Isaac's World

Isaac is Deaf but hears with cochlear implants. He received his first cochlear implant on September 25th, 2006. He received his second cochlear implant on September 10, 2008. This is his journey with sound as told by mommy.

Monday, December 17, 2007

Denied Completely

Today was a bummer of a day. Ian's private insurance will cover Isaac's second implant 80%, but we received a letter from our state's medical assistance insurer (Gateway Health Plan) that they will not cover a second implant because, "After physician review, the request for service is: denied completely because: the second cochlear implant is denied as because it is determined to be experimental and therefore not a covered benefit of the Pennsylvania Medical Assistance Program or the Gateway Health plan."

I am so angry and sad. I don't understand why we have to fight for so much. I try to stay positive most of the time, but this has really hit a nerve for me. We struggled so much with the decision and now it seems like we are being slapped in the face. I know I have to write letters and make phone calls, but I am just so tired. Tired of insurance companies controlling everything! I kind of expected a denial, but I was hoping for the best. I am going to contact CHOP and the Let Them Hear Foundation tomorrow. Please say prayers for us. Hopefully tomorrow will be a better day.

5 Comments:

Blogger Jennifer said...

Oh, Shiloh, I'm sorry :( How discouraging! They will likely come around eventually, but I know you're discouraged...this shouldn't be so hard, should it? (((HUGS))) Hang in there!

10:06 PM  
Blogger diber said...

Oh no!! I'm so sorry. I hate the fighting and frustration that comes with the territory. *hugs* hang in there. I hope you can find some help fast.

10:08 PM  
Blogger Mom to Toes said...

Oh, Shiloh, that is just awful news.

Let Them Hear does amazing things, and I am confident they will be able to help you.

But it is still so discouraging to have to fight for what is right.

Please keep us posted on how things are going.

Big hugs!!!

Wendy

12:43 PM  
Anonymous Anonymous said...

Hi Shiloh,

My name is Amy Brown. I am the Associate Director of the Let Them Hear Foundation Insurance Advocacy Program. You can reach me at (650) 617-2255. I welcome a phone call from you to discuss your son's bilateral cochlear implant appeal.

Best regards,
Amy

1:37 PM  
Blogger Hetha said...

So sorry to see this post Shiloh. I know how you are feeling, we have lost our state assistance recently and it pays for massive amounts of therapies that our insurance denies. It's very disheartening.

On the bright side, you've got some very smart people at LTHF and parents on CiCircle who can help, and you are very intelligent and willing to pursue it. It will be done.

Happy Holidays to you and your beautiful family.

xoxo
Heather

11:43 AM  

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