A new fight over cochlear ear implantsby Lorna Benson, Minnesota Public Radio
Cochlear ear implants have enabled thousands of deaf people to hear. It's an expensive procedure though and for years in the 1980's and '90s insurance companies frequently denied requests to pay for it. Eventually, the Americans with Disabilities Act and other changes made it much more difficult to deny single ear implants. New medical evidence now suggests that two cochlear implants work far better than one, particularly in young children, rekindling the battle for insurance coverage.
Edina, Minn. — Paige was Katherine Christenson's first child, so the young mother wasn't sure what was normal behavior in an infant. But she found it odd that Paige never flinched around loud noises, Christenson says.
"We have this booming, loud dog. She wasn't responding to booming, loud, happy dog."
At the age of two months Paige was tested. Her doctors said she had profound hearing loss in both ears. They recommended a cochlear implant.
They waited about a year, and when Paige was big enough, she got the device in her right ear. The results were amazing, Christenson says. Within months the toddler had caught up to her peers developmentally and was learning to speak.
Paige is now eight and she's doing extremely well in school. But it's getting harder for her daughter to keep up as her academic and social environment matures, Christenson says.
"She continues to do great. It's just it's difficult to do great with one ear," she says. "And where's it hard to hear, Paige?"
"Busy places," Paige says.
"Like's what's an example of a busy place?"
"Malls, lunch rooms," Paige says. "Places where people talk a lot."
Unstructured classes are tough, too. When fast-paced group discussions are taking place, Paige has a hard time figuring out who she should filter out and who she should listen to. A translator helps her in the classroom. And, she carries a portable microphone that she can hand to anyone who's talking to help isolate their voice. But her microphone system doesn't work so well in a crowd, Paige says.
"Like sometimes if we're in a group and someone starts talking really fast, I have to scramble to get them the microphone really fast. And that's how it is sometimes."
Paige and her parents think a second cochlear implant would fix these problems. And studies suggest they might be right. In the past few years new research has shown that two cochlear devices help patients localize sound better than just having one.
But the Christenson's insurance company denied their request for a second implant. The company, Preferred One, wouldn't talk specifically about the case. But the insurer did say it believes the new evidence on two implants doesn't show a substantial enough benefit to change company policy.
Paige's physician, Dr. Frank Rimell, says he has heard this argument from insurance companies many times.
"This is not experimental surgery," he says.
Rimell is a pediatric ear specialist at the University of Minnesota Hospital and Clinic.
"It's strictly a money matter because it's expensive for the insurance company," Rimell says.
A typical cochlear implant can cost more than $100,000. Rimell says many of his patients who have succeeded in getting a second cochlear implant have had to sue their insurance companies to get the approval. However, he says the state's three largest non-profit health plans, Blue Cross Blue Shield of Minnesota, Medica and HealthPartners, seem to have become more willing to approve a second implant in the past year or so as the new evidence grows.
But Preferred One Medical Director Dr. John Frederick says he doesn't think his insurer's position on cochlear implants is out of the norm.
"If you're doing implants you probably have a different perspective than if you are paying for implants. And that's kind of one of the on-going battles is whether the cost of something is worth the benefit that it delivers."
Frederick cites evidence gathered by Milliman, an industry source of evidence-based guidelines, that shows more study is needed to determine the benefits of two cochlear implants.
But evidence aside, there's another issue at play in the cochlear implant debate. The Christenson family gets its insurance through husband Keith's self-insured employer. That employer pays for the cost of all of its employees claims. So when it selected Preferred One to administer its health insurance, it picked a plan design that only pays for one implant.
It's not uncommon for self-insured employers to exclude a very expensive medical procedure like a cochlear implant, so they can pay for other conditions that might be more likely to occur in their workforce, Frederick says.
"We could cover a lot of other people's other medical issues for that. And I'm not saying it's right or wrong. But that's the way a number of employers have to make their decisions on what it is they can afford."
Paige's parents say they can't afford to wait any longer for Paige's second implant. Their daughter is almost nine and studies show that cochlear implants are not as effective after age 10.
- Morning Edition, 02/28/2008, 7:45 a.m.