Navigating Cochlear Implant Upgrades: Lexi's Journey

For years, many families and recipients of cochlear implants were told that upgrades were simple. After five years, you could expect to receive new processors with little to no pushback from your insurance company. Those days have changed.

Understanding the New Reality

Today, most insurance companies no longer treat five years as an automatic approval. Instead, they evaluate each case individually. They review medical necessity, performance issues, and documented needs. This means your upgrade process may now take more time and require a lot more coordination than in the past.

Lexi’s Real-Life Upgrade Journey

Recently, our founder Jaime’s daughter, Lexi, went through her own upgrade process with Cochlear Americas after reaching 5.5 years with her current processors. Over time, Lexi’s processors showed signs of wear and tear. She experienced glitches, battery failures, and reliability issues that impacted her daily life as a student and athlete.

Rather than simply submitting an upgrade request, Jaime (also Director of our Care Team) built a strong case for medical necessity. Here’s what that process looked like:

1. Documenting Issues: Every glitch, battery failure, and wear-and-tear concern was noted.

2. Securing Letters of Medical Necessity: Jaime obtained letters from both Lexi’s audiologist and surgeon, clearly stating why an upgrade was required.

3. Coordinating with the Surgeon’s Office and Audiologist: Jaime worked closely with the surgeon’s assistant to ensure paperwork and authorizations were aligned.

4. Partnering with Cochlear Americas Insurance Specialists: This back-and-forth lasted nearly two months to ensure all details were correct.

5. Tracking Every Step: Weekly calls, emailed updates, and maintaining a log of every contact helped keep the process moving.

6. Staying Proactive with Insurance: Jaime called once a week to confirm the claim was progressing.

7. Staying Gracious and Persistent: Saying thank you, building relationships with specialists, and ensuring the case never stalled.

   
   

After weeks of persistence, partnership with providers, logging information, and prayer, the upgrade was approved. Lexi’s cochlear implant processors are on the way! Special thanks to Audiologist Tracy Burger (*TCU), Dr. David Haynes (VBWC), and his amazing assistant, Lisa Adams; also the incredible upgrade and customer service teams at Cochlear Americas and Blue Cross Blue Shield - TN

What This Means for You

If you’re approaching the five-year mark on your cochlear implant processors, it’s important to start early and be thorough. Approval is no longer a box checked at year five. You’ll likely need to:

• Document your device performance issues.

• Gather medical letters supporting the upgrade.

• Partner with your audiologist and surgeon’s team.

• Stay actively engaged with both Cochlear’s insurance team and your insurance company.

• Follow up consistently — weekly if needed.

  
  

The Importance of Preparation

Preparing for an upgrade can feel daunting. However, being proactive can make a significant difference. Here are some tips to help you through the process:

Keep Detailed Records

Maintain a detailed log of any issues you experience with your current processors. This includes noting the frequency and severity of glitches or failures. Having this information readily available will support your case for an upgrade.

Communicate with Your Healthcare Team

Regular communication with your audiologist and surgeon is crucial. Make sure they are aware of your concerns and are prepared to provide the necessary documentation for your insurance claim.

Understand Your Insurance Policy

Familiarize yourself with your insurance policy regarding cochlear implants. Knowing what is covered and the process for upgrades can save you time and frustration.

Build a Support Network

Connect with other cochlear implant recipients or support groups. Sharing experiences and advice can provide valuable insights and encouragement.

You’re Not Alone — We’re Here to Help

At LexCare Hearing, our Care Team understands how overwhelming this process can feel. Whether it’s your first upgrade or your third, we’re here to guide, track, and support your journey — just like we did for Lexi.

If you have questions about preparing for an upgrade or need help navigating your insurance, reach out to our Care Team today.

👉 Contact the LexCare Team: www.lexcarefoundation.org/care-team