Category Archives: Pre-Determination

A Visit with an Audiologist – The Pre-Determination Process

My husband and I went in for our audiologist appointment on Friday – nothing says romance when you get your assistive listening devices check out together! I waited patiently while he went first. He just got two new behind-the-ear (BTE) hearing aids for his moderate hearing loss and needed to get them adjusted. We left for lunch and came back later to talk with a different audiologist who specializes in cochlear implants.

So we came back from lunch to meet with the audiologist. There were a lot of things I learned that I didn’t know before and some things I learned about even though I heard about them (she just made them make more sense). I expected to walk in there to be whisked away for the hearing test and THEN ask the questions. But she sat us down and just talked first. My husband and I just racked our brains of all the questions we could think of and asked her. We must have been there for two hours. Time wasn’t important, understanding was. First off, she really put us at ease, well me anyways at least. I think the fact that she could answer our questions with more information than what we had, was wonderful. She understood our concerns with the surgery and the outcomes of getting a cochlear implant. She understood the propaganda that was going on out there with both people in general and the cochlear implant companies. Not only that but she has told us not to worry about work, scheduling the surgeon, insurance, etc., etc. she would take care of all that stuff. It was up to us to make that decision: that is the only stress we have at the moment, which is such a relief (I have a huge dislike for dealing with insurance people – I’ve done that in the past, and I don’t look forward to doing it again) .

One of our questions was: How fast would this all take? The reason why was my job contract ends at the end of December. It may be renewed again, but it may not and if it doesn’t, I would lose the insurance I have and have to start all over. The answer she gave came as almost a shock to us. One of my other concerns was that I didn’t want to miss that much work.

She told us that we could get the CAT scan, blood work, other testing, surgery, mapping and (I think) a secondary mapping all in a week and a half. The incision that the surgeon would make would be so small that the swelling wouldn’t be that bad and thus the magnets could attach the very next day (the one that’s under my skin and the one that would go on the outside would be able to attach together). There isn’t anything postponing the activation date except the swelling of the skin. The incision that would be made would only be about two inches and would go behind my ear.

Our next question was: which implant? There are three major cochlear implant companies: Cochlear, Advance Bionics and Med – El. She told us that Med-El was really behind in CI technology (and they look ugly – my audie said they look like a gun), so that was off our list right away. Advance Bionics has had three recalls total. They provide a range of colors for the external piece and rechargeable batteries. Cochlear hasn’t had any recalls and they have a disposable battery as well as (I think) rechargeable ones. The quality of sound is pretty much the same for either AB or Cochlear.

The next was: am I a qualified candidate? We told her I had meningitis when I was two. That worried her a little because if you get meningitis then bone may fill up the cochlea and thus I can’t get one. That’s when I went to get my hearing test done. If I respond at all to the hearing test in my right ear (that’s the one I would get implanted), then I shouldn’t have that problem. I did respond and the audiologist declared me a candidate.

Next steps: My audiologist is calling my insurance company for approval, she is also talking to the surgeon about my case and says she will get back with me. In the mean time I can e-mail her as many questions as I want (which I fully intend to do!). I will let you know what happens.


Square One

When you pull out “Trouble” or “Monopoly,” the game starts at square one. Life is a little like that sometimes. Let me explain.

I am a deaf, 24-year-old female, considering a cochlear implant. It wasn’t but a month ago that I thought it would never happen to me. This wasn’t ever going to be part of my life plan. Children, yes. A graduate degree, yes. But a cochlear implant was no where in that horizon. It may have been the very thought of that invasive surgery that I would have to go through. Or maybe it was the social stigma of having such an ugly thing attached to my head (and this is from someone who wears a hearing aid every day). Maybe it was the fact that I didn’t think it would work, or at least not be much of a benefit to me. Maybe too, that I picked up a little on the deaf community’s strong stance against them, which, by the way, seems to grow weaker by the day.

Sign language is my best friend. It is my communication tool. It is my foundation of confidence and self-esteem. Unfortunately, I don’t use it as much as I would like. Everyday I am continuously using spoken English. Very rarely do I get a chance to use my beloved language any more. I think it has to do with my move from Austin. I am living in a post-Katrina New Orleans. The deaf community has all but disbursed here. Before the hurricane, the deaf community thrived. Several deaf organizations were in place. A deaf club was still in business. A lot has changed.

But it is not only the current location that has me thinking. I will have hearing children. While I know I’ll be a good parent, I think they deserve me to try as hard as I can to provide for their all needs and that includes hearing them a little better. I’ve had countless nightmares of not being able to save someone such as my children from death or serious injury because of my hearing. Which I know is fruitless, because I may save someone from a certain death because I can’t hear. Life’s funny that way. But still I worry.

This is where the cochlear implant comes in. A good friend pointed out to my stubborn self that cochlear implant is just like sign language – it’s a communication tool. It’s communication that gives me that sense of confidence about myself, not specifically the language.

It also does not make me hearing. I will always be deaf, perhaps even deafer than I have ever been. I take off that cochlear implant, as when I do my hearing aid, I am deaf.

But now is not the time to make that decision. The only decision I’ve made so far is to get myself evaluated. That is after all square one. It involves no invasive surgery. It involves no life-changing decisions. It’s just going to see the good doctor who will hopefully tell me how much I will and won’t benefit from a cochlear implant.

So to do that, I first approached my health insurance company last week. I wasn’t sure what square one was, so I thought it was probably smart to find out if they would pay for it. Unfortunately, I spent my first half hour on the phone with someone who didn’t even know what a cochlear implant is before asking for a supervisor. I don’t know why I bothered with her, she only made me worry more and told me that a cochlear implant would not be covered with my plan. When I got the supervisor on the phone, I was informed that she would have to get back with me because she needed to find out the specifics of my plan. And that was that for about four days. My husband got the call for me that they did indeed cover it. Square one accomplished!

There was one catch, so I got to go back a half a square. I wasn’t sure what to do next. My husband took the call, so I really didn’t know what I was supposed to do. I spent the next couple of days trying to contact someone who does cochlear implant evaluations with no avail. before finally confessing to my husband what I was doing. He told me to go talk to the insurance company again.

They told me yesterday that I had to go through a “pre-determination” process. Basically I have to find a doctor who will vouch for me and tell the insurance company that I really do need this cochlear implant. So goody, I get to convince the doctors before they convince me. That shouldn’t be a problem. I’ve had several audiologists who have tried pushing the cochlear implant with me in the past, telling me what an ideal candidate I would be. *I’m rolling my eyes a bit here*. So I moved up and completed my square. Now onto square two – the pre-determination process.

The women I talked to at my insurance company told me that there was a committee that reviewed documents that the doctor submits (and when she said doctor, she meant ANY doctor/specialist) but she didn’t know what the qualifications were. So I have to pass some secret qualification test. I’m very curious as to what’s on this test. I also find it interesting that health insurance has so much control over whether or not I get covered. If they deny me, I hope it’s not over something stupid like I have a “pre-existing” condition. I would contest that. After all, the cochlear implant is so new that most people would have a “pre-existing” condition. I think that might reasonably change in the future, which makes me sad.