to a month sitting in a drawer because I thought I had too much residual hearing to qualify. As it turned out, I "failed" with flying colors and as they say, "the rest is history."

 

[Hear Again]

Jag,

I'm sorry...that was a typo. I meant to type 63% -- not 53%.

 

[LTHFAdvocate]

Some insurance companies follow Medicare guidelines, which requires 40 % for normal implantation and 60 % if you are in a clinical trial. So it's a YMMV sort of thing -- depends on whether your insurer follows a) Medicare, b) FDA, or c) whatever it wants to make up itself.

Sheri

53%? I was told at my evaluation that the gov. programs (and thus insurance companies) had set the number at 60% and this was only about 14 months ago? Has that since changed?

 

[Hear Again]

Some insurance companies follow Medicare guidelines, which requires 40 % for normal implantation...

This also happens to be the case in order for someone to qualify for bilaterals. My speech discrimination with CI/HA had to be 40% or below to qualify for a second CI.

 

[jag]

This also happens to be the case in order for someone to qualify for bilaterals. My speech discrimination with CI/HA had to be 40% or below to qualify for a second CI.

I really think it would be nice if those who make up the rules had to actually live with the rules they make. Someday maybe they'll hear only 69 % like I did and be frustrated to because they set the bar where it is. Of course if we had socialized medicine it would probalby be the 50% or lower and they'd do kids first.

 

[deafskeptic]

I for one an very happy to have the latest 'trendy' technology. It's 1000x's better then the HA's that should have benedfited me alot more then they did. I hope that many people can take advantage of the latest 'trendy' technology, even if only on one side of the head. I'm happy that my dr's persued the 'trendy' technology for me and I heard 69% in the nice quiet booth on sentence recognition before implantation.

There's alot to be said about the 'trendy' technologies advantage over the HA's. Why would I want to use a cumbersome body aide (which was never offered and which I'd concider a PITA) or powerful HA that only created distorted sound over the 'trendy' technology which gives me clarity of speech, those who stuggle with their HA"s and hearing/speking 'thinking' they are getting great benefit from the HA's won't "know' what they are missing without getting the 'trendy' new technology.

To me being hoh with a CI is much better then being hoh with a HA. I'll take the new 'trendy' technology any day.

I'd much prefer my CI to my old analog HA. It's a vast improvement over my old analog HA.

 

[Hear Again]

I really think it would be nice if those who make up the rules had to actually live with the rules they make. Someday maybe they'll hear only 69 % like I did and be frustrated to because they set the bar where it is. Of course if we had socialized medicine it would probalby be the 50% or lower and they'd do kids first.

I couldn't agree with you more. I've always said that if the people who work at insurance companies could experience what it's like to be severely hard of hearing or deaf, they would have a different perspective about what life is really like for someone who cannot hear.

I'd also love it if these people could experience deafblindness. As I mentioned in a previous post, I know a CI user who has been trying to obtain a bilateral CI for the past 6 years but because he only has Medicare coverage, he cannot receive a second CI.

 

[LTHFAdvocate]

Depends on your definition of "a lot of benefit".

If it is PTA scores but doesn't translate into speech recognition scores, then I would say they are implant candidates anyways on the dead side. Speech isn't the same as beeps.

Another question is whether or not the person is known to have a progressive loss. If the loss is progressive and the person is inevitably going to be a CI candidate in both ears, you might implant the dead ear earlier, knowing that the ear that gets benefit is going to be dead eventually.

I disagree that bilateral implantation is relatively rare. 15 % of the US implants in 2006 were bilaterals. In some countries, 100 % of children are bilaterally implanted. Thanks to our appeals programs, almost 1/2 of Americans have coverage for bilateral implants, and I hope that will be closer to 100 % in another eighteen months.

Sheri

On the other hand Sheri, what about cases where the person has a "dead" ear, but gets a lot of benifit being aided on the other side?
Do you think there might be a bit of a downturn in implantation, if insurance cos covered hearing aids?
I'm totally not against it. In fact I am VERY supportive of them in the right circumstances.... but I do think that the "gotta have latest technology" group,
I really think that bilateral CIs are probaly going to remain relatively rare. After all, relatively few Americans have really really superb insurance that covers bilateral implantation. Also a lot of people tend to have uneven losses or whatever. I know too that its very indivdualistic....there are people who LOVE the HA/CI combo, and then there are people who love CI/CI combo. Hell, there are even people who still love plain ol' analog aids!
Good on you for pointing out that its 97% of canidates. Not all dhh kids are eligable for implantation, and in countries with socialized medience it's very difficult to qualify off the bat.

 

[Hear Again]

I think bilateral implantation will become standard practice within the next 5 years, if not sooner. With more and more research being conducted in regards to the benefits of bilateral CI hearing and more children/adults being implanted bilaterally, insurance companies will come to realize the many advantages of being bilateral.

 

[deafdyke]

I disagree that bilateral implantation is relatively rare. 15 % of the US implants in 2006 were bilaterals

Yeah, but that is

relatively

rare.
That's only about 15%. How many were performed in 2006?
It's very hard to say if bilateral implants will ever become the norm. Also, maybe the group appears to be growing b/c the people with generous benifit plans are getting them. Plus the people who desperately need them (after all, bilateral VERY significent impairement that can't be helped with hearing aids, at ALL is pretty rare) Some people may have them, but b/c satisfication with hearing technology is so across the board.... Like one person may have bilateral implants but, the other person may have a combonation of CI plus top of the line digital aids. Just really hard to say you know?
PLUS, the difference in hearing with bilaterals is very minimal. Basicly sound localization, and abilty to hear in noise. It's not like a bilateral CI improves speech perception or whatever. It just seems like a lot of cost (for insurance, shareholders etc) for somewhat minimal benifit. I mean unilateral hoh folks can't localize sound and the gross majority of hoh folks have difficulty in noisy situtions (hell even HEARING people have trouble in noisy situtions. I just returned from a girls weekend out
Oh and Hear Again, that's awesome awesome that you waited til it was absolutly needed to get the CI. I have NO beef whatsoever with people like you. But, there does seem to be a significent albielt small group who seems to be doing sort of the "it's the latest technology. Therefore it's got to be the best, therefore I need it instead of hearing aids or other options types."

 

[R2D2]

But, there does seem to be a significent albielt small group who seems to be doing sort of the "it's the latest technology. Therefore it's got to be the best, therefore I need it instead of hearing aids or other options types."

Sorry but I disagree with you. I've never observed people who benefit significantly from hearing aids exchanging them for CIs for the sake of gagetry alone on this board nor on CI Hear either, which is a very large CI e-mail group. As if insurance companies are going to fund such people anyway!

My observation is that people who benefit well from hearing aids tend to be very reluctant to give that up for something that is irreversible, even if they might get better results. I was like that. An audiologist once suggested that I look into CIs a few years ago but I firmly said "no" and my main reason was because of risk and it was only when I lost my residual hearing that I did something about it. And this even though today my CI outperforms my hearing aid back then.

I think you tend to notice a couple of obnoxious people on a particular board and you can almost convince yourself that there are lots of people like that. It's like taking a couple of deaf militant extremists on a board and thinking that there are lots of them out there. There are jerks in every population, nothing can be done about that.

 

[ismi]

PLUS, the difference in hearing with bilaterals is very minimal. Basicly sound localization, and abilty to hear in noise. It's not like a bilateral CI improves speech perception or whatever. It just seems like a lot of cost (for insurance, shareholders etc) for somewhat minimal benifit. I mean unilateral hoh folks can't localize sound and the gross majority of hoh folks have difficulty in noisy situtions (hell even HEARING people have trouble in noisy situtions.

You've posted a lot of variations on this theme, but I think there are two flaws in your argument. One is that the benefits involved are greater than you suggest. For example, you keep pointing out that even hearing people have difficulty hearing in noise; while this is true, the threshold where noise becomes a problem is much lower for people who are HOH, or have implants. Also, speech perception is not the be-all, end-all of hearing; there's a lot of focus on that, because it is one of the more important results of having hearing, and perhaps because that used to be all you could hope for; but there's something to be said for music perception and localization.

The other major flaw is that your goal seems to be "good enough" - keeping up with the hearing world. There may be something to be said for the point of view of implantation as a form of bodily augmentation. That is, rather than looking at an implant or a hearing aid simply as a way of accessing speech - of fixing what's broken, if you will - why not look at it as providing oneself with additional capabilities? The abilities that an individual gains by getting an implant (or any other body augment - a hearing aid, a wheelchair, an orthotic) may not be directly comparable to normative human functioning, anymore than a watch is comparable to one's internal sense of time; but that's no reason not to consider it, particularly if it helps compensate for a reduced capability in some function that is considered normative.

 

[Drew's Dad]

The other major flaw is that your goal seems to be "good enough" - keeping up with the hearing world [...] The abilities that an individual gains by getting an implant (or any other body augment - a hearing aid, a wheelchair, an orthotic) may not be directly comparable to normative human functioning, ... but that's no reason not to consider it, particularly if it helps compensate for a reduced capability in some function that is considered normative.

Yes. It really doesn't matter to me if bilateral CI's don't compare to "normal" hearing. Any significant gain in abilities that outweigh the varied costs of being implanted means (to me) that the implantation is "good enough". Each person's conclusion will vary, but whether the CI-aided hearing is identical to "normal" hearing is irrelevant to me - though good to know from an expectation standpoint.

 

[set2]

I don't think anyone really thinks of CIs as the latest "trendy gotta have latest technology" I think they are looking into them because they want to hear better than what they are with HAs.I don't think anyone is going to find them as "trendy" when they see the large BTE. If a person can achieve better hearing with a CI then a HA they should be able to get it. One of the questions that a CI evaluation answers is "Will the patient hear better with a HA or a CI? " If it is determined the person could hear better with a CI then they are a Candidate. Likewise, If someone could hear better with bilateral CIs than with a CI/HA combination then they should be able to get a second CI. No CI program is going to give someone a CI unless they are going to benefit from it and not just some slight benefit (say 5 %).

It is good people are talking about this now because there are a lot of baby boomers and younger who will be able to benefit from Hybrid implants. We are just seeing the tip of the Iceberg.

a bit off topic but related:

How do we pay for all this hearing technology, I have an idea:

I find it unconsionable that our goverment allows corporations to sell devices (MP3, CD) that are damaging the hearing of the those who use them. I think the corporations manufacturing such devices as well as the music industry (Baby boomers damaged there hearing going to concerts) should have to put money into a fund that will cover HAs and CIs for those who can't afford them.

I also think we need to encourage hearing preservation. There should be Public Service announcements featuring music stars. The music stars are taking care of their hearing. I noticed that The Dixie Chicks wore Ear monitors and two of the Police wore hearing monitors at recent shows. (In case you are wondering, I bring binoculars and have a habit of checking, LOL) Prevention would preserve hearing. There should also be warnings on Concert tickets. If it save people from Hearing Loss Hell it would be worth it!


I have had tinnitus since a concert 20 years ago and have been one of the few to wear Hearing protection at concerts since then. That is why I feel so strongly about this.

 

[shel90]

I don't think anyone really thinks of CIs as the latest "trendy gotta have latest technology" I think they are looking into them because they want to hear better than what they are with HAs.I don't think anyone is going to find them as "trendy" when they see the large BTE. If a person can achieve better hearing with a CI then a HA they should be able to get it. One of the questions that a CI evaluation answers is "Will the patient hear better with a HA or a CI? " If it is determined the person could hear better with a CI then they are a Candidate. Likewise, If someone could hear better with bilateral CIs than with a CI/HA combination then they should be able to get a second CI. No CI program is going to give someone a CI unless they are going to benefit from it and not just some slight benefit (say 5 %).

It is good people are talking about this now because there are a lot of baby boomers and younger who will be able to benefit from Hybrid implants. We are just seeing the tip of the Iceberg.

a bit off topic but related:

How do we pay for all this hearing technology, I have an idea:

I find it unconsionable that our goverment allows corporations to sell devices (MP3, CD) that are damaging the hearing of the those who use them. I think the corporations manufacturing such devices as well as the music industry (Baby boomers damaged there hearing going to concerts) should have to put money into a fund that will cover HAs and CIs for those who can't afford them.

I also think we need to encourage hearing preservation. There should be Public Service announcements featuring music stars. The music stars are taking care of their hearing. I noticed that The Dixie Chicks wore Ear monitors and two of the Police wore hearing monitors at recent shows. (In case you are wondering, I bring binoculars and have a habit of checking, LOL) Prevention would preserve hearing. There should also be warnings on Concert tickets. If it save people from Hearing Loss Hell it would be worth it!


I have had tinnitus since a concert 20 years ago and have been one of the few to wear Hearing protection at concerts since then. That is why I feel so strongly about this.[/QUOTE]


My aide, who grew up in deaf schools and strong Deaf Culture, had the same problem as u which is why she got her CIs 5 years ago at the age of 30 even thought she really didnt want them. She was so happy that the CIs really did eliminate her tinnitus in addition in helping her to be able to communicate with hearing poeple a little better. Funny, she said that she understands them so much better but they still struggle to understand her cuz her speech skills are terrible while myself, without CIs, is the total opposite..hearing people can understand me better than I can understand them. LOL!

My dad is a baby boomer and is rapidly becoming deaf (he is 57 years old)..he keeps saying "huh"? and all that but refuses to have his hearing checked...I think he is scared. I think his hearing loss is from all the concerts he went to in the 70s...nothing related to genetics but he is just in denial and I keep tellig him that CIs or HAs will help so pls consider them. He said "FUCK I aint gettng a magnet in my head! I can HEAR! " Ok..whatever;...

 

[deafdyke]

Well overall I've seen a lot of " waited til I really needed it." people.
That does rock.

I think actually that the "techno trendies" may be a dying breed. I have seen a more realistic portrayal of the CI...........but, I mean I'd say that there are still some of them out there. They aren't NUMEROUS NUMEROUS, but they are basicly the same sort who were all "digital revolution!" back when digitals came out.

If a person can achieve better hearing with a CI then a HA they should be able to get it.

But where should the dividing line be between CI canidate and HA user?
The fact of the matter is that response to hearing technology is just so indivdual, that its hard to say.
I mean if a person is borderline for canidacy I think that they should go see an audi at a really good clinic and spend some time doing an intensive HA try out, just to see if changes and tweaks in a HA might improve their hearing status a little.

 

[R2D2]

I mean if a person is borderline for canidacy I think that they should go see an audi at a really good clinic and spend some time doing an intensive HA try out, just to see if changes and tweaks in a HA might improve their hearing status a little.

No one disagrees with that and I believe in practice this is what already happens for most, if not all, borderline candidates. However, I dont' think you are going to get huge differences in quality among the same class of hearing aids, unless the audie is absolutely inept at programming, as was the case with Tami Ann. I think it's enough to take home 2 or 3 hearing aids to try out.

To be honest I think more energy in debating this point could be diverted toward those who easily qualify for CIs and who have strong motivation to make them work but who cannot get them for insurance reasons. And you're worried about the relative few who might have done just as okay with hearing aids? It's not as if the money potentially saved from one group of people is going to get transferred to the uninsured is it? The saving will simply go to bottom line in their profit and loss statement.