While health plans have their own definitions of medical necessity, cochlear implants are recognized as standard treatment for severe-to-profound deafness and most insurance companies cover them. In 2004, Medicare, Medicaid, the Veteran’s Administration and other public health care plans covered cochlear implants. In 2004, more than 90 percent of all commercial health plans covered cochlear implants1.
Bone conduction implant system
The Centers for Medicare and Medicaid Services (CMS) revised its hearing aid definition in 2005 so that Auditory Osseointegrated and Auditory Brainstem Implant (ABI) devices and related services are clearly covered under Medicare as prosthetic devices2.
Insurance support for sound processor replacement parts, accessories and repairs
Usually cochlear implant centers take responsibility for obtaining prior authorization from insurance companies prior to surgery. But after the initial surgery and fitting, where do you turn when you need insurance support for replacement parts, accessories and repairs?
Cochlear takes the hassle out of getting insurance coverage for replacement parts, accessories and repairs by offering direct insurance billing for plans with which we are contracted. We provide direct insurance billing support for many major private insurance plans, Medicare, Medicaid* (including HMOs) and Tricare.
Cochlear’s full-service insurance support is available for recipients who are covered under one of the plans with whom Cochlear is contracted. See the list of insurance companies in which Cochlear is contracted and watch the following Direct Insurance Billing video to learn more about the process:
Parts and accessories generally covered by insurance typically include those that are required for the device to function, such as cables, coils, magnets and rechargeable batteries. To see what types of services and items are typically covered by insurance, visit the Cochlear Insurance Hub to view the list of Healthcare Common Procedure Coding System (HCPCS) codes used by Medicare and other health insurance providers. You may be surprised to learn what insurance companies consider medically necessary– to keep you or your child in sound.
If you are covered by a contracted plan you can purchase parts and accessories on the Cochlear Online Store and bill them to your insurance.
You can access the Cochlear Online Store by logging in or activating your Cochlear Family account.
Keep in mind, items in the Cochlear Store, marked with this iconare generally covered by insurance. For these items, you will need to check the box for ‘Bill my insurance’ if you would like Cochlear to bill your insurance for the selected product. Once your shopping cart is full, complete your purchase by following the steps as prompted.
Receive free shipping on orders over $50, by purchasing your parts and accessories on the online Cochlear Store today4.
- Coverage determinations and out-of-pocket costs may vary for individuals with private insurance.
- Free shipping is valid on orders over $50 and shipped to single U.S address after promotions and discounts are applied. Taxes do not qualify toward the minimum purchase requirement.
- 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.
- If Cochlear is a participating provider with your insurance plan, then you may be eligible to receive in-network benefits. Cochlear suggests placing your order through its Reimbursement and Insurance Services team to maximize your benefit options. To determine whether Cochlear is a participating provider with your insurance plan, please click here: www.Cochlear.com/US/insurancelist. Should you wish to forego having Cochlear file a claim on your behalf to secure in-network coverage, and elect to pay for your replacement part, accessory or repair at Cochlear’s self-pay rate then you acknowledge that Cochlear will not be credited toward satisfying any deductible that you may be subject to under your insurance plan, unless otherwise permitted under specified terms of your insurance plan. If you later decide to seek reimbursement from your insurance plan on your own and are denied, you agree that: Cochlear shall not be financially responsible for any costs associated with your self-pay transaction, will not attempt to acquire insurance-related documentation retroactively, will not submit a claim to your insurance plan on your behalf, nor will Cochlear issue a refund to you.