Thursday, September 23, 2010

Email with Sheri Byrne

I wrote Sheri today asking for her advice on our out of network procedure for insurance.  she said everything looks good, but added that we should include the attached report on the learning curve for atresia surgeries.

The Surgical Learning Curve in Aural Atresia Surgery

Tuesday, September 14, 2010

Getting a referral

We have an appointment with Molly's ENT Dr Cravens on November 8th at 2:30pm.  I'll give him all the info that we've collected so that we can hopefully get the out of network approved.

But first I have to get a referral from Molly's primary care to go to Dr Cravens.

Wednesday, September 8, 2010

Letter from CEI

Ok, I received a letter from CEI telling our insurance company why we should come to CEI instead of a local doctor who hasn't performed as many atresia canalplasties.

Now the work is back on my shoulders, I need to schedule an appointment with Molly's local ENT, Dr Cravens, to get his referral to Dr Roberson.

If anyone wants to see the letter, here it is...

Molly's Letter from CEI

Tuesday, September 7, 2010


Sent a followup to Cheryl at CEI regarding the letter for our insurance. I'll probably try and call her today as well.

BAHA Repair

Molly's BAHA is fixed and we should have it back by tomorrow!

Tuesday, August 31, 2010

BAHA Repair

Ok, Molly's BAHA is off for repair.  I actually bought the Silver service plan which give us one year of repairs, and one scheduled maintenance cleaning all for $495.  That's what I was expecting to pay just to do a one time repair.

We're anticipating Molly getting atresia repair and BAHA implants combined in the next 4-6 months so at least we will have one of her BAHAs covered until then.

Monday, August 30, 2010

MedPor Reconstruction with Dr Reinisch

Dr. John Reinisch performs his Medpor plastic surgery on a little boy from Ireland born with Microtia with amazing results.

The TV is too loud!

Aside from the issue with both of Molly's BAHAs not functioning, we have a little girl who is now requesting to use them.  She hasn't really cared for them too much for various reasons.  But now I think something has shifted in her and she wants them, mainly during TV/Movie watching.  So now she is requesting to turn the TV up way too loud so that she can hear it.  Plug your fingers in your ears solidly and that is a fairly good approximation of what she hears.  It's about a 30-40dB conductive hearing loss with your fingers in your ears.

I think I'm going to try and get her some headphones, either wired or wireless and have her use those until we can get the BAHA fixed.  Even after the BAHA is fixed, this should be a good compromise when she gets tired of the BAHA and just wants to watch a movie, or use the computer.

Friday, August 27, 2010

Atresia Repair

I received a email reply from Cheryl today regarding our out of network insurance battle with Aetna.  She will ask Dr Roberson to craft a letter to Aetna so that they may see the light in respect to allowing us to go out of network instead an in network hack. :)

BAHA damaged

Molly came home from school yesterday with her BAHA not functioning.  I can her it making some noise and slight feedback but it is not transmitting to the post at all.  I'm thinking it's moisture related so I have it sitting in the jar of stuff that came with it to try and remove the moisture.

She has two BAHA Divinos.  Her first one is also damaged, the post connecting it to the softband has a tiny piece broke off and the battery door has a piece of plastic broke.  So now she is without any assistance at all.  We're going to bite the bullet and send the first one off for repair, $495 flat fee to fix.  Yikes.

Hopefully I can revive the second one myself.  We can't afford to fix two right now.

BAHA Billing Codes

For future reference, BAHA Insurance Billing Codes

Thursday, August 26, 2010

Dr Cravens

Erin received a call from Dr Cravens office (Mollly's ENT) and they refer to Dr Roberson!  Woo-hoo!  Doesn't change anything about needing an out of network authorization, but it will certainly help to have a specialist recommend Roberson over some in-network doctor.

Wednesday, August 25, 2010


Called Cheryl Soriano today, she was out of the office returning either today or tomorrow so I will try to call again Friday.

Tuesday, August 24, 2010

Round One of Doctors

Here is the list of doctors I have to call to see if they do aural atresia repair.

Update: Erin has called the list and is waiting on call backs from a few.

Confirmed do not perform 8-24-10
Mindy Ann Black520-498-1800
Randall Scott Cohen520-694-8888
Robert Cravens520-694-8888 Refers to Roberson!
Robert L Dean520-694-8888
Steven Blatchford520-792-2170
David Miyama520-792-2170
Adam Ray520-792-2170
James Roy Carlson520-795-8777
Thomas Sunil Kang520-795-8777
Jonathan Ray Lara520-795-8777
Stanley Coulthard520-296-8500
Joe Huerta520-296-8500
William LaMear520-296-8500
David Parry520-296-8500
Keith Soderberg520-296-8500
Elias Stratigouleas520-296-8500
Afshin Emami520-792-2170
Eugene Falk520-792-2170
James Gordon520-792-2170
Joseph Small520-795-1581
Thomas Tilsner520-886-1291

Out of Network Authorization.

Starting the process of calling ENT's in our area and finding out if they do the aural atresia repair and if so how many. I spoke with one doctor's office today (Mark Syms) and his surgery scheduler said that he only does 2-3 per year. Yikes!

I called Aetna and the lady on the phone will email me a list of ENTs in our area, I just have to call and work my way down the list.

She also suggested that wne we make our request to Molly's primary care for an out of network authorization, that we include information that Dr Roberson does around 125 of these per year.

The surgical learning curve in aural atresia surgery.

Patel N, Shelton C.

Otolaryngology Head & Neck Surgery, University of Utah, Salt Lake City, Utah 84132, USA.


OBJECTIVE: The objective of this retrospective case review is to examine the effect of surgical learning on hearing outcomes and complications in congenital aural atresia surgery.

PATIENTS: Sixty-four consecutive ears (in 60 patients) operated on during the period of 1994 to 2004 at a tertiary referral center were studied.

INTERVENTION(S): Intervention consisted of aural atresiaplasty through an anterior approach by the same surgeon (C.S.).

MAIN OUTCOME MEASURE(S): Hearing outcomes and complication rates were compared between four temporally sequential groups of 16 ears. Acceptable hearing and complication rate outcomes were defined as results comparable to larger series in the literature.

RESULTS: Hearing results, in the short term, comparable to larger series were achieved during the first group of ears (nos. 1-16). A plateau in the learning curve for short-term hearing outcomes was achieved after the first two groups, that is, after 32 ears. Hearing outcomes, in the long term (>1 year) comparable to larger series, were achieved in the second group of ears (nos. 16-32). The learning curve for long-term hearing demonstrated a significant improvement in outcomes in the final group of 16 ears compared with the first 48 ears. Long-term hearing results for the final group show closure of the postoperative air-bone gap to less than 30 dB in 94% of cases. Postoperative complication rates were equivalent to larger series in the first group of 16 ears and showed no statistically significant difference between the four groups. There was one patient with sensorineural hearing loss after surgery; there were no anacoustic ears and no facial palsies in the study group.

CONCLUSIONS: A learning curve of at least 32 ears was required to achieve stable short-term hearing results. To achieve stable long-term hearing results required a learning curve of at least 48 patients in our series. Complication rates remained stable throughout the study period.

PMID: 17202933 [PubMed - indexed for MEDLINE]

First Post

This is for Molly.

She was adopted from an orphanage in Huzhou City, Zhiejang, China at 2.5 years old and has bilateral microtia and atresia. We're going through the process of getting her hearing restored via atresia repair by Dr Roberson in Palo Alto CA.