The Cost of Hearing
MILWAUKEE - Hearing aids can cost families thousands of dollars. Cochlear implants can run them tens of thousands. A new Wisconsin law requiring insurance companies to cover the devices for children gave hope to parents that their kids could finally get the medical help they need. But many have quickly had those hopes dashed.
Diane Marszalkowski only wants what's best for her kids. For her son and daughter, that means expensive hearing aids.
"She has a disability. My son has a disability. It's not something they asked for. They were born with it and we need help with it," Diane told TODAYS TMJ4 reporter Lauren Leamanczyk.
Diane thought she'd finally gotten that help. This January, a new law went into effect requiring insurance companies to cover the cost of hearing aids and cochlear implants for children.
But when the bill came for her kids' hearing aids, Diane got a huge shock.
Patient responsibility was $3,000 for each child. Insurance will not cover any of it.
"I was just sick, absolutely sick to know that I might have to come up with $6,000 for the kids aids for them to learn. To be able to hear. To function and not struggle."
At the Center for Communication, Hearing and Deafness, the Marszalkowskis' experience has become a familiar story. Amy Peters Lalios says she only knows of one patient who's gotten coverage without a fight.
Lauren: "Did that come as a surprise to you?"
Lalios: "It did. It was something that myself, personally had not anticipated and I think it is just heartbreaking for the families who want so badly to provide the best of services and technology for their children."
We asked the State Insurance Commissioner Sean Dilweg why.
Lauren: "Have insurance companies complied with the spirit of this law?"
Dilweg: "Yes."
But most aren't forced to.
"Any mandates that's passed on a state level is really only penetrating about 30 percent of the market," Dilweg explained.
That means 70 percent of people who pay their premiums and meet their deductibles still don't have coverage for hearing aids and cochlear implant.
Self funded insurance plans, which are common among large companies, and out of state plans don't have to follow the new mandate. Insurers also have the option of waiting until a new policy year with a brand new deductible to offer coverage.
Changing that will require a mandate passed at the federal level.
Diane read the law line by line and didn't see any of those caveats.
"Either I'm missing something or there's loopholes in there," she said
Now she's faced with the heartbreaking task of coming up with thousands of dollars or taking away her children's chance to hear.
Experts say Wisconsin's gone as far as the law will let it in requiring insurance companies to pay. Any further mandate would need to come from the federal government.
That's a change families I spoke with would like to push for.
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