Get on the Brain Train (Repost from Cochlearimplantonline.com)

"Whenever people ask me what I do, I tell them that I help families of children with hearing loss teach their children to listen and speak without the use of sign language." 

Get on the Brain Train

Repost from  http://cochlearimplantonline.com/site/get-on-the-brain-train/

January 5th, 2014

"Whenever people ask me what I do, I tell them that I help families of children with hearing loss teach their children to listen and speak without the use of sign language.  Inevitably, the next question I hear is, “HOW?!?”  Those poor people.  Little do they know that they’ve opened up the door for me to talk them to death about my one of my favorite subjects: The Auditory Brain. 

Most people think that hearing loss is an ear problem.  Makes sense, right?  But that answer fails to look into the complicated, incredible processes that help us communicate.  It’s important for the general public to understand, but it’s even more important for the families of children with hearing loss and those who work with them.

Ears are incredible.  Even those weird-looking folds on the outside of your ear (the pinna) are specially formed to capture sound and send it down your ear canal.  The bones in your middle ear — the tiniest bones in your body — work together to send the sound through the system.  The snail-shaped cochlea is filled with many, many tiny hair cells that move when sound waves pass through the fluid that surrounds them, stimulating the auditory nerve and sending impulses to the brain.  All of those steps are important, but here’s the thing: if we could get those electrical impulses to the brain without needing any of those intermediary structures, a person could still experience sound.  That’s what happens with the electrical signals of a cochlear implant (or an auditory brain stem implant).  Those electrical signals travel up the auditory nerve to the auditory centers of the brain.

That’s when the real magic starts to happen.  You see, no matter how good your hearing aids or how well programmed your cochlear implants, those sound waves or electrical impulses are meaningless until they are processed by the auditory cortex in the brain and become linked to sounds, words, or music.  The brain has fantastic capacity to grow and change, and it is one of the crucial components to success with a cochlear implant.  The brain has what we call experience dependent plasticity — a fancy way of saying “what happens to you shapes your brain.”  For a child whose parents have chosen a listening and spoken language outcome, the more words that go in, the more listening experiences that child has, the more that center of their brain will grow.  Conversely, if a person has gone through a long period of auditory deprivation (relying primarily on visual communication and/or not using hearing technology), that part of the brain gets pirated away to be used for different purposes (use it or lose it).

The brain is also all about connection.  All of the cells in your brain (called neurons) connect to one another to form complex webs.  These connections are called synapses.  When a child hears the sound of a word and then puts it together with its meaning, a synapse is formed.  Over time, those connections build stronger and stronger webs that enable us, for example, to hear the word “dog” and know not only what that means but also to connect it to a web of other information we know and have experienced (names of our family pets, different types of dogs, the sound a dog makes, stories we’ve read about dogs, etc.).  If a child’s access to input is limited, either because they are not in a listening, talking environment, do not have appropriate hearing technology, or are not wearing their technology all waking hours, these synapses can be weaker, disorganized or even disconnected.  The richer, fuller input a child receives going IN, the better speech, language, comprehension, and cognition they are going to have coming OUT.  Remember: the quality of the INPUT determines the quality of the OUTPUT.  

The importance of the brain is why many leaders in the field have called hearing loss a “neurodevelopmental emergency.”  If children with hearing loss do not receive access to sound and appropriate intervention as soon as possible, the auditory centers of their brain may never regain the infinite potential they have at birth to become fully functioning members of a world full of speech and sound.  It is also one reason why we see varied results among cochlear implant users.  If we — people with hearing loss, parents, professionals, and the public at large — could stop thinking “ears” when we think about hearing loss and start thinking BRAIN, we would be one step closer to achieving optimal outcomes!

For more information on this topic, I recommend anything written by Dr. Carol Flexer, the queen of the auditory brain!  You can visit her website or listen to this wonderful free recorded webinar."

Dr. Carol Flexer was Lynn's (HearSayLW) professor, her AV Mentor and a dear friend.

"I ATE MY OWNER'S HEARING AID." barked Fluffy.

Source

 You want to know why your dog perks up 

long before you hear someone walking up to the door? 

Dogs hear up to 50,000 to 65,000 cycles per second – humans, just 20,000.

Dogs have 18 or more muscles in their ears allowing them to be mobile.

Dogs hear about 4 times the distance of a humans. 

Dogs hear ultrasonic frequencies like 

dog whistles 

a squeaking mouse or 

whistling hearing aids!

Source

Source

So, remember to open the battery door whenever your hearing aids are not in use,

 so your dog isn't attracted to the high frequency feedback.

Source

Well speaking of dogs, here is Jade my family pet and therapy dog who would never does anything wrong!

Ling's Voice

After about two years of her son’s d/hh of hearing journey began,

 including Auditory Verbal Therapy, Bethany Horn has published,

Ling’s Voice a tool for families and AVTs to provide the children

 with opportunity for sound or word imitation, to test speech detection and

 encourage spontaneous vocalization with use of auditory memory. 

Bethany says, “It’s to assist the kids working so hard to listen and use spoken language!”

You can order your copy at:

 www.lingsvoice.com

 http://www.amazon.com/Lings-Voice-Bethany-Horn/dp/1490819088

 http://www.barnesandnoble.com/w/lings-voice-bethany-horn/1118091050?ean=9781490819082

UNDERSTANDING INSURANCE PLANS

Source

This article is adapted from © Jennifer Getch, MA CCC-SLP 

www.nwspeechtherapy.com/blog

First, talk to your Audiologist or Auditory-Verbal Therapist to determine which specific codes will be used for billing. You will need to know both the:

• The CPT procedure code(s)  

• ICD-9 diagnosis code(s)

When calling your insurance company to check on benefits for Auditory Rehabilitation, Auditory Verbal Therapy or Auditory Processing Therapy utilize the "cheat sheet" below.

Insurance Terminology

It can be daunting when dealing with insurance companies regarding the health coverage of auditory rehabilitation or auditory-verbal therapy sessions for you or your child. Below are some insurance terms you may come across when dealing with insurance.

Co-pay: People are most familiar with a co-pay. This is the specific amount of money that you pay for certain services. It may be $15 co-pay for a doctors visit, a $25 co-pay for a prescription but either way you know exactly how much you will need to pay and it DOES NOT change based on the cost of the service. You will pay your $15 co-pay whether the doctor charges $300 or $3000 for that service.

Co-insurance: This is the amount you will pay for each service and it is based on a ratio that is set by your plan. If your visit costs $100 and your plans co-insurance ratio is 80/20 then your insurance company will pay $80 and you will pay $20. If the same visit was $1000 then your insurance will pay $800 where you would pay $200. Therefore it DOES NOT stay the same as it is based on what the services cost. (NOTE: It is extremely rare for a health plan to have both a co-pay and a co-insurance that would be due for a particular service, it is usually one or the other.)

Deductible: This is the specified amount of money that you will pay out of pocket BEFORE insurance begins to cover any portion of the charges. It is important to specifically ask if a patients deductible has to be met prior to insurance kicking in as there are many plans that have a deductible, however, the patient does not have to meet the deductible for speech therapy services prior to insurance kicking in.

Maximum out-of-pocket: This is the maximum you will have to pay in a year. It is an accumulation of your deductible, co-pays and co- insurance. After the maximum out-of-pocket has been met then insurance will pay 100% for the remainder of charges.

Prior authorization: Prior authorization is pre-approval from your health insurance plan that the specified service WILL be covered. If your health plan requires prior authorization for a service then it is required for you to obtain this approval BEFORE you have the service done. Otherwise Insurance can deny it even though they may have otherwise covered it. Most health plans have forms on their websites to download, fill out and fax in to get this approval. You will need to send the evaluation report, if available.

CPT code: This is a 5 digit numerical code that is used to describe medical procedures. Common ones for Auditory Rehabilitation are:

CPT code 92626, Evaluation of Auditory Rehabilitation Status, first hour

CPT code 92630, auditory rehabilitation, prelingual hearing loss
CPT code 92633, auditory rehabilitation, postlingual hearing loss

ICD-9 code: This is a coding system used to describe signs, symptoms, conditions, injuries or diseases. (NOTE: ICD-10 will begin in October 2013).

Exclusions: These are specific conditions (ICD-9 codes) not covered by an insurance plan.
Appeal: This is the course of action you can take when coverage of a service has been denied and you would like the insurance company to re-assess in the hopes that they may change their decision and cover the service previously denied.

Allowed amount: This is the amount that an insurance company bases their payment on. It is not necessarily the amount that the provider billed. For instance, the provider may bill $130 for a service however; the insurance company only allows $100 for that service so the co-insurance amount is based on that allowed amount and not the billed amount from the provider.

In-Network: Most insurance plans have different coverage based on whether the provider is "in-network or out-of-network". Co-pays, Co-insurance and deductibles are often lower for in-network providers. To be considered in-network, the provider has to have a contract signed with the insurance company. The downside to this, for a provider, is that this contract often limits the amounts that the provider can charge the insurance company for a particular service and the insurance company does not allow a provider to bill the patient for the amount over what insurance allows.

Out-of-network: Patients will often pay more for co-pays, co-insurance and deductibles when utilizing an out-of-network provider. They will also often incur the additional cost above what the insurances allowed amount is. Let’s say that your insurance allows a

provider to bill $250 for a particular service but that provider normally charges $300 for this service. If your co-pay is $25.00 then you will pay $25.00 in addition to the $50  not allowed by insurance. Especially with the big changes happening with health insurance, many providers choose to be out-of-network providers so that they do not have to take such a big deduction in their reimbursement rates.

Medical Necessity: Many insurance plans will only pay for services that they feel are "medically necessary", this often means that they will require reports from therapists, physicians, etc. and will utilize their own professionals to conduct an evaluation of these reports in determining if there is a medical necessity for the patient to receive the services in question.

Explanation of Benefits (EOB): This is a summary of the billed service where you are able to see what portion was applied to deductible/co-pay/co-insurance, etc. It will also tell you when services are denied and why.

Check Reimbursement Resource Guides such as:

http://apps.advancedbionics.com/cismart/CPTSummary.aspx

 FOR MORE INFORMATION

Insurance Guide for Parents:

http://www.listeningandspokenlanguage.org/Document.aspx?id=228

Reimbursement and coding:

http://www.audrehab.org/6%20Reimbursement%20Panel%20_Abel%20&%20White.pdf

http://www.audiologyonline.com/articles/audiology-cpt-code-changes-for-1001

http://www.asha.org/practice/reimbursement/coding/ar_reimbursement/

Today, Children Can Share Their Own Stories

SEEMS LIKE YESTERDAY THIS WAS MY MANTRA.

DREAMS DO COME TRUE.

Games that Target Auditory Processing or Related Skills

Terrific Talkers share a resource for: 

Role Model in the Spotlight - Seahawks Fullback Derrick Coleman

This week I shared this video with some of the children and their parents in my practice. They related to Derrick Coleman's story because of the positive modeling and years of high expectations in our Auditory Verbal Therapy.

https://www.youtube.com/watch?v=u2HD57z4F8E#t=11

What's your vision for your child?

The Power of Positive Thinking by Norman Vincent Peale