...and waiting and waiting

Unfortunately, I have no good news to report on the approval for David's surgery by our insurance company. We found out last Wednesday that they denied coverage, and we submitted additional information for reconsideration Thursday morning, and just a few hours later found out they denied coverage once again. The decision was based on David's age, since the Empire policy only covers surgery at 12 months old. Supposedly the policy is "written in stone". Pardon my language, but what a bunch of BS. In my appeal letter I cited a specific case of a little boy who had surgery covered by Empire at 8.5 months old at NYU (a huge thank you to Julia - it's her little boy mentioned here - for her advice and guidance through this process). So obviously it's not written in stone. There is a precedent and, in fact, many many precedents of kids being implanted younger than 12 months. I'm still trying to figure out why it took them almost a month to deny us based on his age and why they even asked us and our surgeon for information supporting implantation before 12 months.

So now we're on to the next stage of the appeal process, where the case is going to be looked at by an actual doctor...imagine that...independent of Empire's policy. Once our surgeon submits additional research supporting our case, it should take 2-3 days for a decision. Unfortunately our surgeon is a busy guy and getting him to send the info may take lots of nagging and calls to his office. I certainly hope it's not our surgeon that holds up the surgery. That would be a real shame.

So why are we fighting to get David his implant now when the surgery is covered as of his 1st birthday? Why does 2 months make such a big difference? I suppose in the long run...1 1/2 to 2 years down the road, it probably won't. But that's a long time to wait. And David will have to work that much harder to catch up to his hearing peers. Two months doesn't seem like a long time, but when you're waiting for your child to be able to hear and speak, it's an eternity. We just want him to have as easy time as possible catching up. And we want him to be ready to go to a "normal" preschool with his little hearing friends. Seems like a lot of pressure to put on the little guy, but our therapists believe that going to school with other hearing kids is beneficial for language, listening and social skills. Other than that, call me selfish, but I'd really like him to be hearing for his 1st birthday. So, these are our goals, and hopefully our surgeon and Empire are both on board and David will be getting his implant on October 8th!