“Insurance does not find it necessary for children to hear.” Elizabethton family champions hearing implant coverage bill

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ELIZABETHTON, Tenn. (WJHL) – Seven-year-old Brody had a few words to describe his new hearing implants.

“Awesome.”

And, secondly, “It’s so loud!”

Brody reacts to his new bone-anchored hearing implants. Contributed: Dayla Hurley.

Brody was born without ears or ear canals, which is a condition called microtia atresia. When his parents, Travis and Dayla Hurley, adopted him, they didn’t realize that insurance wouldn’t cover the procedures he would need to hear.

Brody has one cochlea, which means he can hear if the sounds make it into his head.

He first used a device attached to a headband to hear, but the sound still had to travel through his hair and skin to get to his cochlea, so his hearing wasn’t the best, according to his mom.

It improved with a bone-anchor implant surgery that he received a few months ago. The hearing aids are attached to his skull and extend to the small pegs on either side of his head.

Brody uses a bone-anchored implant to hear.

Brody uses one of the pegs right now, and the procedure greatly improved his hearing. He is scheduled to get the device on the other side next month.

Dayla said she’s loved watching her son come out of his shell after he received the implants.

“It completely changed his personality, completely, like he’s just blossomed,” she said.

But Brody’s hearing didn’t come without an uphill battle.

The right to hear: A battle with insurance companies

Brody’s mother said it took about a year of convincing their insurance company to cover Brody’s implant surgery and appointments.

But the battle is far from over.

“The other part to this story is that these devices are only good for, at the most, five years,” she said. “In five years, when this device is no longer good, we won’t’ have coverage for that and to buy him devices to hear bilaterally would cost probably $12,000 right now.

“And that would be every five years.”

Brody and his mother watch a video of his reaction to getting his new implants.

Dr. Saravanan Elangovan, Director of Audiology at East Tennessee State University, said out-of-pocket costs for cochlear implant surgeries can reach up to $150,000.

MediCare covers the more expensive cochlear implants, he said, but doesn’t cover hearing aids. Private insurance isn’t mandated to cover implant surgery at all, though some companies have begun adding the procedure to their policies with restrictions.

There is no federal law that requires insurance companies to cover hearing aids or implants like Brody’s. Under Tennessee law, insurance companies must provide up to $1,000 “per individual hearing aid per ear” for children under 18.

That law doesn’t cover cochlear implants or bone-anchor hearing aids, the latter of which is what Brody needed to be able to hear.

“We found early on that these things are not covered by insurance, that insurance does not find it necessary for children to hear,” Dayla said. “They like to lump these things under hearing aids and a lot of insurance does not have coverage for hearing aids.”

Brody’s hearing implants weren’t initially covered by his family’s insurance plan.

Dr. Elangovan said insurance companies usually take hearing aid and implant coverage on a case-by-case basis.

The Centers for Medicare and Medicaid Services have the final say on billing services for disabilities, he added, and research within the past decade has proven the benefits people with hearing loss experience when they have access to hearing aids and implants.

“The way the CMS looks at it is it needs to be researched under stringent criteria – how (people with hearing loss) are productive, how (a hearing aid device) improves their social life,” he explained.

A 2010 study found that adults with hearing loss were more likely to suffer from depression. Dr. Elangovan said other research shows a cognitive decline in people with hearing loss.

And as people age, hearing loss becomes more likely.

“After the age of 18, 15% of adults have some degree of hearing loss,” he said, adding that the percentage increases dramatically with each decade of life.

“It’s an inevitable sensory loss for most individuals.”

Ally’s Act

That could change with House Bill 5485, also known as Ally’s Act, which would require insurance companies to cover procedures and devices associated with hearing loss.

Read the bill HERE.

According to the bill, private insurance companies would be required to cover auditory implant devices, maintenance of those devices, an upgrade every five years, accessories needed for devices, hearing assessments, surgeries for devices and doctor’s appointments related to hearing loss.

The bi-partisan bill is currently on the docket in the House Committee of Energy and Commerce and needs 290 co-sponsors to move forward.

According to the website, the bill has five co-sponsors as of Jan. 22.

Brody’s parents are pushing for residents to ask representatives to sponsor the bill by reaching out to them.

Rep. Phil Roe (R-Tenn.) responded to a request for comment with a statement:
“As a physician, I have seen how technological advancements are allowing people with serious hearing impairments to achieve a vastly improved quality of life, and how burdensome insurance companies can make the process to get treatment approved. I believe we must work to ensure this equipment is accessible to patients. I also believe Congress and state governments should carefully examine how patients are being affected by current coverage requirements for medical equipment, like cochlear implants, and make updates to the law if necessary.”

A bright (and loud) future

Brody and his parents before he got his hearing implants.

For Brody, the bill would mean he and his family won’t have to worry every five years when it’s time to upgrade his implants.

As technology advances, it opens more opportunities for people with hearing loss, but it also means regular upgrades to hearing implants to stay up-to-date.

Because of his implants, Brody can use Bluetooth devices to listen to music or take phone calls, much like wearing earbuds.

His classroom at East Side Elementary School is equipped with an audio enhancement system, which can also be cast in his device using Bluetooth.

Those advances in technology will help Brody with his independence as he gets older, his mother said, giving him opportunities he might not otherwise have.

“The devices are out there for people to hear, we should have access to that, especially when you’re paying premiums for insurance,” she said.

“That was the hardest thing was knowing that it was available but how to get it for him and just to keep fighting until he had it.”

Copyright 2020 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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