Sometimes it’s unclear whether a part or an accessory you need for your sound processor is generally covered by your insurance plan. To understand what insurance companies may cover, first we need to understand how insurance companies define what is medically necessary.
Typically, each health insurance plan has their own definition for what is medically necessary; however, there are some common themes. Usually, a product is covered by insurance if it:
- Improves your hearing
- Decreases risk to your personal safety
- Improves your quality of life
- Is required for the hearing device to function
Some examples of parts and accessories that are generally covered by insurance are cables, coils, and rechargeable batteries.
Cochlear provides direct insurance billing for covered parts and accessories1234. To verify medical necessity, we will request a letter or certificate of medical necessity from your clinician. This documentation typically includes the Healthcare Common Procedure Coding System codes (HCPCS codes) that apply to the specific parts or accessories. Insurance companies use these HCPCS codes to identify if you have coverage for the product or service. It’s important to check these codes periodically with your insurance company or Cochlear as they are subject to change.
Watch this video to learn more about how medical necessity is defined and how to navigate these definitions when seeking reimbursement for relevant parts and accessories.
Visit our blog to find out more about payment options, including direct insurance billing through Cochlear’s Reimbursement and Insurance Services and self-pay, for parts and accessories.
Purchase parts & accessories today at Cochlear’s online store, where you have the option to shop in insurance mode. In insurance mode, you will see only parts and accessories that are generally covered by insurance; and you can place orders and bill them directly to your insurance if you are covered by a plan that is contracted with Cochlear.5
- 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.
- . 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.
- 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.