Jillian's promise

I have submitted Jillian's request for Cochlear implants three times and she has been approved and then denied three times.
The doctor's and I have recently appealed her case. At this point, I no longer applied my case with feelings but with facts.
I contacted all the other successful Moms with children that have been implanted asking for their advise and their letters so that I can coordinate success and feelings all in one letter to accomplish my goal.
Below is my appeal letter that was sent to my insurance company......

November 7, 2007

Appeal of denial for benefits for the Nucleus Freedom Cochlear Implant

Dear Appeal Reviewer:

I am writing to appeal the recent denial of benefits for my child, Jillian R.

The cochlear implant is a prosthetic device designed to restore an individual’s ability to regain auditory stimulation by replacing the permanently inoperative function of the internal organ known as the cochlea. Since the hair cells, which stimulate the auditory nerve, in the inner ear do not function (functional defect), the cochlear implant assumes the functions of these damaged hair cells (permanently inoperative or malfunctioning body member) in the inner ear. The cochlear implant then stimulates the auditory nerve fibers with electrical impulses, thus restoring auditory stimulation to the auditory nerve.

Cochlear implants not only enable deaf/deafened individuals to hear verbal and environmental sounds, but also allows these individuals to take advantage of increased educational and employment opportunities. They can converse with others comfortably, talk on the telephone, and become active in our hearing society. As a result of implantation, Jillian will be able to hear verbal and environmental sounds that both orient her as well as alert her to potential dangers. For both children and adults, cochlear implants are a vehicle to increase the productive abilities of the profoundly hearing impaired. Without a cochlear implant, Jillian is at risk for several potential accidents since she is unable to hear verbal warnings, alarms or other environmental noises warning of danger.

Critical learning periods exist in early childhood that affect the ability of children to develop normal speech and language. Because of the potentially deleterious impact of hearing loss on a child’s speech and language development, it is logical that early diagnosis, treatment and intervention is critical for optimal outcomes. When hearing aids do not provide detection of conversational speech, it is not possible to develop the speech perception skills that assist with speech and language development. In these cases, cochlear implants have provided the auditory input that facilitate acquisition of speech and spoken language.

In light of the medical necessity and demonstrated outcomes, I would appreciate a reconsideration of Jillian’s denial of benefits for the cochlear implant procedure and related services. Humana’s denial withholds from Jillian the only opportunity to ameliorate her disability and receive the invaluable benefits of hearing. I strongly petition you to reconsider and reverse Humana’s decision to deny cochlear implants and their related services.

Please contact me if you require any further information. I look forward to your prompt reply to this formal appeal.

Jillian's Big Day...

Jillian's turning one in a few days.....
I have been out shopping for gifts specific to her needs. I found so many toys that light up, books with smells and different touch of textures to feel. I loved the challenge to find gifts appropriate to her needs.
I found myself walking throughout the aisles with a smile on my face knowing that these presents this year will help her gain the strength in others areas and knowing that next years purchases will be geared towards noise and speech.
Throughout all of the denials, I know that our prayers will be answered!

Jillian's Hope....

In the month of October there was an article in the St. Petersburg Times, regarding a little girl named Rhyan who had just been bi-laterally implanted. As I read the article tears came to my eyes, to think of the joy that family and child were going through!
The excitement that she could hear; the birds chirping, the sounds of laughter, the soon to be heard Christmas carols, being able to hear her sister talking and being able to verbally communicate with her family! The opportunities await her!
My husband contacted the editor from the column asking for any guidance and resources that he may have learned while interviewing and writing the article.
Around the middle of October I was sent an e-mail from Shelly (one of Jillian's audiologist) introducing me to Courtney, Rhyan's Mom. She explained that Courtney and her husband were creating this fundraiser for Cochlear Implants and the deaf community and are in need of a candidate. I was so truly blessed imagining that one day, Jillian would feel the same happiness and sound that Rhyan was given.

Jillian's Story

Jillian was born on October 11th, 2006 and at birth, her Dad and I were told that she did not pass her hearing test and that she would need to be re-tested within 30 days. We were told that this was common with a c-section delivery and she probably just had excess fluids in her ears. As we brought our newest angel home, we scheduled her appointment and went about celebrating her new life.

As I took Jillian to her appointment, I held extremely positive, I guess in retrospect, naïve to a degree. All that changed very quickly. My first sign of concern was after I was originally told the test could take up to three hours, shortly after only 20 minutes was I told the testing was complete. As our audiologist left the room, to say that she’d be back with the results, I held Jillian close to me, praying that this sinking feeling in my stomach was wrong.

When the audiologist returned, she told me that Jillian had been diagnosed with profound hearing loss. I can still remember sitting there, holding Jillian tighter than ever before, and praying. I prayed that somehow they were wrong. My husband and I come from families who hear – we didn’t know anything different – and I felt lost.

Amidst all the confusion and sadness that I was feeling, I was given a small glimmer of hope before I left that day. The audiologist told me about Cochlear Implants, and that with hard and continuous work, someday Jillian would be able to hear.

I walked out of the hospital holding Jillian in my arms, pushing the stroller to the car. I sat in the car holding her and praying to God for strength. Too many thoughts were running quickly through my head – how do I protect her from danger? How will she know how to take care of herself? I was overwhelmed. But as I sat there holding Jillian, I observed other parents entering the hospital with their children. There were children who were bound to wheelchairs valiantly pushing themselves into the hospital, their parents’ right by their side. Children obviously fighting cancer, their little heads bald from the radiation, yet still walking proud, as their parents held their hand tight. It occurred to me that I was blessed, that Jillian was blessed, and that I had the strength and courage to do whatever it took to have Jillian hear someday.

That night I spent hours online researching, gathering information and learning everything I could about Cochlear Implants and the Deaf community. We also prayed and thanked God that He chose us to be Jillian’s parents, knowing that we would take care of her and her situation. Not being people who took “no” for an answer or understood what “can’t” means, my husband John and I knew we had a fight ahead of us, and we were going to be prepared.

We also made lifestyle changes. At that time John could stay home during the day to make sure Jillian could go to her speech therapy three times a week and ensure she was wearing her hearing aids that she was fitted for at two months old.

For our family, Jillian’s future rested squarely in her ability to have the Cochlear Implant surgery as soon as she was medically able, which we were told was at age 1. Our next set of challenges came as we began the process of requesting approval from our insurance company to cover the cost of this surgery. They repeatedly denied our requests, citing “non-medically necessary procedure”. Just as we were feeling our spirit weakened, I received an email from our audiologist, introducing me to Courtney Baker, Rhyan’s Mom. Our audiologist explained what Rhyan had gone through and that she had successfully received bi-lateral implants.

The next several months I found myself learning first-hand through the experiences of Rhyan’s family how to better proceed and navigate through this complicated world of forms and approvals and appeals and frustration. I also discovered a world of so many families facing the same obstacles, and fighting the same fight for their deaf children. But most importantly, we found friends in Courtney and Matt, and their journey re-energized ours and filled us with direction and hope.

I thank God daily that he blessed the Baker family with Rhyan, just as he blessed us with Jillian. I thank Him that he gave the Baker family the vision to create their foundation so that others may have the same opportunity as Rhyan. We were humbled that Jillian was selected as their first sponsored child, and that through their generosity, and the generosity of others, our little angel will someday be given the gift of hearing.