A Young Boy Receives The Miracle Of Hearing
Published: December 10, 2005
It was an operation that could make a world of difference for the six-year-old boy.
That is, it would allow him to hear out of both ears.
He was all set for the surgery, but then, his insurance company delivered bad news: they would not pay for it.
Seven On Your Side now with advice for anyone who has medical insurance.
Jacob Nuland looks like an average six-year-old: full of fun and energy — until you see his cochlear implant.
Tappy: “So if I talk from over this side, you can hear me okay?”
Jacob: “Yeah.”
Tappy: “But if I talk from over on this side, you can’t hear me as well?”
Jacob shakes his head yes.
Jacob’s first cochlear implant was five years ago. Eyewitness News was there when he heard his first sound.
Now, Jacob was scheduled for an implant in the other ear, called a bilateral implant.
Lisa Nuland, mother: “The doctor recommended it.”
But late last month, the family’s insurance company — Oxford — denied coverage.
They said the operation was not yet proven to be effective.
Lisa was stunned: “We sent them studies from New York University, the University of Iowa, major universities who did studies, showing them that there were benefits.”
Lisa appealed to her insurance company. But, it turns out there is another way — it’s called an external review and you have the state step in.
Alan Ripka: “The way it works is, you are going to appeal to the State Insurance Department.”
And you must convince them that the operation is medically necessary.
Alan: “That’s the key. Why this procedure may help you get rid of an illness or continue in good health.”
If the state approves your case, they can order the insurance company to pay.
As for Lisa, she got Seven on her side.
We called Oxford, and just one week after her denial, they reversed their decision and approved the operation.
Lisa: “I’m so grateful that this is working out for our child, but I don’t know how many parents know that you can do this. … That you can say wait a minute … You can’t say no.”
And because Lisa didn’t take no for an answer, Jacob’s operation is scheduled for later this month.
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