It’s important to find the payment option that fits your lifestyle when ordering items related to your sound processor. Many medically necessary parts and accessories, such as cables, coils, and rechargeable batteries, may be generally covered by insurance. Learn more about your payment options and how you can manage your overall costs.
Shopping for parts and accessories
You can shop and place an order for parts and accessories on the online Cochlear Store, where you have the option to shop in insurance mode or in self-pay mode. In insurance mode, you will only see parts and accessories that are considered medically necessary, which varies by insurance provider, and are generally covered by insurance.1
Learn about payment options
You have three payment options for parts and accessories related to your sound processor.
- Direct insurance billing– Cochlear provides direct insurance billing for covered parts and accessories, such as cables, coils and rechargeable batteries for many contracted private insurance plans as well as Medicare, many state Medicaid plans (including HMOs), and TRICARE23. In insurance mode on the Cochlear online store, you can place orders and bill them directly to your insurance if you are covered by a plan that is contracted with Cochlear4. Before the order is fulfilled, 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).
- Self-pay and seek insurance reimbursement on your own- 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.
- 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
- Complete insurance claim form
- Send documents to insurance after making a copy to keep in your own records
- Wait to hear back and follow up with your insurance plan’s member services as needed
Watch this video to learn more about seeking reimbursement for covered parts and accessories on your own.
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.
- Self-pay without insurance– If applicable you can pay for your parts and accessories with personal funds. Signing up for Cochlear Family, gives you exclusive access to periodic promotions and discounts.
Managing your cost
Regardless of how you decide to pay for parts and accessories related to your sound processor, there are options to help manage your out-of-pocket costs.
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. Y ou can save money by using “un-taxed” dollars to pay for parts and accessories and by reducing your taxable income, as these dollars are 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.
Seek Assistance Groups: If applicable you can seek assistance through non-profit organizations 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.
CareCredit®: CareCredit offers interest-free financing plans5 that can spread payments over 6, 12, 18 or 24 months to help fund out-of-pocket costs and coinsurance for those who have an approved application. Longer period terms, up to 60 months, are also available for eligible purchases at fixed interest rates.
Visit our insurance support center page to find out more about Reimbursement and Insurance services and payment options.
- 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. You will be responsible for paying any applicable coinsurance, deductible, or amounts not covered by your insurance to Cochlear. Coverage determinations and out-of-pocket costs may vary for individuals with private insurance.
- As of Feb 1, 2018, Cochlear provides direct insurance billing support for many major private insurance plans, Medicare, Medicaid (including HMOs) and Tricare for repairs, parts and accessories. Cochlear’s full-service billing support is available for recipients who are covered under one of the plans with whom Cochlear is contracted. If you would like to place an order for a replacement part or accessory, please keep in mind orders may take up to 2 weeks to process and ship, so please plan ahead.
- Cochlear is currently enrolled with Medicaid programs in the following states: AZ, CA, CO, CT, DC, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, ME, MI, MN, MS, MT, NC, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, and WY.
- 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 and Insurance Services.
- 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.