Medical aid leaves deaf champion high and dry

Tim Stones, a journalist with Daily Dispatch, who has struggled with hearing loss since birth, was overjoyed when he was scheduled for the intricate, high-tech surgery.

The cochlear procedure implants a tiny electronic device in one or both ears to replace the damaged cochlea, which is the spiral inner ear that is critical for interpreting sound vibrations. In Stones’s case, the procedure was only performed on his left ear; he wears a powerful hearing aid in his other ear.

Stone set seven Deaf World records in a 24-hour track race in Polokwane in 2018.

He is also a single parent, with two children. His youngest lives with Moyamoya disease - a rare, degenerative and potentially terminal disease where the arteries in the brain constrict.

His joy at receiving the treatment after many years of preparation has turned to panic as his medical aid scheme, Bonitas, reneged on its pre-approval for the procedure, leaving him on the hook to pay R277,000 to the service provider, Southern ENT in Pretoria, which provided the implant and related technology.

Bonitas authorised the implant procedure in a letter dated February 14, with the operation slated for St James Hospital on April 12.

The pre-authorisation letter specifically approves the cochlear device implant and tympanomastoidectomy, along with other procedural steps.

Bonitas has already settled the bills for the surgeon and hospital, and half of the anaesthetist’s account. But the scheme seemingly balked at the cost of the implanted device itself – R147,000 – and of the external processor – R138,000 – which drives the implant.

The cochlear implant combines with the external processor behind the outer ear, which receives an incoming sound, converts it to a digital signal and sends it to the implant which in turn stimulates the hearing nerve to communicate with the brain.

Stones was advised by Southern ENT on April 23 that Bonitas had rejected its claim.

A re-submission of the claim had no effect on the scheme’s position.

Stones said: “I was born with a zero apgar score – no life signs – and had to be resuscitated.

“As a consequence of oxygen deprivation, I lost most of my hearing. My hearing loss, however, was only picked up and diagnosed at the age of five, when I acquired my first pair of hearing aids, and learnt to speak and to read for the first time.

“While it was recommended that I attend a school for the deaf, my parents made the decision to mainstream me.

“I’ve faced many challenges throughout my schooling career, but with perseverance and a great deal of input, especially from my mom, I did well enough to be able to enter UCT, where I graduated, ultimately, with a Master’s degree in religious studies in 2005.

“My hearing has steadily deteriorated over the years, to the extent that, for the past few years I have been severely to profoundly deaf. I have known I was a candidate for a cochlear implant for the past decade, but due to various life circumstances, as well as the enormous cost of the procedure, I delayed it until it became increasingly obvious that I was missing far too much in general conversation, unable to hear with a landline.

“The deciding point came when I realised I was struggling to hear the voices of my two young sons, and could no longer follow music to the extent that I used to with my hearing aids.

“As visual cues are an essential tool for effective communication, especially for a hearing-impaired person, the fact that my vision is also not as good as it used to be means I have to ensure I have access to the best possible hearing technology available to me.

“From everything I was told, all my research, prior to the operation, it became clear that the cochlear implant was an absolute necessity for me at this stage of my life. I have enormous hope that much of what I have missed for so many years, sounds I have never been able to hear – birds singing, crickets chirping, the indicator ticking in my car, and the fullness of my sons’ voices – will be realised through this miracle that is a cochlear implant.”

Over a two-week period, the Dispatch has made several attempts to obtain comment from Bonitas, without success.

On Thursday, we were advised telephonically from the office of the scheme’s principal officer, Gerhard van Emmenis, that an e-mailed response would be received later in the day. It was not.

Among other questions in our request for comment from Van Emmenis, we asked for reasons for the rejection of the claim in the light of the pre-authorisation. If the pre-authorisation may only have been for a portion of the costs of the procedure, we asked why Stones was not advised of this.

Stones said that he would not have proceeded with the surgery without the approval from Bonitas. “Clearly I would not have had the surgery – it would not have been able to proceed.

“Given this, I don’t understand the delay for the payment for this most vital part of the surgery, without which it makes no sense to have gone through the surgery.”

He said the delay in finalising the medical aid payment so that the technology could be activated was compromising his quality of life. “I have been loaned an external processor by a mom of a deaf child but it will have to be returned.

“When one considers the enormous monthly fees we pay in order to ostensibly ensure access to health care, I feel utterly let down.”