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Cochlear Implants in Children: Ethics and Choices

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The GRI survey asked parents to indicate whether their medical insurance provided full, partial, or no coverage for reprogramming/remapping, post-implant speech production therapy, post-implant auditory habilitation training, or for any other insurance-covered accommodations or services. Table 5.3 summarizes the responses to these questions:

Table 5.3
Post-Implant Medical Insurance Services

Medical Insurance Service

Percent of Parents Reporting Full Coverage

Percent of Parents Reporting Partial Coverage

Percent of Parents Reporting No Coverage

Implant reprogramming or remapping

58%

29%

13%

Post-implant speech production therapy

41%

34%

25%

Post-implant auditory habilitation training

42%

32%

26%

In addition to these services, a few parents reported that their insurance carrier also paid for such things as batteries, new cables or wires, and summer speech therapy. These findings closely mirror the findings in our interviews in that insurance companies are more willing to pay for mapping expenses than for speech or auditory therapy, and that many families incur significant out-of-pocket post-implant expenses.

The GRI questionnaire also asked parents how long, after the initial “hook up,” their medical insurance covered “CI habilitation services such as speech perception training and speech production therapy.” A little more than two-fifths of the respondents (43%) said that this benefit was provided for 6 months or less, whereas a little more than one-quarter (27%) said that nothing at all had been covered. Only about 30% of the respondents had habilitation services paid for, in whole or in part, by their insurance carrier for more than 6 months.

Short-Term Post-Implant Outcomes

About a month after the surgery, implant patients need to return to the cochlear implant center to have their implant activated. This involves magnetically attaching the external microphone or transmitter to the internal receiver and programming or mapping the speech (or sound) processor so the implanted electrodes will be able to do the job they are designed to do: Stimulate the auditory nerve endings in the cochlea and thereby enable the user to perceive sound. For virtually all of the families we talked with, this was a very exciting time; the initial mapping session was the first time they would be able to see if the equipment actually worked as they hoped it might. Of course, many families realized that nothing dramatic might occur since the cochlear implant center had cautioned them against being too optimistic about what their child might be able to initially hear with the implant.