View Our Catalog

Join Our E-Mail List

What's New

Sign Language Studies

Press Home

Cochlear Implants in Children: Ethics and Choices

Previous Page

Insurance Issues

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 interviews. 

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. 

We heard some very interesting stories about insurance-related problems from many of the parents we interviewed. One mother said, We went [to the hospital] that day for the surgery not knowing if they were going to pay for it or not. [And] we were prepared to take a loan out to pay for it. But the doctor’s secretary came down into the waiting room and told us that she got the word that they were paying for it. Another family got their insurance company to pay for everything, but, the father said, then they promptly rewrote the insurance contract so that they would never have to pay for another . . . . In the paragraph where it says hearing aids are excluded . . . the new version [says] that hearing aids and cochlear implants are excluded.

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.