American Cochlear Implant Alliance, Salary from American Cochlear Implant Alliance, McLean, Virginia.
The Ohio State University Wexner Medical Center, Columbus, Ohio.
Otol Neurotol. 2023 Sep 1;44(8):e628-e634. doi: 10.1097/MAO.0000000000003969. Epub 2023 Jul 25.
There is increasing interest in providing cochlear implants (CIs) in single-sided deafness (SSD) or asymmetric hearing loss (AHL). CI clinics have experienced a range of outcomes when seeking insurance coverage for patients. The study explored the extent to which CI clinics were able to secure insurance coverage and whether there were differences in successfully gaining such coverage.
A SurveyMonkey questionnaire was used to collect data from US CI clinicians. Respondents were from all regions of the United States and represented a diversity of clinic types including hospitals, university-based clinics, private clinics, and schools. Data were collected during August-October 2021 from 105 respondents regarding their clinic's experience in gaining health insurance coverage for pediatric and adult patients who had SSD or AHL. Strategies that had been used for gaining coverage after an initial denial were explored. Interviews were conducted with some respondents to gain additional insights beyond the survey.
There was a substantial increase in the number of SSD operations conducted after 2019, the year when the Food and Drug Administration (FDA) manufacturer criteria expanded to include CI in SSD and AHL. Respondents were grouped into four categories based on volume of SSD operations before 2019 (≤10, 11-29, 30-49, and ≥50). The number of SSD operations after 2019 went up in all categories except for the 10 or less category, which declined by 43%. A minority of respondents indicated that they were able to obtain SSD insurance coverage infrequently (5%) or almost never (8%). Peer-to-peer review was the most successful approach to overturning an initial denial. Many clinics note that they are nearly always declined for SSD coverage on the first submission and must appeal.
There is variability in CI coverage for SSD and AHL. Some health insurance coverage is available for patients of all ages, although some clinics note more difficulty gaining coverage for children younger than 5 years because of the FDA criteria. Clinicians are most successful at gaining coverage after an initial denial with peer-to-peer review, although the process is time-consuming and delays surgery. Efforts to expand access to CIs in SSD for children and adults who may benefit might best be addressed by reflecting on what was done to expand insurance coverage in bilateral deafness-a process that depended on relevant clinical research; research presented to the FDA for guidelines change; information sharing with the general public and constituencies in the hearing loss field including professionals, parent, and consumer organizations; and ongoing advocacy for change with insurers. To date, outcomes research in young children with CI in SSD is limited. Until such research is conducted and published, insurers will continue to argue that other rehabilitative options are approved and available.
在单侧聋（SSD）或不对称性听力损失（AHL）中提供人工耳蜗植入（CI）的兴趣日益增加。CI 诊所为患者寻求保险覆盖范围时经历了一系列结果。本研究探讨了 CI 诊所获得保险覆盖范围的程度，以及成功获得此类覆盖范围的差异。
使用 SurveyMonkey 问卷调查收集来自美国 CI 临床医生的数据。受访者来自美国各地，代表了各种诊所类型，包括医院、大学诊所、私人诊所和学校。2021 年 8 月至 10 月期间，从 105 名受访者那里收集了有关他们的诊所为 SSD 或 AHL 患者获得儿童和成人健康保险覆盖范围的经验数据。还探讨了在最初拒绝后用于获得覆盖范围的策略。对一些受访者进行了访谈，以获得调查之外的其他见解。
自 2019 年食品和药物管理局（FDA）制造商标准扩大到包括 SSD 和 AHL 中的 CI 以来，SSD 手术数量大幅增加。根据 2019 年之前的 SSD 手术量，受访者被分为四组（≤10、11-29、30-49 和≥50）。除了手术量减少 43%的 10 或更少的类别外，2019 年之后所有类别的 SSD 手术数量都有所增加。少数受访者表示，他们很少（5%）或几乎从不（8%）能够获得 SSD 保险覆盖范围。同行评议是推翻最初否认的最成功方法。许多诊所指出，他们几乎总是在首次提交时被拒绝 SSD 保险范围，必须上诉。
SSD 和 AHL 的 CI 覆盖范围存在差异。尽管一些诊所指出，由于 FDA 标准，为 5 岁以下的儿童获得覆盖范围更加困难，但所有年龄段的患者都有一些医疗保险覆盖范围。在最初的否认后，临床医生通过同行评议最成功地获得了覆盖范围，尽管该过程耗时且会延迟手术。对于可能受益的 SSD 中儿童和成人的 CI 接入扩大工作，最好通过反思在扩大双侧耳聋保险范围方面所做的工作来解决，这一过程取决于相关的临床研究；向 FDA 提交的用于改变指南的研究；与包括专业人员、父母和消费者组织在内的听力损失领域的公众和利益相关者共享信息；以及与保险公司持续进行变革宣传。迄今为止，SSD 中接受 CI 的幼儿的结果研究有限。在进行和发表此类研究之前，保险公司将继续争辩说，其他康复选择已获得批准和可用。
