Saturday, February 20, 2016

Government Run Health Care – Possible Consequences For Cochlear Implants?

By Eric Sherman

The following was a post I saw online from a CI parent, from another country, which has universal health care and it got me wondering what could be the possible consequences for cochlear implant users if a universal health care system was implemented in the United States:

“Our government funded system holds one contract only with another implant company - therefore blocking AB from our market. No insurance cover for implants, so its government funding or private. We implanted AB because we had to pay private. I know our country blocks users from accessing some clinics due to wearing AB and not Cochlear. A lot of politics at play here.”

Our recent attempt at using Medi-Cal to try to purchase CI equipment really opened our eyes to how one of our government’s health care programs runs in this country. 

When needing to order headpieces, we were told that it could take up to 90 days to receive approval from Medi-Cal.  Around the 90th day, we were informed we needed a case number to receive an authorization.  I spent additional weeks trying to find out a case number.  When I finally reached the Nurse Case Manager, she said she had no record of my son ever receiving a cochlear implant.  My son has been in the system for 11 years.

My son qualified for Medi-Cal because of his severe hearing loss and the program was used as a secondary insurance to receive his cochlear implants.
The nurse asked for a recent audiology report, so we sent our son’s last audiogram.  The nurse then informed us the audiology report was not acceptable and that they need to verify my son is deaf and has cochlear implants at one their approved facilities.   

According to the Board of Audiology, there are 34 Audiologists in the United States who hold a Cochlear Implant Specialty Certification.  Our son’s audiologist is one of them.  A simple phone call, from the case nurse to our audiologist, probably would have been enough to provide confirmation that my son was deaf and had cochlear implants.

To receive any benefits under Medi-Cal, you need to see a Medi-Cal provider.  There are only two Medi-Cal provider locations in Los Angeles where an audiologist could conduct an audiogram to confirm our son’s diagnosis.   UCLA was one of the facilities, so the Case Nurse set up an appointment for us. 

The UCLA audiologist was surprised they were being asked to do an audiogram on a CI child to confirm they had no hearing.  They happily did the test wrote up the report and submitted it.  We got a case number submitted it to purchase the headpieces and to this day we still don’t know if Medi-Cal paid for any portion of the headpieces…and it has been almost a year.

Our experience and the comment from someone living with a government run single payer system made me wonder what would happen here in the U.S. if single payer government run health care system was implemented:
  • Would the government drive down the cost for cochlear implants that only one manufacturer could afford to deliver products to meet government price requirements?
  • Could one manufacturer lobby for exclusivity for their devices?
  • Would there be enough ENTs to choose from to do the surgery in a timely matter that would accept the government’s reimbursement rates?
  • Would there be enough audiologists to choose from who accept the government’s reimbursement rates to activate and service cochlear implants?
  • Would a universal health care system inspire new innovations by manufacturers if they already had a secured government contract for their device?
  • Would a child miss valuable language development time waiting for an approval to receive a cochlear implant or even getting the needed equipment in a timely fashion?
  • Would we be sacrificing quality care for costs?
These are just some important questions to consider when examining a possible government-run health care system.   

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#singlepayer #cochlearimplant #insurance 

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