It’s important to find the payment option that fits your lifestyle when ordering items related to your sound processor. Many parts and accessories are covered by insurance, and you may choose to self-pay and seek reimbursement on your own. Learn more about your payment options and how you can reduce your overall costs.
Determine Your Payment Options
- Flex Spending Account (FSA): An FSA is a pre-tax savings account for out of pocket medical costs. You may establish an FSA during your employer’s insurance open enrollment period, if available. FSA funds can only be used for the portion of the cost not covered by insurance, and the funds do not carry over year to year. You can save money by using “un-taxed” dollars to pay for parts and accessories and by reducing your taxable income, as these dollars set aside in a pre-tax savings account.
- Health Savings Account (HSA): An HSA supplements high-deductible health plans (HDHPs) by allowing you to put aside money for medical expenses not reimbursed by insurance. Additionally, some employers even contribute a set amount or make matching contributions to help fund an HSA account. If your health plan qualifies as a high-deductible plan, you may establish an HSA during your employer’s insurance open enrollment period. HSA funds can only be used for the portion of the cost not covered by insurance. HSA funds can be carried over year to year, so you can plan for larger future medical expenses. HSA funds are tax deductible or set aside pre-tax through payroll deductions, any interest earned on the funds is tax free and withdrawals made are also tax free for qualified medical expenses. Learn more about the triple tax benefit of establishing a health savings account.
- Self-pay with Personal Funds or Seek Assistance Groups: If applicable you can pay for your parts and accessories with personal funds or contact local, state, and national organizations to inquire about funding assistance. Worthwhile resources include vocational rehabilitation agencies and nonprofits active in causes related to hearing loss. Signing up for Cochlear Family also gives you exclusive access to periodic promotions and discounts.
Understand Your Benefits
If you are seeking reimbursement on your own, you will need to coordinate with your insurance provider to submit a claim. First, you will want to check with your provider to see if your Cochlear parts and accessories are covered in network or out of network, as well as identify the Healthcare Common Procedure Coding System codes (HCPCS codes) associated with the relevant part or accessory. Ask your insurance provider if prior authorization is required and what the process is to obtain it. This can help you determine in advance what items will be covered under the specifics of your plan. If prior authorization is not required, but you still want to understand what is covered under your specific plan, ask if your provider will allow you to submit a Predetermination of Benefits to check if your plan provides coverage for the requested items. Both processes are a great way to better understand your insurance coverage, but do not guarantee payment. Be sure to address any out of pocket costs you may have with your insurance provider, so you can plan accordingly.
Place an Order
You can shop and place an order for parts and accessories on the online Cochlear Store by logging into your Cochlear Family account. If you are covered under a contracted plan and wish to bill insurance for your part or accessory order, Cochlear may need to reach out to your clinician or clinical care provider to get a Letter of Medical Necessity (LMN) or Certificate of Medical Necessity (CMN).
Submit a Claim
Once you’ve checked your benefits, placed your order, and made the initial self-payment it’s time to submit a claim to your health insurance provider. Follow the guidelines for reimbursement as provided by your insurance plan. Although your specific process may vary, some general steps to follow include:
- Collect documents & forms (including insurance claim form)
- Complete claim form (make a copy for your own records)
- Send documents to insurance
- Wait to hear back and follow up with member services as needed
Watch this video to learn more about seeking reimbursement for covered parts and accessories on your own.
Visit our insurance support center page to find out more about Reimbursement and Insurance services and payment options.
Also, it’s important to please keep in mind that if you choose to self-pay for an item generally covered by insurance, you may not be able to submit a claim on your own if Cochlear is contracted with your private insurance provider. Visit our insurance list to see if Cochlear is contracted with your insurance provider. If Cochlear is contracted with your insurance provider, we suggest placing your order through Cochlear’s Reimbursement and Insurance Services.
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- Information provided by Cochlear Americas regarding insurance coverage or reimbursement is provided as guidance only and is not intended as reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding such information or its completeness, accuracy, fitness for a particular purpose, or that following such guidance will result in any form of coverage or reimbursement from any insurer. Information presented is subject to change at any time. To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement needs. In all cases, products or services billed must be medically necessary, actually performed and appropriately documented in the medical record.
