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Wis. could be first to require coverage for cochlear implants

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Wisconsin Capitol
The Wisconsin State Capitol in Madison.
Photo courtesy of the state of Wisconsin

(AP) - Wisconsin lawmakers acted Thursday to become the first state to require insurance companies to cover cochlear implants for children with severe hearing problems.

Both houses of the Democratic-controlled Legislature approved a bill that requires private health insurance plans to cover cochlear implants, hearing aids and related treatment for anyone under the age of 18. Gov. Jim Doyle, a Democrat, will sign it into law, a spokeswoman said.

While hearing aids help some children with hearing loss, those with more severe problems may be candidates for cochlear implants. The devices turn sound into electrical impulses that activate the hearing nerve, allowing the deaf to hear.

How a cochlear implant works
How a cochlear implant works: A microphone (1) on the outside of the ear picks up sound and sends it to a microprocessor (2) behind the ear. The microprocessor converts the sound into signals that are sent through a transmitter (3) to the internal implant (4), which includes an electrode (5) that stimulates remaining hearing nerve fibers in the ear.
Image courtesy of the Marshfield Clinic

Supporters say too many families with deaf children cannot afford to pay for implants that cost $50,000 or more when their insurance policies exclude them.

They say getting the devices as early as possible is critical to help children develop their language skills.

"This bill is going to allow children to keep their hearing, to become members of society, to go to school and keep a job," said Rep. David Cullen, D-Milwaukee.

While several states require insurance companies to cover some hearing aid costs, advocates said Wisconsin would be the first to extend the mandate to cochlear implants.

The mandate applies to the roughly 1.6 million residents, or 30 percent of Wisconsin's population, who are covered under private insurance plans regulated by the state.

"Anytime you mandate ... coverage for something, you are most likely adding to the cost of that coverage."

Others in self-funded plans favored by many big businesses will not be bound by the mandate. Most government-funded plans such as Medicaid already cover the devices.

Ann Brensel of Fort Atkinson, whose daughter Abigail was born in 2005 with profound hearing loss, was part of a coalition of parents who pushed lawmakers to act. The family tried to get her a cochlear implant before she turned 1 but was denied by their insurance company, which had a policy of excluding the devices from coverage.

Abigail finally got the device implanted in her left ear last year after her husband switched jobs and added his insurance coverage on top of hers. Still, the initial denial delayed Abigail's language development and put a strain on the family's finances.

Her mother said Abigail will now have to go to a special school about 35 miles away in Waukesha rather than the local elementary school. The family, meanwhile, has struggled to afford the $800 monthly cost of both insurance premiums and has fallen behind on mortgage and car payments.

"There really was no reason she should have had to lose two years of precious time when she could have been learning sounds and learning to use her voice," Ann Brensel said. "I hope this bill helps the next family not to go through what we had to go through."

The measure passed the Senate on a voice vote and by an 80-16 margin in the Assembly.

Opponents, who included some Republicans and business groups, complained the mandate would drive up costs for small businesses and employees struggling to afford health care costs.

"Today, you're not voting for hearing aids and cochlear implants," Rep. Leah Vukmir, R-Wauwatosa, told her colleagues. "You're voting to take away insurance for employees who work for small businesses."

The potential cost of the mandate is unclear and will vary widely by company, said Phil Dougherty, senior executive officer of the Wisconsin Association of Health Plans. He said some of its members already provide coverage for hearing aids and cochlear implants while others do not.

"More people will be seeking cochlear implants because now it's a covered benefit," he said. "Anytime you mandate, you add coverage for something, you are most likely adding to the cost of that coverage."

The bill allows insurers to apply routine cost-sharing provisions for the procedures.

Wisconsin's insurance commissioner estimated last year that a similar, but slightly less-generous version of the bill would cost people enrolled in private insurance plans less than 10 cents per month. The analysis estimated that 1,200 kids in Wisconsin schools were deaf and up to one-third of them had cochlear implants.

Supporters said the mandate would save taxpayers money in the long run by reducing special education costs and allowing more people born deaf to enter the workforce.

David Friedland, a doctor with the Koss Cochlear Implant Program at the Medical College of Wisconsin, said the center performs about 100 surgeries to implant the devices per year, half of them on children.

"This will help with the small number of people who are candidates, but carry insurance that has a specific rider that excludes cochlear implants," he said. "This will allow those people now to hear."

(Copyright 2009 by The Associated Press. All Rights Reserved.)