Notes In The Margin

A few weeks ago I mentioned that I am scheduled to have a BAHA installed. However, last week, we found out that, contrary to the audiologist's expectations, the insurance company, Anthem Blue Cross Blue Shield, has declined to cover the procedure. Naturally, I'm very disappointed. I do tend to expect that a company will honor their agreements with me, particularly when I am paying them a large amount of money every month to do so.

As I read it (and, I admit, Insurance has always been confusing to me. I presume they do that on purpose.) my policy clearly states that it covers reconstructive surgery to restore hearing that has been damaged due to trauma or earlier surgery. It says that cochlear implants are covered. It says that reconstructive hearing surgery, and hearing prosthetics, are all covered. And then there's this weird clause that says that hearing aids are not covered, unless stated differently elsewhere in the document. Which it is.

So, the appeals process has now begun, but it seems that the chances of getting the surgery done next month are pretty slim. Folks on the BAHA Patients Site report battles with insurance companies lasting 6 - 18 months, which isn't terribly encouraging. But they seem to report that insurance companies are gradually becoming acquainted with this device, and becoming more open to it.

I also spoke with folks from the Let Them Hear Foundation, who gave me some tips of how to appeal this, which I'd be glad to share with you if you're going through this process yourself. They couldn't assist me directly in the appeals process, because their funding is specifically to help kids in this process.

It certainly seems to me that insurance companies say no the first time, regardless of the issue, and that this is pretty much how they are geared to operate. And it seems that this is more the case now than it ever has been. It's not right that insurance companies are the ones making medical decisions. And it's not right that no matter how many presidents and governors have promised to fix this situation, it just gets steadily worse.

Well, it's been 25 years since I lost my hearing, and I expect that another year or two isn't going to be so terrible, if there's an end in sight. And I'm pretty sure I'm just stubborn enough to win this battle. But it's pretty discouraging to find this out 3 weeks out from my surgery date.

About 25 years ago, I had a tumor removed from my left ear. It was in the canal, in the middle ear area, and consumed the ossicles and the ear drum. Once the tumor was removed, I was almost completely deaf in my left ear.

A few years later, we discovered that the tumor had not been completely removed, and had grown back. I had a second surgery in 1987, which removed more of the surrounding bone, and left me even deafer. As part of that surgery, I had an experimental device installed. A titanium/steel screw was installed in my skull, just behind my left ear, and I got a hearing aid - a Xomed Audient - which attached to that screw by means of a magnet. A body device, about the size of a cell phone, was worn somewhere on the body, say, in my breast pocket, and a cord went to the magnet attached to the screw. The device was the microphone and amplifier, and the magnet was the speaker.

This device allowed me to hear, but at quite a price. Wearing something that large meant that every time I met a new person, I was obliged to explain to them what it was. Teachers assumed I was listening to music. Kids made fun of the device. It fell off all the time, or would fall out of my pocket when I ran or bent over. But mostly it was the feeling that I was weird that prevented me from wearing it all the time.

Several years ago, the Xomed company stopped making the device, and replacement parts got harder to find. And I just adjusted to being deaf on one side. This meant that in social situations I always maneuver into a seating position where I'm at the extreme left end, and everyone is on my right. If I miss out on that seat, I spend the entire time either contorting my neck to be able to catch what is said, or, more frequently, I just withdraw and don't participate.

About 3 years ago, the Xomed quit working entirely, and I simply didn't go to get it fixed. Even now that I'm 36, there's a social cost to having to explain to everyone I meet why I have this device attached to my ear. Although I expect that with the ubiquity of bluetooth ear thingies, I'd have to explain less than I once would have. Be that as it may, I simply didn't get it fixed. The cost of wearing the device outweighed the benefits.

About a year ago, I started seeing more and more and more people - mostly children - wearing hearing devices attached behind their ear. Knowing how embarrassing it is to have attention drawn to this, I avoided asking any of them about it, but I started getting more and more curious.

Yesterday, I went to the ENT (Ear, Nose Throat) doctor. I first talked with the audiologist, and she said, what you need is a BAHA. While waiting for the ENT, I looked up BAHA on the web, and found this page at U Maryland which described it in some detail both the device and the procedure. What could be simpler?

Here's more technical information from the company that makes these things.

Bone conduction hearing is hardly a new concept. It's how Beethoven continued his music career after going completely deaf. He sawed the legs off of his piano, and then laid on the floor to feel the music through his bones.

So, if all goes well, in just a few weeks I'll be having a new screw installed in my skull. It will have to heal for 3 months. During that time, the bone actually grows into the micro-holes in the screw, to completely anchor it in the bone, so that it won't move when the device is attached to it several times a day for the next few decades. Once it is firmly anchored, I'll get the external device that snaps onto the screw, and, after 25 years of being deaf on one side, I'll be able to hear normally.

For those of you who hear normally, you may have never noticed how I twist my head to hear you, or arrange to sit or stand on your left side, but you've certainly noticed how I ask you to repeat things again and again, or seem to give inappropriate responses to things when I simply get too frustrated trying to figure out what you're saying. Hopefully, 4 or 5 months from now, that will no longer be the case.

I'm really excited about the prospect.