Insurance support
Below is a list of frequently asked questions regarding coverage and payment for a cochlear implant. Complied by Cochlear Americas, this information is designed to be used as a guide. If you have additional questions, please call the Reimbursement Department at 800-633-4667, or email us at reimbursement@cochlear.com.
For Baha insurance support, visit our Baha Insurance Support page.
FAQs
Review the following questions. For more information email us at reimbursement@cochlear.com or visit the OMS Insurance Support website:
http://www.omsinsurancesupport.org/
- How do I start the process to find out if I am eligible for coverage?
- Will my insurance/Medicare/Medicaid cover a cochlear implant procedure?
- Will Medicare cover batteries and other replacement parts, also called parts, accessories and services (PAS), for the cochlear implant?
- Medicare covers me. How do I order repairs or replacement parts?
- What type of payment does Cochlear accept?
- How does Cochlear’s Reimbursement Department obtain my Medicare billing information?
- What if I am covered by a Medicare HMO or MCO (Managed Care Organization), also called Medicare Advantage?
- Will my commercial insurance company (such as Blue Cross Blue Shield, United Healthcare, Aetna, etc) pay for batteries and replacement parts?
- Will Medicaid pay for replacement parts for my cochlear implant?
- Which State Medicaid programs does Cochlear Americas contract with for replacement parts?
How do I start the process to find out if I am eligible for coverage?
First, an appointment with your audiologist and physician is necessary to determine if you are a candidate for cochlear implantation. If tests reveal that you are a candidate, your clinic can advise you on the necessary steps to take concerning insurance coverage.
Will my insurance/Medicare/Medicaid cover a cochlear implant procedure?
If you are covered by a private insurance policy, you will have to check your benefits policy/booklet and/or call your health plan’s customer service unit for benefits and coverage information. Your plan may require preauthorization of the surgery and other services. If needed, your audiologist and/or physician may help obtain pre-authorization of coverage.
Medicare covers cochlear implants providing you meet Medicare coverage guidelines for candidacy. Your audiologist and physician can help determine if you are a candidate for Medicare coverage.
Cochlear implant coverage for Medicaid differs by state. If Medicaid covers you, it’s best to check with your audiologist to determine Medicaid coverage guidelines in your state.
Will Medicare cover batteries and other replacement parts, also called parts, accessories and services (PAS), for the cochlear implant?
Yes, Medicare will cover all services and replacement parts required to maintain function of the beneficiary’s cochlear implant, including batteries and rechargeable batteries.
Below is a partial list of replacement parts necessary to keep your cochlear implant functioning:
· Batteries
· Battery Covers
· Cables
· Coils
· Magnets
· Earhooks
· Microphone
However, some items are considered a convenience item and not covered by Medicare. If in doubt, view a list of products that are considered Convenience Items, call the Reimbursement Department for clarification, or email us at reimbursement@cochlear.com.
Medicare covers me. How do I order repairs or replacement parts?
Call Customer Service at 1-800-523-5798, or online catalog, to order parts. For most replacement parts, you will need to pay at the time of order. Please advise the customer service representative that you have Medicare, or note it by checking the Medicare “box” during the ordering process on the online catalog. On your behalf, Cochlear’s Reimbursement Department will file a claim with Medicare. Medicare will then reimburse you directly.
If you require 1) a repair to your speech processor, 2) a replacement speech processor; or, 3) a replacement headset, you will not have to pay at the time of order. Cochlear’s Reimbursement Department will accept assignment and file a claim with Medicare. Because medical necessity may need to be established, a request for these “assigned” services must come from your audiologist to our Reimbursement Department.
What type of payment does Cochlear accept?
We accept Visa, MasterCard or American Express credit cards, or you can mail a check or money order to:
Cochlear Americas
ATTN: Customer Service
13059 E. Peakview Avenue
Centennial, CO 80111
How does Cochlear’s Reimbursement Department obtain my Medicare billing information?
At the end of the checkout process, Cochlear’s online catalog allows you to download a “signature authorization” document required for Medicare billing. This document must be completed, signed and returned to the Reimbursement Department (at the same address above except ATTN: Reimbursement Department). Please include copies of all your health insurance cards including Medicare and any supplemental or secondary policies.
If you do not order online, or Cochlear does not have your information on file from a previous transaction, we will need to collect that information. We cannot bill Medicare until this information is received. If you are unsure whether Cochlear has your information on file, please call or email for confirmation.
Cochlear will mail the “signature authorization” document to your home. Please complete, sign and return to Cochlear at your earliest convenience. As above, a copy of your Medicare card, and other health insurance cards, are required. Unless there is a change in your insurance status, you only have to supply this information and signature once every three years.
What if I am covered by a Medicare HMO or MCO (Managed Care Organization), also called Medicare Advantage?
If you receive your Medicare benefits through a Medicare Advantage plan, you should not order PAS online. To order, you must contact Cochlear’s Reimbursement Department. Please inform the representative of your Medicare Advantage status.
Medicare HMOs usually require a preauthorization or referral from your primary care physician (PCP). Medicare Advantage plan guidelines regarding preauthorization or referral must be followed before services are provided. If plan procedures are not followed, the plan may deny benefits or payment.
Will my commercial insurance company (such as Blue Cross Blue Shield, United Healthcare, Aetna, etc) pay for batteries and replacement parts?
Coverage for PAS by commercial health plans is not necessarily an automatic benefit. Coverage for replacement parts and repairs may need to be “established”, or requested, from the insurance company. First, look at your benefit booklet for benefits or coverage language regarding PAS. If the coverage language in your policy is vague, or you are not clear about what is or is not covered under you policy, contact your health plan. Your policy may not cover PAS but you will not know unless you ask.
If you are required to obtain a pre-authorization for coverage, you will need to ask your doctor to write a letter of medical necessity and submit it to your insurance company for authorization. If a pre-authorization is not required, you can submit the invoice or claim to your insurance company after you have purchased the replacement item. You will always have to pay at the time of order regardless of pre-authorization requirements. Cochlear Americas is not a provider for any commercial insurance health plans and does not submit claims to them.
Will Medicaid pay for replacement parts for my cochlear implant?
Some Medicaid health programs do not cover PAS, or at the very least have not been challenged regarding coverage. Many Medicaid programs do cover PAS but with controlled or limited benefits. Cochlear has signed provider agreements with 23 Medicaid programs that cover PAS. A provider agreement means Cochlear can distribute PAS to centers or users and submit claims directly to the state; the Medicaid program pays Cochlear directly.
If you live in a state with which we are contracted, your cochlear implant replacement parts that are deemed medically necessary will be covered. There are various procedures that must be followed to get authorization from state Medicaid programs. If you have Medicaid in a state where Cochlear Americas is a provider, please contact the Reimbursement Department at 1-800-633-4667 to find out what steps must be followed to get authorization for replacement parts.
Which State Medicaid programs does Cochlear Americas contract with for replacement parts?
Arizona, Colorado, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Nebraska, New York, North Carolina, North Dakota, Oklahoma, Pennsylvania, Texas, Virginia, West Virginia and Wisconsin.
If you, or your child, are not covered by one of the Medicaid programs listed above, contact your audiologist for help in determining where and how to obtain PAS.
