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Pre CI process hints, from one who successfully got the following accomplished and fully covered by insurance all in a period of eight months: CI evaluation, CI approval, visits to three CI doctors, four audiologists, two CI surgeries (same ear, hookups included as part of the authorization) with the second one including three month post op follow-up all “out of network, out of area”
1. Figure out how you will effectively give and receive information from all the people who will be involved in your CI journey. People would call me a lot at first during the process especially regarding appointments. Because I had such difficulty on the phone I used the team list sheet (See #2) to ask who was calling. Early CI process typical phone conversations went a little like this. “Is this about my cochlear implant? I cannot hear much on the phone so I will ask you some questions to try to better understand and communicate with you. Is this so and so, (down the list)? Is this about an appointment? …. Or, one of my favorites: Could you either email me, mail me, fax me or call back and leave a message and I will have my family tell me what it says when they get home? Which will you do? I will respond to you by (your method of choice)” Then I had them repeat and I repeated it back so I was sure of which way to expect communication from that person. It was very hard and stressful. I had use of a fax machine and email. Many who regularly communicated with me quickly learned to use one of those methods! I also made frequent walk-in trips to my primary care doctor during the paperwork proceedings ( thank God for my lipreading ability.)
2. At the beginning of your CI evaluation journey start two manila folders, one for medical records, the other for insurance documentation (very important: authorizations in writing.) Information I put in both files was what I referred to as my CI team members. My “CI team list” got so extensive and involved I eventually put it all on one sheet, stapled a copy inside the front cover of each folder and gave a copy of that sheet to each provider. This was helpful if they needed to communicate with anyone else during my process. CI team members list should have all the following: your insurer address, number and case manager information (see below); address, phone, fax, email addys and office assistant names for the following professionals involved in your process: your audiologist up to the point of CI journey (this person may no longer follow you after CI.); your primary care MD, the CI audiologist and other evaluators (psychologist? I never had one because they could tell I was a tad nutty when they met me LOL), prospective CI physicians (it never hurts to get more than one opinion).
The first item to place in your medical file is the audiogram test that triggered your being told to explore CI as your option. From then on throughout your CI process get a copy of each medical evaluation report and place it in the folder. ALWAYS KEEP YOUR ORIGINALS. I had to share many of these medical records with three audiologists, five MDs and obviously the insurer. (Keep a log of expenses like copying, mailing, faxing costs, mileage to and from all medical appointments as it all adds up for tax time.)
3. As soon as you start the CI evaluation process, call your insurance and ask for the name and the extension number of the nurse case manager assigned to follow your case. If you do not have one, ask to be assigned one explaining that CI surgery is expensive and involved. In my situation much of what happened to me got routed through that person and evaluated by the plan medical director for authorization. (My insurer paid upwards of $100,000 to after the two surgeries. Unfortunately my family refuses to grant me any more respect than they did before!) Introduce yourself to your case manager using your preferred method of communication. (phone or relay or email)Explain your communications problem and the need to work out a mutually convenient and effective way to communicate with him or her. I found that I ended up communicating with my case manager at least once a month during the pre CI period. Faxing and emailing worked best for us.
4. Involve your primary care doctor if you need referrals for insurance authorizations. Give him the above case manager information, especially the name and fax number, along with your insurance number and info, which they should have on file.
5. Save copies of all insurance communications, never giving away your originals. Get authorizations in writing before the surgery and other consultations if you need them. You may need to get separate authorizations for CT scan, audiology tests depending upon your insurer. This is why you need to maintain good positive communications with the case manager.
6. Be patient, courteous and persistent with all involved parties. Know the office assistants/receptionists names for your audiologists and also get their fax number as well. If you fax insurance authorizations you get you might speed things up considerably. Again, having your CI team list easily accessible is very helpful.
Jot down dates, who you called when, what happens next etc in your folders so you are on top of where the process is and what needs to be done. If someone tells you “I will get back to you” answer them: “If I do not hear from you by_____ I will contact you on ______.”
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