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Single-sided Deafness: when insurers say no, reviewers often say yes
In 12 published external-review decisions involving single-sided deafness, independent physician reviewers overturned the insurer’s denial 50% of the time.
Published decisions
12
2001–2026
Overturned
50%
6 denials reversed
Most-fought treatments for single-sided deafness
What insurers denied — and how those fights ended.
| Category | Decisions | Overturned |
|---|---|---|
| Cochlear Implant | 6 | 33.3% |
What the insurer actually argued
Denials fall into different categories, and they don’t succeed equally — so the reason on your letter changes how you should answer it.
| Reason given | Decisions | Overturned |
|---|---|---|
Medical Necessity The plan said the care wasn’t medically necessary. The most common fight, and the most winnable. | 9 | 44.4% |
Experimental/Investigational The plan called the treatment unproven. These turn on published evidence, so the appeal is a literature argument. | 3 | 66.7% |
Typical time to a decision
13 days
Most land between 7 and 14 days
Handled as urgent
33.3%
Expedited when a delay would cause harm
What the reviewers wrote
Excerpts from the independent reviewers’ published findings — the actual reasoning, quoted, not summarised.
Where the denial was overturned
Nature of Statutory Criteria/Case Summary: The patient’s parent has requested authorization and coverage for left cochlear implantation surgery with or without mastoidectomy. Cochlear implants (CIs) have been used to treat sensorineural hearing loss for over 40 years. Traditionally, CIs have been utilized for bilateral hearing loss when conventional amplification techniques do not provide adequate hearing rehabilitation. The benefits of treating unilateral hearing loss (UHL) and single-sided deafness (SSD) with CI are well documented in the literature over the last two decades, leading to a paradigm shift in the treatment of UHL and SSD. Patients with UHL and SSD suffer specifically from difficulty with speech comprehension in both quiet and competing noise environments, sound localization, and severe ipsilateral tinnitus.
Findings: The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for a cochlear implant device and a surgical implantation procedure. The benefits of treating single-sided deafness with cochlear implants have been documented in the literature, including improvements in word comprehension, sentence recognition, and tinnitus. Cochlear implant placement is U.S. Food and Drug Administration approved for appropriate candidates, including patients with single-sided deafness. Clinical guidelines support cochlear implantation in patients who have failed traditional non-surgical amplification.In this case, the patient has a history of right-sided deafness with severe tinnitus and has failed traditional non-surgical amplification.
Where the denial was upheld
Worth reading too — these show what an appeal has to overcome.
Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for unilateral cochlear implant. The U.S. Food and Drug Administration (FDA) approved MED-EL’s cochlear implant for single-sided deafness (SSD) and asymmetric hearing loss (AHL) for patients five years of age and older in 2019. However, to fully meet criteria for cochlear implant for this indication, the FDA requires that “individuals with SSD or AHL must have at least one (1) month experience wearing a Contra Lateral Routing of Signal (CROS) hearing aid or other relevant device and not show any subjective benefit.” The documents submitted for review do not demonstrate that the patient used a CROS hearing aid, bone-anchored hearing aid (BAHA), or other relevant hearing aid for 1 month.
Nature of Statutory Criteria/Case Summary: An enrollee has requested authorization and coverage for durable medical equipment (DME) hearing aids/molds for the left ear CROS system hearing aid for treatment of the enrollee’s bilateral sensorineural hearing loss. Findings: The physician reviewer found that a CROS hearing device is utilized for a patient’s hearing improvement when there is a sudden change of hearing unilaterally. The DME requested includes one device that serves as a microphone to pick up ambient sounds on one side of the head, and the other device serves to send the messages received into the good hearing ear by routing the signals received from one device to the other side. With this technology, the patient’s good ear can hear sounds from both sides of the head with improvement of hearing.
Figures and quotations on this page come from 42,749 published decisions in the California DMHC Independent Medical Review dataset. These are California outcomes — every state runs an equivalent external review, but the rates here are California’s. Excerpts are quoted verbatim from the public record and describe this condition generally, not any individual case.
How to use this in your appeal
These outcomes come from California’s external review program — an independent physician panel whose decision binds the insurer. Every state has an equivalent, and internal appeals succeed even more often. If your care for single-sided deafness was denied, the published record says the denial is worth fighting.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.