Does anyone know if Humana covers cochlea implants from personal experience?
Does anyone know why Humana would turn down a request for an MRI to determine if implants are needed?
I found this on the FDA website:
Do insurance companies pay for cochlear implants?
Because cochlear implants are recognized as standard treatment for severe-to-profound nerve deafness, most insurance companies cover them. In 2004, Medicare, Medicaid, the Veteran’s Administration and other public health care plans cover cochlear implants. In 2004, more than 90 percent of all commercial health plans cover cochlear implants. Cochlear implant centers usually take the responsibility of obtaining prior authorization from the appropriate insurance company before proceeding with surgery.
If you meet the criteria for a cochlear implant, the doctor should be the one pursuing coverage approval. When I needed my first of 3 joint replacements, my health insurance denied the approval to proceed with the first knee, but the surgeon’s office handled the appeal, had to have a video conference call with the ins co’s orthopedic surgeon. My surgeon said it wasn’t much of a battle once he showed them my knee x-ray from 8 years earlier and 3 weeks earlier. My point is, this is part of what medical practitioners do, they are used to doing this. And from the FDA info I quoted, I guess you have to have AT LEAST severe to profound nerve deafness. Not all deafness is nerve based, so that is part of it, and mild or moderate deafness does not qualify either. But I’m sure there are other parameters that have to be met. The practitioner should be handling this part of the process.
I would call them or go online and find Humana cochlear implant if they offer a handbook. Not all insurance cover cochlear implants.Calling them on the specific insurance type you’re inquiring about will help. I would ask them to provide you with a handout or info that talks about it to make sure that you’re getting the right information. Maybe asking the CI clinic will also be helpful. Even the CI company can help provide some info.
@fwlee an MRI doesn’t determine if an implant is needed, it determines that all the structures within the skull are in the correct position. Particularly the facial nerve and other major nerve structures. As well as fInding and foreign bone that shouldn’t be in the skull. Therefore ensuring the CI surgeon won’t get any nasty surprises on the day of surgery. My MRI wasn’t covered by insurance either.
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Insurance coverage is specific by the plan and policy, not by company. To really know you need to read your plan documents or contact Humana so they can look it up.
Curious about this statement.
I did not have a MRI prior to implant. I had a CT scan.
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