Exploring CI

[nick14]

Hello,

My name is Nick. I'm currently exploring CI this year as my hearing in my right ear is in the severe-profound range. My left ear is nerve dead since birth. 

I have located an ENT at USC Keck who is "In-Network" who will do a CI evaluation on June 24th. That same day in the same department I'll be seen by a CI Audi who will also do the CI eval. So basically I have a insurance question and not sure if others have had experience with it. Anthem Blue Cross does not have CI audis that are in network except for those who are hearing aid dispensers such as Connect Hearing, Sonus, etc. The CI Audi's at USC are "out of network" and that is frustrating as the whole point in saving money is doing "In-Network". Has anyone else had a problem like this? 

Also one other question in regards to the CI implant, processor and transmitter. Are these classified as "Prosthetic's" on your insurances? I'm alittle nervous if they are classified as "out of network" via an audiologist who is also out of network. 

I wanted to ask these questions as my Anthem is slow as a snail via email (I can't hear on the phone well with my HAs). 

Thanks! 

[Mary Beth]

Hi and welcome @nick14!

It is very helpful if our CI surgeon and CI audiologist are in network.  Insurance can be difficult to figure out.

I chose a large CI center and was thrilled that they were in network.  Even being in network, I hit my maximum out of pocket.

Our CIs are durable medical equipment under our insurance policies I believe.

I suggest you ask about charges at your CI center when you go for your eval.

My CI center is super about processing all necessary insurance claims.  I did not have to do anything at all with my insurance.

 

Wishing you the best.

[nick14]

13 minutes ago, Mary Beth said:

Hi and welcome @nick14!

It is very helpful if our CI surgeon and CI audiologist are in network.  Insurance can be difficult to figure out.

I chose a large CI center and was thrilled that they were in network.  Even being in network, I hit my maximum out of pocket.

Our CIs are durable medical equipment under our insurance policies I believe.

I suggest you ask about charges at your CI center when you go for your eval.

My CI center is super about processing all necessary insurance claims.  I did not have to do anything at all with my insurance.

 

Wishing you the best.

Hi @Mary Beth,

Yeah that's the trouble I'm having right now. No matter which large CI center or (even small) I look up, while the ENT's who do the procedure are in network, the audi's who specialize in programming are out of network and it boggles my mind. I guess I'll just being paying 50% co insurance for activation and programming 😕 if that's the case. 

Yeah my out of pocket remaining in network is $411, so no biggie there with the implant procedure itself as Anthem will cover the rest 100%. Was your processor and transmitter fully covered (not out of pocket) also? 

 

[Mary Beth]

@nick14

This is a very expensive journey.  Please make sure you get your anticipated costs in writing ahead of time if part of your CI center is out of network.  There are so many appts after activation before we reach a stable MAP.  Some CI centers include a certain number of those appts in the surgery charge.  Other CI centers charge separately for activation and every MAPping appt after that.

My CI center is terrific with insurance.  My insurance was terrific with the surgery and included processor kit.

Is your CI center a one or two processor center?  Some CI centers in the US give us two processors with each surgery so we always have a back up processor.  Other CI centers do not.  Your CI audiologist will know.

 

Good luck.