Mother of deaf twins ‘fed up’

Published 12:00 am Thursday, November 25, 1999

A world of silence was changed for Morgan and Matthew Smith this July when the deaf twins had their cochlear implants turned on for the first time.

Cochlear implants can restore hearing to profoundly deaf individuals, but they are expensive. In the twins case, it cost $33,872.70 per ear for the devices to be surgically implanted – a fee the parents’ insurance company now refuses to pay

&uot;I’m really fed up,&uot; said Tonya Clary, mother of the twins. &uot;We just had the implants turned on in July and now they don’t want to pay.&uot;

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Prior to surgery, the twins’ physician, Dr. Bruce Fetterman of the Shea Clinic in Memphis, Tenn., sent a cost estimate for the surgery and related expenses to the family’s insurance company, Mississippi Administrative Services.

In a pretreatment estimate sent to Fetterman’s office, Mississippi Administrative Services authorized the treatment plan for the twins, which included the $33,862.70 in surgical expenses for each child.

After the surgery was performed June 18, the medical claim was denied July 21 by Mississippi Administrative Services, a self-funded insurance plan carried by the City of Natchez.

The twins’ father, Charles G. Smith, III, is insured with Mississippi Administrative Services through his employment as a policeman for the City of Natchez.

&uot;This has never happened before in my practice,&uot; said Fetterman. &uot;Someone could have figured out what is covered.&uot;

Wayne Jones, vice president of Mississippi Administrative Services said he followed routine procedure in handing the case.

&uot;You never really know what’s covered until you’re on an actual claim form,&uot; Jones said.

The predetermination of benefits form sent to the Shea Clinic included a clause which states that the predetermination of benefits statement is not a guarantee of payment.

&uot;It’s a tough deal,&uot; Jones said. &uot;These services are outside the plan.&uot;

Most major medical insurances do not cover vision and hearing services, said Frances Trosclair, City Clerk for Natchez.

Trosclair said Mississippi Administrative Services designed the Natchez insurance plan based on industry standards.

&uot;They fashioned the plan after other insurance policies,&uot; Trosclair said. &uot;Dental, vision and hearing care are exclusions under the plan.&uot;

Leigh Bonner, accountant for the Shea Clinic, takes issue with this determination in the wake of a predetermination of benefits that approved the medical treatment for the twins.

&uot;The coverage of the cochlear implants should have been researched in advance and we should have been told in advance,&uot; Bonner said.

Self-insured plans like the one the City of Natchez has with Mississippi Administrative Services are not governed by the Mississippi Insurance Department – meaning that the state cannot hold these plans accountable, said Linda Parish, Consumer Service Supervisor with the Mississippi Insurance Department.

The U.S. Department of Labor would regulate these self-funded insurances, Parish said.

Bonner said she has taken the twins’ case to the Department of Labor and has hopes that some relief for the family can be found there.

Meanwhile, Clary is left with mounting medical bills.

Medicaid covers some of the treatments the children have received – but not the cochlear implants or the follow-up care at the Shea Clinic.

The current bill adds up to around $90,000, Clary said.

To help with costs, friends of the family have set up a fund in the twins’ names at Concordia Bank and Trust to offset medical expense in their treatment.