Tag Archives: health insurance

Yesterday was quite the day.

I had my evaluation at Jefferson for my second cochlear implant. The day started out pretty well. I was off of work so getting to sleep in a couple extra hours was definitely a perk for one. For two, before I even left for Jefferson, they called me to let me know my insurance was approved.

However, there was a slight catch…

I had to meet the criteria.

I’ll be honest I completely ignored the part about meeting the criteria. After all, Dr. Wilcox did say during my last appointment that it was just a manner of “Crossing our t’s and dotting our i’s”. I knew that I was deaf in my right ear every bit as much as I was in my left ear that I already had implanted. I knew that none of this has changed in the last year. I knew that I didn’t benefit at all from my hearing aid (before I broke it I mean). There’s no reason why I shouldn’t have been a candidate…

However, they left out the part about meeting the criteria being based off of how well you do in the best aided conditions and that for me that would mean how well I do with one cochlear already on…

I had a new audiologist for my appointment since my usual one, Louisa, was on vacation. The audiologist’s name was Paula and she was working with her extern, Alyssa. She was a lot different than Louisa, but seemed nice enough. She said there was no guarantee I’d qualify, but we’d test and see.

I had to do a series of hearing tests that were identical to the ones I did last year for my first cochlear implant evaluation. First they tested me for being able to hear the beep with my cochlear and a hearing aid on (they had a hearing aid for me to borrow). Next they tested me with my cochlear and hearing aid on for sentences without background noise. Then they did it with background noise. The last tests they did were without my cochlear on and for both beeps and sentences.

I did okay on the tests with my cochlear. The cochlear in my left ear certainly helped,but I still didn’t have “perfect” hearing. I noticed that I couldn’t hear from my right ear. Having the cochlear in my left ear helped me with word recognition a  bit, but no so much for general sounds especially softer ones and high-frequency.

I got a 73% for the sound and 99% on my word recognition with my cochlear. However, once they took my cochlear off I scored a 0. I am deaf in my right ear. I can’t hear anything at all. Excuse my language, but the direct quote from my audiologist regarding my hearing (or actually lack thereof in my right ear) is that “You can’t hear shit”.

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The blue lines show my left ear without my cochlear. The red circles are my right ear. The S’s are where I am with one cochlear implant. What a difference! I can only imagine how great I’ll do with 2 implants if I can get insurance to approve it!

Unfortunately, the FDA says that in order to qualify for this surgery, I have to score a 60% or below in the best aided conditions. Since I score 73% I did too well. That doesn’t mean though that I can’t get the surgery. I had to have Dr. Wilcox and my audiologist, Paula, submit a pre-cert. What this does is explains the test results and why they still believe I would benefit from getting my second cochlear implant and why they recommend it.

They also had me fill out a quality of life survey to submit to the insurance company. This tells the insurance company a little bit of information about how my hearing loss affects my daily life. It asked me about how I perform in social situations, what my dating life was like, how I viewed and felt about myself, etc. I explained how I sometimes skipped social events if I thought it would be too awkward or too loud and I wouldn’t hear well enough. My love life? Yeah my hearing has definitely mad an impact on that. I was in an abusive relationship in the past where my ex would yell at me and make me feel bad for my hearing all the time. My most recent ex was pretty good with my hearing (FYI, that guy I previously wrote about a lot? We just broke up. But that’s another story), but that’s not usually how it works.

Dr. Wilcox went ahead and scheduled my surgery. He said this would force the insurance company to act and make a decision about whether or not they’d cover my surgery. However, we had to schedule it out far in advance (not as soon as last time — last time we scheduled it exactly 1 week after my evaluation!) to give them enough time to make a decision.

So my (tentative) date of surgery is………………………………….

December 14th! If this date remains and insurance is approved I will have my implant just in time for Christmas and will have my stitches out (and be able to wash my hair — thank god lol) the day before Christmas Eve. The receptionists who scheduled it said if insurance approves my surgery before that date we can always move it up though which is what I plan on doing of course.

I also have to go back for pre-testing on December 2nd like I did last time. Exact same procedure.

I didn’t pick out a color for my cochlear or what accessories I want yet, but if it gets approved I will. I’m leaning towards silver. I definitely want a different color from the caribbean blue that I already have. I can never match or be normal of course lol.

I’m feeling a wide range of emotions in regards to my testing. On one side I’m disappointed because I thought for sure I’d be eligible with no questions asked and schedule my surgery right away. But on the other hand I feel blessed to have scored as well as I did on my test. To have 30% hearing is a miracle to me. 73% is something I never imagined I could possibly have. If this is the most I’ll ever have, that alone is a true blessing.

All that I can really do now is just pray and hope for the best. I put it all on God’s hands and trust that he’ll lead me down the right path. It’s as my pastor tells me, the Lord already has the answer and knows what is best for me and he will reveal all of his incredible plans for me over time.

Please continue to keep me in your thoughts and prayers during this time. I do still have a good feeling about it because I know my surgeon is a strong advocate for it. He definitely supports me getting a 2nd cochlear implant and I know that he was making sure to carefully word his pre-cert for the insurance company. Also, my surgeon is a Christian that has called me on a Sunday before my first surgery in the past to pray with me. I know that prayer can make all of the difference in the world right now.

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Ever since I got my first cochlear implant I have wanted to get my second ear done. Getting my cochlear implant is the best thing I’ve ever done. Read pretty much any of my past entries on this blog and you’ll see why. It’s given me many new opportunities that I never had before. I can enjoy music like never before, I can call my boyfriend when he’s on the road, I was able to take on a new role at work as a Digital Marketing Manager where I’m making calls to clients on a daily basis, and I can even hear while swimming for the first time ever!

Some people end up going bilateral all at once. This is especially common when it comes to young children. However, more often than not people get one done at a time. This is what my surgeon recommended to me. He recommended waiting at least a year before getting the second one done so that I’d have time to get used to and fully adjust to my first implant and hearing all of the sounds. Well, we are coming up on a year now…

This past weekend I was talking with my mom about my upcoming appointments. I knew I had one with my audiologist, Louisa coming up. I originally thought it was in October, but it turned out it was actually not until December. We still felt like we were missing something something, so we decided to call and find out when my next appointment with my surgeon, Dr. Wilcox was. Turns out, there wasn’t one scheduled. Initially, we made the appointment for the same day as my appointment with Louisa in December, but I ended up moving it up a bit.

My appointment is on Wednesday, September 16th. This is a very important day. It is my grandfather’s birthday, so that right there feels like a positive sign. It is also the one year anniversary of when I first met Dr. Wilcox for my initial consulting appointment where I asked him 244353553 questions about cochlear implants. Wow. What are the chances of that?

My mom did a little research already on my health insurance. When I got my first implant I had Horizon insurance which covered almost the entire cost of the procedure. My work decided to switch health insurance providers a couple of months ago to Aetna. This will actually likely benefit me since it is a new health insurance provider that hasn’t already covered this surgery. Also, my mom found in her research that Aetna is known for being a big supporter of cochlear implants. It sounds very likely that they will cover the cost of me going bilateral.

I have a very good feeling about going bilateral. I really think I’m going to go through with it and it will be successful. I think it will be much easier than my initial surgery was. I know that I am a candidate, so I won’t need most of the testing I had to go through the first time around. I know I definitely won’t need a CT Scan and likely not an MRI either since I can’t get them done with my cochlear. I will probably just need a basic checkup with my doctor and blood work done. Other than that everything should be pretty smooth sailing.

Please keep me in your thoughts and prayers as I begin my journey into going bilateral. Yes, I’ve gained so much with my one implant. Some people ask me, “Why would you want to go through with the surgery and all of that again when you’ve already gained so much with just the one?” Here is my answer: two is better than one.

Imagine if you only had one arm and one hand. Yes, you could get by. Maybe that hand would be phenomenal for you. Maybe you’d catch and be able to hold things better than anyone could ever imagine. But would it still not be better to have two hands?

What if you were blind in one eye and could only see out of the other? Try this now: Close one eye and keep the other open. Try to perform a simple task like typing a sentence on your computer. You might be able to do it and do it well. Maybe you even have 20/20 vision in that one eye. Now, try it again with both eyes open. Chances are, you performed the task much quicker and more successfully.

Two is better than one.

I have been doing great with my one implant, but I can’t even imagine how amazing it will be with a second one.

I still wear a hearing aid in my other ear, but it’s as good as useless. Sometimes I forget to wear it. And when I’m swimming, I go completely without it. I never miss it. I don’t notice much of a difference without it.

However, not having my cochlear is a complete tragedy. I can’t hear a thing. There is practically a 100% difference (definitely 90% or higher) difference with having the cochlear vs. not having it.

God gave us two ears for a reason. Mine might not work the way they are supposed to, but through technology I have been given the chance to correct it and make them like new again. My new, bionic ears.

Why wouldn’t I want to seize that opportunity?