Senator Joe Donnelly, First, I would like to thank you and your staff for their support with TRICARE. I have been communicating with your team about my 5 year old daughter Mackenzies authorization to receive a cochlear implant. Obviously, it has not been a smooth process. Kari Easley and myself knew that Mackenzie was going to be special before we met her. Early ultra-sounds indicated that there was a problem. After some tests, and many anxious moments, we learned that Mackenzie had a chromosome deletion. The short arm of her 6th chromosome (6p) was not complete. Mackenzie arrived in late July of 2009 in Logansport, IN. She was and still is perfect. The great staff at Logansport Memorial Hospital noticed tested her hearing, and she failed 3 hearing exams. Of everything that could go wrong with a deletion, we considered ourselves lucky. Mackenzie received her first set of hearing aids from Indianas First Steps program at just 4 months of age. Mackenzie has worn them since then, and has fought to overcome every disadvantage that has come her way. Whether the numerous trips to Riley Childrens Hospital, or an NG tube for feeding, or the trips to Walter Reed for her orthotics, et al. Somehow, Mackenzie has done it all with a smile on her face. Anyone that knows Mackenzie will tell you that her smile will brighten a room. She is funny and smart. As her parents, we know her as a fighter. Nothing comes easy for her. She works for everything. Even when it would be so easy to give up, she fights. She has been fighting to overcome her hearing loss. She is now in Kindergarten. Even with all her support through her teachers and speech therapists, she has now plateaued in her ability to listen to learn. She continues to fight and work as hard as she can, but the hearing aids do not allow the level of hearing that the cochlear implant allows. Now, her fight is against time and the government run health insurance company TRICARE. Mackenzie was supposed to receive her cochlear implant tomorrow at UNC Chapel Hill. TRICARE denied her authorization. The following is the link to the TRICARE Policy Manual concerning cochlear implants: humana-military/southmanuals/policy/AsOf/C4S22_2.PDF The dates on this policy are all over the place with dates being more recent than the effective date. The most important date is the issue date for this section, March 2, 1988. It is almost 30 years old, and the policy makes absolutely no sense. The policy say if you are 18 years or older your hearing can be better than someone younger and still receive the implant. There is no evidence to support that an older person reacts better to a cochlear implant and its performance. There is ample amount of evidence to show that the earlier a cochlear implant is utilized, the greater its results on speech and listening to learn. It makes no sense that someone older can have a 20 point better hearing level and receive an implant. The only explanation is that it is to save money, which I will discuss later. The policy also has a one size fits all hearing loss at certain Hz levels. Because of Mackenzies chromosome deletion her hearing loss is essentially abnormal for hearing loss. At lower Hz levels is where she struggles the most. Her score is greater than 90 as required in certain Hz levels. This surgery is not elective. Kari and I have discussed this in great detail with her doctors, her therapists, her educators, and ourselves. Dr Buchman, the 2014 NC AG Bell Award Winner for his work with children with hearing loss, is the doctor that recommends this. However, when it was received by the Medical Necessity Board at TRICARE, it was denied by a Nurse. I am not at all downplaying the importance of Nurses, but they are not a doctor who specializes in this field. I have inquired with TRICARE several times, and they say that it is not a medical necessity for her to receive the implant. So a Nurse decided a Doctor was wrong? I understand their policy manual is in place for a reason, but nothing is ever set in stone when it comes to medicine. They denied us the treatment, and we are currently in the appeals process, which is another 30 days for TRICARE. Her next chance for a cochlear implant is December 2nd. After the new year, my family must prepare to move since I am a Marine and I must receive orders for the Commandants Career Level Education Board. The longer we wait, the less time she will have with her team here to start the most important phase of Mackenzie learning to use her cochlear implant. We will still continue to see her doctors for her hearing to evaluate her, and still receive the therapy. However, if she cannot receive the cochlear implant, the benefits of these services will be diminished. In the long run, the expense of this therapy and not giving her a cochlear implant will be more expensive then allowing her to receive the surgery. I know you are a businessman, so I am sure you can see that the total cost without a substantial benefit is essentially sunk. This is not to mention not allowing a child to achieve her full potential in school which will cause even more expenses. TRICARE is the example of how government health care, the Affordable Health Care Act, will run according to speeches made by the highest members of our executive and legislative branch. TRICARE is responsible for processing the authorizations and referrals for less than 1% of the population, but there are always lengthy delays in processing and numerous levels of red tape. It causes missed and delayed appointments that adds to medical costs, when right now the goal is to lower them. Not to mention a great deal of frustration for those involved. This is not just for parents with special needs children. The system is hard for everyone. The policy manual does not have an MD. It does not evaluate patience. It IS out of date though. You have the ability to change that. This is not just about Mackenzie, it is about everyone who struggles with TRICARE. I understand that medical care is expensive, but the denials, waits, and red tape are very costly as well. I know you are a father, so I hope that you can understand the level of frustration for a parent when a insurance company holds your childs future in their hands. Especially when they are using an outdated policy manual, and the decision is being made by people who are not experts in the field. I am asking you to fix the system. Again, I thank you for your help in this matter Senator Donnelly. I will ask you for one more thing before I go. I ask you to look at Mackenzie, something the insurance company does not do, and decide against her doctors recommendations for her to receive a cochlear implant. Something that if she does not receive will negatively effect her future. Thank you again. Very Respectfully, Scott Easley Family and friends please like and share this if you can. #CochlearforKenzie
Posted on: Fri, 14 Nov 2014 03:05:51 +0000
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