ECMO should be considered for any neonate with severe cardio-respiratory failure, so this was an appropriate treatment for this patient's diagnosis and condition at birth. She has recently been diagnosed with severe sensorineural hearing loss.  ECMO is initiated by a surgeon who places cannulae in large blood vessels to provide access to the patient's blood.  The ECMO machine is like a heart-lung machine, continuously pumping the patient's blood through a membrane oxygenator that imitates the gas exchange process of the lungs, removing carbon dioxide and adding oxygen.  Its purpose is to maintain the patient for a limited time, while allowing the patient's lungs and heart to recover.

There is clear evidence and documentation in the medical literature showing that ECMO is associated with hearing loss. In an article by Fligor, et al., the authors state that children undergoing ECMO are at high risk of developing sensorineural hearing loss. In that study, 26 percent of ECMO survivors developed sensorineural hearing loss. The onset was noted to vary between several months of age to more than eight years of age. In an article by Murray, et al., the authors conclude that "these data confirm that there is an increased incidence of SNHL in neonatal ECMO survivors at 9-13 years of age and suggest that SNHL may also present later in childhood in this patient population."

In this patient's case,  plan language specifically allows hearing aids or similar devices and the fitting of hearing aids when it is medically necessary due to birth defects, trauma, or illness causing hearing loss. The patient's congenital diaphragmatic hernia and the treatment associated with it appear are the causative for her hearing loss.  Therfore, the request for hearing aids for this patient meets the plan language criteria and is a covered benefit.