Implants in Children: Ethics and Choices
A cochlear implant operation is quite expensive, and
implantees and their families encounter additional expenses for postsurgical
habilitation procedures, including frequent mapping (programming) of the sound
processor and speech/auditory-verbal therapy sessions. At the present time in
the United States, the cost for the surgery (including the cost of the device
itself) is at least $40,000. Since few families have the resources to pay for
implant surgery themselves, the question of how to pay for the device is one
that is of great importance to parents and others contemplating implantation.
Clearly, it was of concern to virtually all of the parents we talked with in our
It appears that about 1 of every 5 or 6 families we
interviewed had significant problems getting their insurance carrier to pay for
the cochlear implant for their child. Of the 52 families we discussed this with,
10 of them said that their insurance company or other medical provider refused
to pay anything at all for the operation or for postsurgical mapping and
habilitation (3 families), or would only pay after one or both parents spent a
considerable amount of time on the phone, writing letters, making threats, or
some combination of all three of these activities. Moreover, even when some of
these recalcitrant insurance carriers finally did pay, they often did not cover
the entire cost. In fact, several families we talked with said they have paid a
great deal of money themselves for the surgery or postsurgery mapping and
habilitation (primarily speech and listening therapy) expenses.
As far as the surgery/hospitalization is concerned, it
appears that, in about 42 of the families we interviewed, their insurance
company (or Medicaid or another public program) eventually paid 90–100% of the
costs. In another 4 families, the insurance paid approximately 75–80% of the
surgical/hospitalization expenses. Not all of the parents we talked with
mentioned specific percentages, and, as noted, some of the insurance companies
delayed paying for a considerable amount of time.
Perhaps the most important reason why a number of insurance companies delayed paying for the procedure was because it was new and because no one had asked them to pay for it before. In a few cases, insurance companies delayed paying for the implant either because the device had not yet been approved by the Food and Drug Administration (FDA) for use in children or because the child was too young to be implanted according to the FDA guidelines (under 18 or 24 months, depending on when the surgery took place). Thus, it is understandable that, in some cases, a considerable amount of time was needed to secure approval for the procedure. To facilitate this process, the major cochlear implant companies, as well as many cochlear implant centers, now have specific offices or positions assigned to handle insurance-related problems and to secure payment from insurance carriers.