The U.S. Fourth Circuit Court of Appeals issued a landmark decision on cochlear implant coverage in 2006 that prevents employer health plans from continuing to deny coverage for cochlear implants on the basis that they are equivalent to hearing aids.
Although the case does not go quite as far as suggested in
press summaries, it does represent an important first victory in chipping away at the ERISA pre-emption that has prevented other cochlear implant cases from succeeding on Americans with Disabilties Act (ADA) or other discrimination
grounds (most notably the 2000 Angie King case
versus Benicorp insurance backed by the American Speech Language Hearing Association.)

In this case, Carolina Care Plan (CCP) tried to
say that cochlear implants fit under their policy exclusion for "hearing aids". When the insured
appealed by showing that Food and Drug Administration (FDA) coverage criteria explicitly states that cochlear implants are not hearing aids,

CCP tried to claim that ERISA allowed them to
interpret their policies however they wish.

The Fourth Circuit held that while ERISA does give
employer health plans discretion in interpreting their own policies, CCP abused that discretion by
trying to make such an obviously incorrect claim
as equating cochlear implants to hearing aids. Since ERISA does not protect plans that abuse discretion, the Court ordered CCP to cover the cochlear implants.

Unfortunately, nothing in this case prevents CCP
or other insurers from specifically excluding cochlear implants.  Such specific exclusions will be the subject of future federal court battles.

The case is
Carolina Care Plan v. McKenzie , Case No. 05-2060 (4th. Cir., 2006) posted on the Fourth Circuit's website at