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

:gpost: R2D2,] . It really put this issue in perspective.
 
The data shows that bilateral implants are already an accepted recommendation in the otology community, and will become a standard practice as more and more insurers start covering them. We did a comprehensive survey last year of all US cochlear implant centers where 73 % of centers reported having done at least one bilateral implant, and 1/3 of the centers who had not, had recommended one but been blocked from performing the surgery due to insurer denials. That is a total 84 % rate philosophical adoption of bilateral cochlear implants by cochlear implant surgeons. Today, the number is actually closer to 90 % because several surgeons who reported never having performed a bilateral who belonged to a closed HMO have started doing them as the result of policy changes that our Foundation was involved with helping make happen.

Let Them Hear Foundation :: Advocacy

I really hope to put myself out of a job in 18 months and move on to the next thing that insurers won't cover which I think will be hybrid implants. I will be even more personally vested in the fight because my daughter is almost a hybrid implant candidate.

Sheri


Hear Again said:
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.
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That is only true for Medicare. There are actually no FDA rules specifying audiological guidelines for bilateral implantation. Medicare has decided to go with the most conservative approach which is that to get the second one, you still have to meet the guidelines to get the first one. Most private US insurers do not use this criteria, they look to see whether or not the patient gets any speech benefit from aiding the unimplanted side.

Hear Again said:
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.
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deafdyke said:
Yeah, but that is rare.
That's only about 15%. How many were performed in 2006?
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Once again, a disagreement in semantics. My daughter has Branchio Oto Renal Syndrome. That syndrome affects 1 in 50,000 people, which fits my definition of "relatively rare." 15 % is better than 1 in 7. I don't consider that relatively rare, especially when you are looking at a situation where the past couple of years leading up to the 2006 results, the numbers were substantially lower. The 15 % of bilateral implant recipients in 2006 in the US probably represents a total of slightly over 1000 patients, of which almost 200 got their approvals courtesy of our appeals program. Several hundred more of those 1000 likely got their approvals as a result of policy changes that took place as a result of our appeals.

It was reported at the April 2007 CI conference in Charlotte that the current # of bilateral implantations worldwide is over 5000, which over 3000 of those are in children.

deafdyke said:
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
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Actually, studies show that bilaterals do improve speech perception. Please refer to Dr. Tyler's paper from April of this year which found:

"Results showed that all subjects received a significant bilateral improvement on at least one speech perception test compared to either implant alone."

Speech perception and localization with adults wit...[Ear Hear. 2007] - PubMed Result

and Dr. Kuhn-Inacker's paper from 2004 which found that:

"Qualitative and quantitative data show clearly that bilateral CI improves the children's communicative behaviour, especially in complex listening situations. Children examined with the speech in noise test scored significantly better under the bilateral condition compared to the unilateral condition. Integration of the second implanted side and use of binaural information was observed to be easier and faster in children with a short time lag between both implants. "

Int J Pediatr Otorhinolaryngol. 2004 Oct;68(10):1257-66

Finally, never discount the importance of the ability to localize sound -- I've lost track of how many stories I've heard about serious physical injuries that have happened due to the lack of ability to localize sound, or injuries that were avoided due to the recovered ability to localize sound.

Additionally, I receive almost continuous anecdotal reports from patients and parents of patients that we have previously done appeals who are reporting how much better/easier it is for the CI recipient after they received their second implant at work/school, and several whose children are achieving 90 % HINT scores with bilateral implants.

Remember, the cost to provide bilaterals to everyone is $1.25 per person per year, when averaged out over the entire country. You can't even get a cup of coffee at Starbucks for that. And if insurers covered more simultaneous bilaterals, the costs would be even lower, because of the average $22K reduction in OR fees, surgery fees, and rehab time due to both implants being done in one surgery over sequential procedures.

Sheri
 
jillio said:
I haven't seen the documentary yet, but do look forward to it. I have some rather strong opinions of our health care system--in particular, insurance companies, however, so remaining objective won't be easy!:giggle: But whether you agree or disagree with Moore, he certainly makes you think, and that is a good thing.
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He doesn't make me think anything but the following: "I don't like liars." Moore wouldn't know fact from fiction if it bit him, and so I ignore all his stuff. I don't care about his politics--I just don't pay attention to people who lie. (I feel the same about Ann Coulter.)
 
LTHFAdvocate said:
That is only true for Medicare. There are actually no FDA rules specifying audiological guidelines for bilateral implantation. Medicare has decided to go with the most conservative approach which is that to get the second one, you still have to meet the guidelines to get the first one. Most private US insurers do not use this criteria, they look to see whether or not the patient gets any speech benefit from aiding the unimplanted side.
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Sheri,

What do private U.S. insurers consider to be "lack of speech benefit?" 20% speech discrimination? 60% speech discrimination? Do they compare the percentages between CI only and CI/HA?
 
deafdyke,

Actually I can tell you that having bilaterals *does* improve my speech perception. With two CIs, speech is much easier to understand both in quiet and in noise. Two CIs also give speech a fuller, richer sound quality that I don't hear when only using one CI.
 
LTHFAdvocate said:
Remember, the cost to provide bilaterals to everyone is $1.25 per person per year, when averaged out over the entire country. You can't even get a cup of coffee at Starbucks for that. And if insurers covered more simultaneous bilaterals, the costs would be even lower, because of the average $22K reduction in OR fees, surgery fees, and rehab time due to both implants being done in one surgery over sequential procedures.

Sheri
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Sheri,

I was going to ask you about the cost of simultaneous vs. sequential bilaterals and assumed that simultaneous bilateral implantation would be less expensive.
 
Hear Again said:
deafdyke,

Actually I can tell you that having bilaterals *does* improve my speech perception. With two CIs, speech is much easier to understand both in quiet and in noise. Two CIs also give speech a fuller, richer sound quality that I don't hear when only using one CI.
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Yeah, Hear Again has stereo! Lol, don't mind me.....
 
Capmeister said:
He doesn't make me think anything but the following: "I don't like liars." Moore wouldn't know fact from fiction if it bit him, and so I ignore all his stuff. I don't care about his politics--I just don't pay attention to people who lie. (I feel the same about Ann Coulter.)
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Okay. \\and his lies would be.....?
 
jillio said:
Okay. \\and his lies would be.....?
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There are many websites that go into deep detail on what some consider his lies. Here is an example concerning Bowling For Columbine:

Truth about Bowling for Columbine

I find it unfortunate because I am interested in the topics he covers, but I find that I can't appreciate his "documentaries" because I can't tell what is honestly portrayed and what is edited, left out, or stretched to fit his pre-concieved point of view on the matter. In my opinion he takes too much liberty with the films and it destroys his credibility too much.
 
Since there are no FDA guidelines, the insurers can pretty much do whatever they want regarding the definition of lack of benefit provided their rules are promulgated in "good faith" and not contrary to the general opinion of the otolaryngological community. Since the opinion of all ENTs is hard to derive, we're pretty much back to "whatever they want."

Keep in mind, it is really still quite early in the game, no insurer has been covering bilaterals for more than 12 months, and 1/4 of them have only been covering them for 4 months, so criteria is definitely still very much a moving target. That being said, so far, from what I've seen, they are not looking a SD scores on the implanted side, they are only looking at whether aiding the second side adds any value to the SD scores on the implanted side.

This leaves patient with "ceiling effect" SD scores on the implanted side in quite a grey area, i.e. you can't prove that the aiding the unimplanted side does or doesn't do anything for them. For those patients (who generally still have HINT scores in the 50-70 % ranges) we focus on that particular test instead. With children, we also focus on any areas where the child is documented to be behind age appropriate levels, generally focusing on articulation, syntax, expressive/receptive speech etc.

Hope this helps

Sheri

Hear Again said:
Sheri,

What do private U.S. insurers consider to be "lack of speech benefit?" 20% speech discrimination? 60% speech discrimination? Do they compare the percentages between CI only and CI/HA?
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Focus on the message, not the messenger -- there are very few people that I know that would contend that the American health insurance system doesn't require extremely fundamental changes if not a complete overhaul.

For what it's worth, the family I worked with is thrilled with how the movie turned out. Also, there is supposedly a People magazine follow-up article coming, if anyone sees it and could let me know, I would very much appreciate it.

Sheri

Drew's Dad said:
There are many websites that go into deep detail on what some consider his lies. Here is an example concerning Bowling For Columbine:

Truth about Bowling for Columbine

I find it unfortunate because I am interested in the topics he covers, but I find that I can't appreciate his "documentaries" because I can't tell what is honestly portrayed and what is edited, left out, or stretched to fit his pre-concieved point of view on the matter. In my opinion he takes too much liberty with the films and it destroys his credibility too much.
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Drew's Dad said:
There are many websites that go into deep detail on what some consider his lies. Here is an example concerning Bowling For Columbine:

Truth about Bowling for Columbine

I find it unfortunate because I am interested in the topics he covers, but I find that I can't appreciate his "documentaries" because I can't tell what is honestly portrayed and what is edited, left out, or stretched to fit his pre-concieved point of view on the matter. In my opinion he takes too much liberty with the films and it destroys his credibility too much.
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Oh, for heaven's sake! The website you referenced is put out by someone trying to sell their own book. He has a vested interested in his claims-financial. He's no more impartial than you accuse Moore of being.
 
:gpost:
LTHFAdvocate said:
Focus on the message, not the messenger -- there are very few people that I know that would contend that the American health insurance system doesn't require extremely fundamental changes if not a complete overhaul.

For what it's worth, the family I worked with is thrilled with how the movie turned out. Also, there is supposedly a People magazine follow-up article coming, if anyone sees it and could let me know, I would very much appreciate it.

Sheri
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MyBlueEyes said:
Sorry, Moore is full of shit !!! :barf:
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Okay. You're entitled to your opinion. But do you agree that the private health insurers have had many negative consequences on the health care received by United States citizens?
 
shel90 said:
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;...
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My dad is a bit deaf now. I wouldn't presume to suggest he get a hearing aid as not everyone likes them. My great grandmother was very deaf and refused to have a hearing aid. She had a right to that choice. I don't think we should push elderly people into getting hearing aids if they don't want them.
 
dreama said:
My dad is a bit deaf now. I wouldn't presume to suggest he get a hearing aid as not everyone likes them. My great grandmother was very deaf and refused to have a hearing aid. She had a right to that choice. I don't think we should push elderly people into getting hearing aids if they don't want them.
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Then my dad needs to stop asking everyone about how to improve his hearing. LOL! I think he wants a magican to come and wave a wand to restore his natural hearing.
 
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