Cigna: Approve coverage for my daughters cochlear implant
My daughter Nicole was born with several health issues. In her first four months of life she had three bowel surgeries, one heart surgery, bacterial meningitis, and we learned that she would need a liver transplant. We also learned that Nikki suffered from undetermined hearing loss, however during that time the doctors and her family was focused on life saving procedures. Nikki is now three years old (almost 4) and she has neuropathy in her left ear and has been pronounced profound deaf in her right ear.
We have been fortunate to be able to send Nikki to the Atlanta Speech School, which has worked wonders with her speech ability. However, her speech pathologist, therapist, teachers, and doctor have determined that Nikki has reached a plateau and will not likely improve in her speech or hearing abilities. Based on her doctor recommendation along with the advisors at the speech school, we requested Cigna (my employer provided insurance) to cover the cost of the cochlear implant. Cigna denied to cover the implant based on information provided and we appealed.
The initial reason Cigna denied coverage was stated that Nikki’s hearing loss was not significant enough and she had not utilized hearing aids for at least a three-month period. During the appeal Cigna was informed that Nikki had in fact utilized hearing aids in both ears for more than two years, and her deafness was far greater than what Cigna required. Cigna denied our appeal for coverage stating that they felt that Nikki was progressing or could progress with further use of hearing aids. Due to Nikki being immune suppressed it is difficult to keep her healthy long enough to have a surgery, (she has had at least 8 pneumonia infections in the last year and a half). We have her scheduled to receive the implant at the end of July, however without coverage Nikki will not be able to receive the implant.
Nikki is now three years old and has overcome so much adversity in her young life. According to the rules she is “disabled”, but with the cochlear implants that would enable her to hear she would no longer be “disabled”. Change.org was able to assist another family in the same area that we live who were also undergoing the refusal of the insurance company. I work as a police officer and my wife is a lawyer who provides legal services to indigent clients as well as others.
In Georgia it seems that insurance companies do not cover any hearing loss coverage. Nikki’s hearing aids were provided for her when she was eligible for Medicaid under the Katie Beckett waiver, however due to the recent changes in the Medicaid coverage, Nikki is no longer eligible to receive the Katie Beckett waiver. Our family hopes that with the support of this petition Nikki will be able to receive her cochlear implants, and other children and their families will not have to endure the hardships of deafness when there is a potential remedy available.
My understanding of the cost of a cochlear implant is each ear cost about $125,000.00. Nikki, like other kids and adults who receive cochlear implants require intense therapy to “train” their brain to hear again. Based on information cochlear implants are performed on a regular basis with overwhelming success. We want our baby girl and others like her to be able to grow and enjoy life with every opportunity. I would be willing to pay even more than I do for the insurance premium, but how can anyone say that hearing is not medically necessary as was stated by Cigna?
Please sign this petition so that Nikki and others like her can receive this life altering procedure.