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Seven tips for dealing with American health insurance for your cochlear implant

Saturday, January 1, 2022

My daughter was born profoundly deaf, and as we began to look into hearing aids and cochlear implants, I was thrown into a world I knew nothing about -- insurance. Sure, I had gone to doctors’ appointments, picked up prescriptions, and had been in the hospital when I had my children, but I never thought about insurance coverage.

Now, I had to learn to navigate the world of American health insurance so my daughter could have the hearing technology she needed. This became a full-time job for the first year. During this time, I learned a lot from the insurance representatives I spoke with, from other families, and through trial and error.

For someone starting out on the process of getting a cochlear implant here in America, the task of dealing with insurance may be daunting.

— Helen Tinsman, M.S. CCC-SLP

We have had a close relationship with our insurance company over the last twenty years. We are intimately familiar with the process of having to use insurance several times a year, not only for hearing technology, but for type 1 diabetes supplies. In just the past two years, we’ve been managing durable medical equipment (DME) orders for my daughter’s insulin pump as well as her recent upgrade to Marvel CI processors.

So, I am keenly aware that, for someone starting out on the process of getting a cochlear implant here in the US, the task of dealing with insurance may be daunting. Here are some of the tips that we’ve gathered along the way that may be helpful:

1. Every insurance policy is different. We have been with five different insurance companies over the years, and each one has had different rules on deductibles, out of pocket costs, who they consider “in network,” and coverage limits for durable medical equipment. When hiring on with a new company or looking to change insurance policies, we always look these terms up before making our final decision.

2. Some companies have covered my daughter’s supplies under “durable medical equipment,”  while others have covered it under “prosthetic devices,” so it’s vital to ask this question up front.

3. Request a nurse case manager! Early on, I became tired of repeating my story every time I called our insurance company looking for an update to an authorization request. We had been given the tip to ask for a nurse case manager--one person who handles authorization requests. This saved me a lot of time and gave me one number to call to go to the right person about our situation.

4. When placing an order with a company, we ask for the date the authorization was requested and if there is a reference number on file. We take it upon ourselves to call the insurance company once a week or once every other week to check the status of the authorization.

5. Have patience. I’ll admit, this is a challenging one for me. Many people are placing orders just like I am, so I have to understand that there is a process, and this can take time. 

If you’re a parent of a child with CIs, here are two extra tips.

6. Teach your kids about this early. When my daughter turned 16, I started having her manage her doctor and audiology appointments. I would go with her, but if there was paperwork to fill out, she did it. Of course, she had a lot of questions at first, but now she’s a whiz at all that paperwork! She also learned to ask questions and speak up for accommodations she needed during appointments. By the time she went away to college, it was no big deal for her to go alone to campus health services or, unfortunately in her case, the ER, during freshman year when she ended up with the flu, a sinus infection, and dehydration from being so sick.

7. Teach your teen or young adult how to make calls to insurance and DME providers by having them listen in. When we would call the DME provider for new supplies, an order status update, or a billing question, I would put the call on speaker and let the representative on the other end know that my teenager was listening so she could learn how to do this for herself soon. I found that people were very open to this, and they were very patient. When she began making calls herself, if she ran into a roadblock, she would ask the representative if she could put them on speaker so her mom could join the call, as she was unsure what they needed. 

Making all the decisions that come with getting a cochlear implant is oftentimes emotional and stressful. Throw in the complication of having to deal with insurance, and it can be overwhelming for the best of us. While every insurance company and policy is different, the ongoing patience and self-advocacy required to get things done is arguably the same. So, with persistence, knowledge, and good manners, you can make the most of your health insurance for your cochlear implant and other durable medical equipment. 

Helen Tinsman, M.S. CCC-SLP
Written by Helen Tinsman

Helen Tinsman, M.S. CCC-SLP

Helen is the Consumer Outreach & Engagement Manager with Advanced Bionics. She lives in Arizona with her husband and five children. Helen has a Master’s in Speech Language Pathology from Arizona State University and has a long history of working and volunteering in the hearing healthcare field.

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