How to Appeal a Denied Cochlear Implant Surgery

Getting a cochlear implant surgery has its challenges for potential recipients. You must go through a rigorous medical screening and testing process to evaluate you for the surgery. Unfortunately, a cochlear implant can be denied for various insurance reasons. If you decide that this surgery is right for you, learn what you need to do to appeal the decision and get your implant surgery.

Things You'll Need

• Denial letter
• Medical letters
• Advocacy application
• Formal appeal letter
• Medicare form

Instructions

1. Contact your insurance provider and ask about the details of your insurance coverage. Check what medical procedures are covered and which ones aren't. Research your medical coverage fully to understand the rules and regulations before proceeding with an appeal.

2. Ask for assistance from your company's human resources or health benefits representative and get him involved in your appeals process. Find out how far your company's health plan covers cochlear implant surgery. Document that information and use it in your appeal.

3. Gather any relevant material you can use in your appeal. No document is too small. Ask your insurance carrier for a written denial letter because you need to have the denial reason in order to proceed with your appeal. Have your surgeon and doctor write letters explaining the importance of you getting a cochlear implant.

4. Call a local advocacy group such as the Let Them Hear Foundation to see if the organization can help get your appeal going. Go to the Let Them Hear website and create a user account to register on the website. Fill out online application for assistance. Contact the organization's customer service for any direct assistance you need or to ask what your next step should be.

5. Write a formal appeal letter for your cochlear implant surgery explaining why the surgery would be beneficial to your everyday life. Focus the letter on discrediting the surgery denial reason and not any emotions you have about your situation. Send the letter to your insurance carrier and contact them with the advocacy group to make sure the denial gets appealed.

Tips & Warnings

• Accept as much coverage as your appeal allows. Find another method of payment from another medical or financial establishment and pursue it. Go to the Medicare website to fill out an application for coverage if your insurance covers only part of the procedure.

• Once you have exhausted your appeals, ask your doctor whether there are any alternative hearing-loss treatments you can pursue. Check whether your insurance carrier will cover the treatments before going any further.

• Don't give up your appeals for your cochlear implant surgery when you don't receive a positive response right away. Keep being persistent by going through the proper medical and legal channels. The longer you continue your appeals process, the better the coverage outcome will be.

• Don't accept the first "No" you get from your insurance carrier or an advocacy group. Get other opinions to see if those organizations agree before proceeding with an appeal or an alternative surgical method.

Resources

• Let Them Hear advocacy application
• Medicare forms and guidelines