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idiopathic sudden sensorineural hearing loss
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3/15/2012 at 2:39:51 PM GMT
Posts: 14
idiopathic sudden sensorineural hearing loss
I was wondering what protocol most centers are using for this diagnosis.  How many treatments are typical?  The research varies from 2 ATA to 2.5 ATA with some studies treating daily , some twice daily. Some treat for 60mins, some for 90 mins and the total number of treatments varies also. What is the UHMS' recommended protocol? Thank you. 

Rosemary Byrne NP
Certified Hyperbaric Registered Nurse


4/16/2012 at 5:56:00 PM GMT
Posts: 5
I was wondering if anyone has actually received an authorization to treat or been reimbursed for this diagnosis yet since it isn't listed in the CMS's approved indications list.


5/10/2012 at 11:12:52 PM GMT
Posts: 5

My question is now not rhetorical.  We have received a consult for someone with ISSHL.  It isn't on the CMS list and the patient's secondary insurance, United Healthcare, has it specifically listed under "HBO therapy is unproved for the follwing clinical conditions:..."

Any advice?  Did UHMS approach CMS or any private insurers during their indication approval process?

(United HealthCare Services policy number 2011T0558A, effective date: 12/01/2011)



5/16/2012 at 5:42:05 PM GMT
Posts: 7
ISSHL

We sat on hold yesterday trying to get an answer with CMS in hopes they might have at least some sort of idea of when they might decide to start covering it...the answer was "I'm sorry, we can not tell you when/if that will be happening." 

The good news is that Aetna does cover it.  Maybe that can be of help in our quest to get other insurance companies to follow suite.  I've turned it over to our folks in the contracting department at our hospital.  They deal with the insurance companies on matters like this and hopefully can get us coverage and set up reimbursement.

 

I hope this information will be of some help to you.  I am so excited by this new indication as this frustrating diagnosis afflicted my mother 2 years ago and she was never able to regain the hearing in her ear again--even with promptly starting the steriods.  It would be so awesome to know that other people would have hope in this situation--as we weren't given much by any of the docs that saw her at the hospital when this happened.  Here's the hyperlink to Aetna's policy.

Best Wishes~ Lisa

http://www.aetna.com/cpb/medical/data/100_199/0172.html



5/21/2012 at 4:55:12 AM GMT
Posts: 7

We haven't treated anyone with ISSHL yet, but are working on our Policy and Procedure.  From the articles we've read in the UHM Journal, we have set up our treatment protocal at:  2.0-2.4 atm for 90 min daily for 10-20 treatments depending on the pt's response to the treatment.  The preference is for a full audiolgical/ENT eval before tx, after the 10th to see if another 10 are needed and then again at the end of 20.



7/11/2012 at 8:52:22 PM GMT
Posts: 5

We have treated two people under the new ISSHL protocol, both at 2.5 ATA. They were both paying out of pocket because it was too new for their insurance companies to have added it to their approved list.


Because of that, we treated both 10 times daily --the minimum treatment threshold for the protocol-- and then had them repeat their audiology exam to see if there was any effect. Neither patient had any measurable improvement in their hearing. The first one was 12 days out from symptom onset when he started HBO, but the second one was only a couple of days.


Are we doing them a disservice by having them retest hearing after only 10 treatments, are our inclusion criteria not strict enough or is the favorable response rate for any intervention so poor in ISSHL that we shouldn't let this discourage us? We are contemplating not accepting any other patients until we see follow up guidance from UHMS or other journals.



10/8/2012 at 4:19:54 PM GMT
Posts: 7
idiopathic sudden sensorineural hearing loss

We just completed our first patient with ISSHL.  Her insurance actually covered it.  She has Aetna.  I think it is the one and only insurance that covers HBOT for ISSHL right now.  Unfortunately, she woke up one morning in the end of July with sudden hearing loss of right ear, had a course of oral prednisone, then received 3 steriod injections into her right middle ear and presented to us on 91712 to start hyperbarics the next day.

She had 10 treatments for 90 min at 2.0 ATA daily with a 2 day break in there for the weekend.  She was so far out at the time of her treatment, we were very dubious if the HBOT would be of any help & it wasn't.  Having a mother that went thru this very thing, I would be willing to try it again--only if insurance covered it--I just can't see making anyone pay for it until we can get a better idea of how much help it will be.

I am kind of with you of waiting to check the hearing at 20 or maybe even 15 treatments to see if that makes a difference.  Have you done anymore?



12/10/2012 at 5:33:36 PM GMT
Posts: 7
Success with an ISSHL patient!

We just completed the 20th dive on a patient with ISSHL a week ago and I am excited to say that while she did not regain 100% of her hearing back in the affected ear, she did regain partial hearing.  Smile

We were able to get her into our program on day 13 after the initial hearing loss and she stayed on oral steriods the entire time.  The first 9 treatments were at 2.0 ata and when she started getting some response, the doctor continued her for a full 20 treatments at 2.4 ata with a 10 minute air break during each one.

She did not take weekends or holidays off as we couldn't tell by the studies whether that would be a disservice to her or not.  She also has an insurance that I had to get pre-authorization for the treatments, but once I did, they were covered by her insurance (Coventry).

As I get more, I will let you know how it goes.



12/15/2012 at 12:02:23 AM GMT
Posts: 16

We have treated several of these over the last year, and after a number of discussions with Aetnas medical director (and support from UHMS website) we got them to add it to their list of approved conditions.  Your best bet with commercial carriers is to have a doctor to doctor discussion and appeal.  Also don't forget to suggest that your patient ask their ENT about intratympanic steroids as that may be more effective than the oral, and not all ENT's think about this.

 

P Benson MD



1/31/2013 at 1:18:45 PM GMT
Posts: 16
Late to the party with this.  We just finished treating a woman a few weeks back. Our 1st ISSHL, we had great success.  She lost about 70% hearing in her left ear, she was receiving steroid injections as well after 10txs 80% hearing in left ear.  Her insurance company approved the 10 txs but 1/2 way thru sent a letter saying they were not going to cover.  After a peer-to-peer review with her insurance the response we got was, "it was accident, we never should have approved it." Well, after we gave her a form to fill out and send to the Department of Banking and Insurance along with letters and studies/articles from our Medical Director and her ENT, they ended paying for her 10 txs. 


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