Reimbursement & Insurance Services

Cochlear provides direct insurance billing support for many major private insurance plans, Medicare, Medicaid* (including HMOs) and Tricare for repairs, parts and accessories, and upgrades. Cochlear’s full-service billing support is available for recipients who are covered under one of the plans with whom Cochlear is contracted. Using these services, please keep in mind orders may take up to 2 weeks to process and ship for parts and accessories and up to 8 weeks for upgrades, so please plan ahead.1, 2, 3 

*Cochlear is currently enrolled with Medicaid programs in the following states: AZ, CA, CO, CT, DC, FL, GA, IA, ID, IL, IN, KS, KY, LA, ME, MI, MN, MS, MT, NC, NE, NJ, NM, NV, NY, OH, OK, OR, PA, SD, TN, TX, UT, VA, VT, WA, WI, WV, and WY.

3 DIFFERENT WAYS TO PAY

Bill My Insurance

1. Shop and place an order: Log in to your Cochlear Family account. If you do not already have an account, you will need to register for one. Click here to activate your Cochlear Family account.  You can access the online Cochlear Store from your Cochlear Family account. Keep in mind, items in the Cochlear Store, marked with this icon  are 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.

2. Complete Necessary Documentation: If this is your first time purchasing products or services from Cochlear or your insurance information has changed, you will need to complete the Insurance Intake Form (IIF) which is available online at www.Cochlear.com/US/IIF.

As a Durable Medical Equipment (DME) provider, Cochlear will request a physician’s order and/or a signed Letter of Medical Necessity (LMN) from your clinician on your behalf. This serves as a prescription that allows Cochlear to provide the products ordered to you and justifies they are medically necessary for your cochlear implant to continuously function.

 

  1. 3.      Cochlear Bills Insurance

Cochlear will work to verify your insurance benefits, gather supporting documentation from your clinician, and for replacement sound processor orders will determine your estimated out-of-pocket costs. Your order will ship after these steps have been completed. Parts and Accessories typically take 2 weeks from the date your order is placed where processors take up to 8 weeks. After shipment, Cochlear will submit claims and receive payment from your insurance. You will be responsible for paying any applicable coinsurance, deductible, or amounts not covered by your insurance to Cochlear.

 

  1. 4.      Track Your Order

Once all documentation is received, Cochlear will process your order. You can track your order status by logging into your online store account with your Cochlear Family login and click on “My Account” on the top right corner and then “Order history.” You will also receive status emails throughout the process to keep you updated as your order progresses. Cochlear will email you a shipment confirmation with shipment tracking details. A signature will be required upon delivery. Please note - if Cochlear is billing your insurance for a part or accessory order, we will collect any remaining coinsurance from you after your order ships.

Self-Pay and Seek Insurance Reimbursement on Your Own3

  1. Multiple options may be available to help you pay out-of-pocket
  • If a Flexible Spending Account (FSA) is offered through your employer, you or your spouse can start the year with a federally regulated amount for medical expenses and gradually reimburse your employer through pre-tax deductions from your paycheck. As the dollar amount is determined by the IRS and subject to change each year, we encourage you to review the amount offered each calendar year. You may establish an FSA during your employer's insurance open enrollment period. FSA funds can only be used for the portion of the cost not covered by insurance.
  • A Health Savings Account (HSA) accommodates recipients with high-deductible health plans (HDHPs) by allowing them to put aside a certain amount of savings for individuals and families for medical expenses not reimbursed by their insurance. These amounts are also federally regulated and subject to change each year. We encourage you to review the amount offered each calendar year. 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.
  • CareCredit® offers interest-free financing plans** that can spread payments over 6, 12, 18 or 24 months to help fund out-of-pocket costs and coinsurance. Longer period terms, up to 60 months, are also available for eligible purchases at fixed interest rates.  Link to the application can be found here. **Interest-free is only applicable if the balance is paid in full prior to terms expiring. Subject to credit approval. Minimum monthly payments required. See carecredit.com for details
  • Contact local, state, and national organizations to inquire about assistance with helping to fund your sound processor replacement. Worthwhile resources include vocational rehabilitation agencies and nonprofits active in causes related to hearing loss.

 

  1. Understand your insurance benefits and obtain prior authorization
  • Call the Member Services phone number on the back of your insurance identification card. If you’re calling for a sound processor replacement, provide the HCPCS to your insurance provider and refer to it only as a “replacement sound processor.” TIP: Replacement sound processors (i.e. sound processor replacements) to newer technology are covered under the Durable Medical Equipment (DME) benefit section of your health plan. If you do not have DME benefits, ask your insurance provider if they will consider covering the billing code under your major medical benefits.

                                           i.     Inquire whether a prior authorization is required. If it is required, ask what the process is and request it from your provider. TIP: If a prior authorization is not required ask if your health plan will allow you to submit a predetermination of benefits. NOTE: Prior authorization and predetermination are not guarantees of payment.

                                         ii.     Inquire if your insurance company will process your claim at in-network benefit levels because Cochlear is the sole provider of Cochlear products. If not, your health care provider must offer you an alternative such as authorizing an “out of network” provider or supplier to provide covered services so you will not be financially penalized for obtaining services.

                                        iii.     You should also ask your health insurance representative about your “out-of-pocket expenses” (e.g., coinsurance, deductibles, reimbursement rate of the items) and if your policy has a DME maximum. If your plan does have a DME maximum limit, you will typically be responsible for any amount over that limit.Please note that this will only be an estimate. The final dollar amount your insurance carrier will cover can only be determined after claims processing.

                                        iv.     Finally, ask your insurer how to submit a claim for reimbursement.

 

  1. Shop and place an order
  • In order for us to process your order, we 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).
  1. Track the status
  • ·        You can track your order status by logging into your online store account with your Cochlear Family login and click on “My Account” on the top right corner and then “Order history.”
  1. Follow your insurance plan's guidelines for reimbursement

Once your order has shipped, follow your insurance plan's guidelines for reimbursement. The requirements may vary depending on the coverage, but the basic steps are outlined below.

The process to file a claim typically includes the following steps:

  • Collect documentation such as receipts, letters, and forms as well as attain a copy of your insurance provider’s claim form.
  • Complete the claim form and make a copy of it along with all your documentation.
  • Mail, fax, or email your form and documentation to your insurance company, retaining a copy for your own records.
  • Wait to hear back from your insurance provider.
  • Follow up with member services if needed.

Self-Pay Without Insurance3

  1. Multiple options may be available to help you pay out-of-pocket
  • If a Flexible Spending Account (FSA) is offered through your employer, you or your spouse can start the year with a federally regulated amount for medical expenses and gradually reimburse your employer through pre-tax deductions from your paycheck. As the dollar amount is determined by the IRS and subject to change each year, we encourage you to review the amount offered each calendar year. You may establish an FSA during your employer's insurance open enrollment period. FSA funds can only be used for the portion of the cost not covered by insurance.
  • A Health Savings Account (HSA) accommodates recipients with high-deductible health plans (HDHPs) by allowing them to put aside a certain amount of savings for individuals and families for medical expenses not reimbursed by their insurance. These amounts are also federally regulated and subject to change each year. We encourage you to review the amount offered each calendar year. 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.
  • CareCredit® offers interest-free financing plans** that can spread payments over 6, 12, 18 or 24 months to help fund out-of-pocket costs and coinsurance. Longer period terms, up to 60 months, are also available for eligible purchases at fixed interest rates.  Link to the application can be found here. **Interest-free is only applicable if the balance is paid in full prior to terms expiring. Subject to credit approval. Minimum monthly payments required. See carecredit.com for details
  • Contact local, state and national organizations to inquire about assistance with helping to fund your sound processor replacement. Worthwhile resources include vocational rehabilitation agencies and nonprofits active in causes related to hearing loss.
  1. Shop and place an order
  • In order for us to process your order, we 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).
  1. Track the status
  • ·        You can track your order status by logging into your online store account with your Cochlear Family login and click on “My Account” on the top right corner and then “Order history.”

 

  1. 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.
  2. Coverage determinations and out-of-pocket costs may vary for individuals with private insurance
  3. Cochlear is pleased to offer this discounted cash price when self-paying directly with Cochlear. This discount does not apply when placing an upgrade order through Cochlear's Reimbursement & Insurance Services. Insurance coverage and out-of-pocket expenses will vary depending on your insurance benefit coverage. Please keep in mind, if you choose to self-pay today, you may not be able to submit a claim to your insurance on your own if Cochlear is contracted with your private insurance provider. Visit www.cochlear.com/us/insurancelist 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 & Insurance Services.

 

 

 

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