Insurance Payer Status Predicts Postoperative Speech Outcomes in Adult Cochlear Implant Recipients

Abstract

Background Cochlear implant qualifying criteria for adult patients with public insurance policies are stricter than the labeled manufacturer criteria. It remains unclear whether insurance payer status affects expedient access to implants for adult patients who could derive benefit from the devices. Purpose This study examined whether insurance payer status affected access to cochlear implant services and longitudinal speech-perception outcomes in adult cochlear implant recipients. Research Design Retrospective cross-sectional study. Study Sample Sixty-eight data points were queried from the Health Insurance Portability and Accountability Act–Secure, Encrypted, Research Management and Evaluation Solution database which consists of 12,388 de-identified data points from adult and pediatric cochlear implant recipients. Data Analysis Linear mixed-effects models were used to determine whether insurance payer status affected expedient access to cochlear implants and whether payer status predicted longitudinal postoperative speech-perception scores in quiet and noise. Results Results from linear mixed-effects regression models indicated that insurance payer status was a significant predictor of behavioral speech-perception scores in quiet and in background noise, with patients with public insurance experiencing poorer outcomes. In addition, extended wait time to receive a cochlear implant was predicted to significantly decrease speech-perception outcomes for patients with public insurance. Conclusion This study documented patients covered by public health insurance wait longer to receive cochlear implants and experience poorer postoperative speech-perception outcomes. These results have important clinical implications regarding the cochlear implant candidacy criteria and intervention protocols.

Barriers to Adult Cochlear Implant Care in the United States: An Analysis of Health Care Delivery

“…56 In cases of asymmetric hearing loss with a better hearing ear that does not meet Medicare stipulations, patients experience a delay in treatment for the qualifying ear as they wait for deterioration of the better hearing ear to ultimately meet bilateral, best-aided Medicare criteria, leading to unnecessary prolonged duration of deafness in the poorer hearing ear. 18 57 As most adults aged more than 64 in the United States constitute the Medicare beneficiary population, unique bilateral criteria which restrict access to care and cause treatment delay do so in the population most vulnerable to significant hearing loss. 58 59 60 Despite the incontrovertible benefits of CI in the elderly population, current Medicare criteria persistently discriminate against the geriatric population with hearing impairment.…”

Sociodemographic Factors and Health Care Utilization in Pediatric Chronic Suppurative Otitis Media

“…Health care utilization is complicated by many factors. Medicaid insurance, younger age, rurality, and low socioeconomic status have been identified as risk factors with otolaryngology practices for no show visits and poor hearing outcomes, [16][17][18][19] but no study has identified the sociodemographic risk factors associated with pediatric perioperative care utilization among those patients with CSOM. Given the chronic nature of the disease and its implications on hearing, 2 audiograms, and otomicroscopy are paramount in pre-and postoperative surveillance of CSOM, and heavily influence decisions to continue medical management or intervene surgically.…”