Because you asked.

Catherine has asked for an update about my efforts to figure out the insurance coverage for my cochlear implant. It took me too damn many phone calls, but I finally determined (a) that all the providers involved in the CI surgery are considered preferred in my health plan, and (b) that this means my insurance company will cover 90% of the plan allowance for everything. This was the easy part.

Because I've been told that the surgery can cost upwards of $90,000, I needed to figure out what that 90% coverage really means, and what kind of real dollars we were talking about. But the insurance company wouldn't tell me what the plan allowance is, and the clinic wouldn't tell me what the full-price cost is. The insurance company insisted that they could only give me a cost estimate after receiving certain specific information from my doctor, and the doctor’s office told me they don’t deal directly with insurance companies.

Finally, I had to cry. Repeatedly. To both the insurance people and the clinic people. While this may not be the most effective negotiation tactic, it worked.  The clinic people gave me a whole list of the medical codes relevant to the procedure, and the insurance company manually ran those codes and gave me the resultant coverage information. More important, the insurance company gave me concrete reassurance that my yearly out-of-pocket costs for services from preferred providers is capped at $4,000. Thus, regardless of how much the surgery actually costs, once my 10% share exceeds $4,000, the insurance company will pay every penny above that four grand.

As frustrating as it was to get this information, now that we have it, we are going forward with the evaluation process. I’ve mentioned before that I’m having some scheduling issues with respect to the actual surgery, and I still don’t have a better sense of when I will be able to have the procedure done.

I’m sorry that I don’t have a more updated cochlear implant update. Instead, I offer you this snapshot, taken during last weekend’s most excellent backcountry skiing adventure.

Comments

[Catherine]

The update is much appreciated! Do let us know how the rest of the CI procedure goes.