Coverage for implants:
is the honeymoon over?

An online Reuters/AOL newsbrief dated October 14, 2002, warns of a trend that affects thousands of persons who want cochlear implants for themselves and their children: a growing number of public and private health-insurance programs are refusing to pay for the full cost of the operation.

This report summarizes a study released on the same day that was conducted by the Rand Corporation, the well-known nonprofit research firm, underwritten by Advanced Bionics Corporation, makers of the Clarion implant, and published in the October 2002 issue of the Archives of Otolaryngology-Head & Neck Surgery.

"Only about 3,000 Americans got cochlear implants in 1999, a small percentage of the hundreds of thousands of deaf and hearing-impaired patients who could have benefited from them," says the Reuters brief. That’s because state-federal Medicare and Medicaid health-insurance programs and private insurers "both refused to pay for the full cost of surgery. (…) The operation costs around $40,000 but hospitals in states where Medicaid payments are lowest may lose as much as $20,000 per patient." Hospitals can lose thousands of dollars each time they allow surgeons to proceed with the operation in their facilities. If the ENT lobby wants to encourage more people to get implants, they want to see payment rates increase.

Quote from the Archives article: "It has been estimated that there are 460,000 to 740,000 severely to profoundly hearing-impaired individuals in the United States. New data reported herein suggest that approximately 3000 people received cochlear implants in the United States during 1999. Factors limiting access to cochlear implant technology may include (1) lack of knowledge about the performance of the technology among primary care physicians, (2) lack of insurance or knowledge about or interest in cochlear implants among hearing-impaired Americans, and (3) objections to cochlear implants from representatives of the deaf community. We analyze another possible factor, namely, financial incentives for professional and institutional providers stemming from payment policies of public and private insurers."

Another quote from the Archives article: "Many factors other than insurance-based, financial disincentives are likely to limit access to cochlear implants, and to increase access substantially, various potential barriers would need to be addressed. Our data point to specific elements of financial incentives that seem particularly important. For patients to benefit from cochlear implants, audiologists, physicians, and hospitals must all be willing to provide services; the access chain is only as strong as its weakest link. While hospital reimbursement appears to be the weakest link in most cases, in some instances hospitals may be willing to allow more cochlear implant surgeries than physicians want to perform."

Quote from the Reuters report: "They [implants] do not provide perfect hearing but have been shown to help deaf people hear a little. For example, a cochlear implant can make it possible for deaf children to attend regular classes in school."

Members of the Deaf community have expressed their objections about helping to pay for other deaf people’s implant operations, particularly when the surgery is being performed on children.

If the audiologists, physicians, and hospitals involved are no longer willing to provide these services, will this mean a continued decrease in the number of implant operations performed in the U.S.? Will those who want implants but can’t afford to pay for them be forced to alternatives ways to pay (such as community fundraising), or do without? Who’s going to pay?

Sources:

"Payment Under Public and Private Insurance and Access to Cochlear Implants," by Steven Garber, Ph.D.; M. Susan Ridgely, J.D.; Melissa Bradley, B.A.; Kenley W. Chin, M.D., Archives of Otolaryngology-Head and Neck Surgery, Vol. 128 No. 10, October 2002.

AOL/Reuters newsbrief, October 14, 2002 (online)


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