Insurance Support

Unlike conventional hearing aids, cochlear implants are covered by many private insurance policies, as well as by Medicare and Medicaid, as long as you meet certain guidelines or requirements. You will need to check for exact requirements and coverage as benefit entitlement may differ from state to state and from plan to plan.

If you are a member of a private insurance company, you should check with your healthcare policy benefits manager or the human resource manager at your place of work to determine exact coverage and reimbursement. Your plan may require something called pre-authorization for certain services. If needed, your audiologist or physician may help obtain pre-authorization of coverage on your behalf.

Some manufacturers of cochlear implants provide services to help guide you through the insurance and reimbursement process. These manufacturers usually have dedicated experts to assist you, even if you’re initially denied coverage. For best results, be sure to enlist these services early on in the process. If you have internet access, visit the manufacturers’ website and search for insurance or reimbursement support for more information.

If you need assistance navigating what can be viewed as a complex process, Cochlear Americas offers individual insurance support. Call Cochlear’s OMS insurance support at 1-800-633-4667 or visit www.omsinsurancesupport.org for help getting started.

The general process for obtaining insurance pre-authorization for a cochlear implant is usually simple. However, there are occasions where additional steps, such as an appeal, are required. The general process is detailed

Step-by-step below:

• Patient’s insurance information is collected.
• Healthcare provider will contact the insurance company to confirm benefits and obtain a fax number or address to send a predetermination letter request.
• Healthcare provider submits a predetermination letter explaining the procedure and includes the billing procedure codes and diagnosis. They may also include a letter of medical necessity from the physician, patient history notes, audiograms, CT scan results, etc.
• Healthcare provider/physician follows-up with the insurance company approximately 10 business days after submission to verify receipt and status of review.
• Healthcare provider/physician follows-up every week to ten days until a response is received.
• If a healthcare provider tells you that a denial is received, check to see what appeal options are available. If the denial letter does not specify the appeal options, check your health insurance benefit book.
• Work with your healthcare provider or a cochlear implant manufacturer for appeal until approved or until all appeal options are exhausted.