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.
