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Cochlear Implant Education Center

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Introduction
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What is a CI?
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Candidacy
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Performance
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Decision Making
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Process
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Insurance
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Surgery
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Education
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Language and Communication
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References
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Deaf Community
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Speech Processor
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Listening
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Resources
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Versión en Español (muy pronto)

 

What About Insurance?

Developed by Debra Berlin Nussbaum, Coordinator, Cochlear Implant Education Center, Laurent Clerc National Deaf Education Center

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Cochlear implants are considered implantable prosthetic devices. The cost of a cochlear implant may range from $50,000 to $100,000 depending on what services are included in the total cost of obtaining an implant.

Private health insurance plans and Medical Assistance (also referred to sometimes as Medicaid) provide varying levels of coverage for each of the numerous components of the implant process. In addition, each hospital implant center has its own protocol regarding how they bill for the varied components of the implant process. Coverage may differ from insurance plan to insurance plan and from hospital to hospital for the following components:

  • Assessment and evaluation to determine candidacy
  • Internal device and external speech processor(s)
  • Hospital surgical services
  • Post-operative audiology services (adjusting the external speech processor and mapping)
  • Auditory habilitation/rehabilitation
  • Bilateral cochlear implants
  • Replacement devices/repairs/batteries/parts

Websites of the three cochlear implant manufacturers and other web sources on cochlear implants indicate the following considerations related to insurance coverage:

  • More than 90 percent of all commercial health plans cover cochlear implants.
  • Commercial health plans, such as Aetna, BlueCross BlueShield, and Prudential, continue to provide the best coverage for cochlear implants. Managed care plans, especially HMOs, may be more restrictive. Medicare, Medicaid, Children's Special Services, Tricare, Veterans Administration, and vocational rehabilitation agencies provide a range of coverage from partial to full.
  • There may be limitations on insurance coverage when a child is younger than 12 months of age as recommended in the FDA guidelines.
  • Only a few insurance companies pay for upgrades to the external speech processor.
  • Not all policies cover repairs or replacement parts, even though they may have covered the surgery and device.
  • Insurance companies have varying policies regarding payment for batteries.
  • The implanted portion of the device is under warranty for 10 years by all three manufacturers, and the external speech processors come with a three-year limited warranty from all three manufacturers. Extended warranties can be purchased from the manufacturers.
  • Insurance coverage on the external speech processor for accidental damage or loss can be purchased through the ESCO insurance company.

Each cochlear implant manufacturer has a division dedicated to assisting individuals with insurance coverage and reimbursement for cochlear implants. For more information, contact each manufacturer as noted below.

Advanced Bionics:

  • Reimbursement Services Hotline—(877) 779-0229 (Voice), (877) 833-6318 (Fax), (800) 678-3575 or (877) 779-0229 (TTY)

Cochlear Corporation:

  • OMS (Otologic Management Services ) is a specialized unit of the Cochlear Corporation Reimbursement Department. OMS provides prospective candidates with insurance preauthorization and verification support at no charge for CI and Baha devices and related procedures. OMS also helps patients seek coverage for bilateral implantation of both cochlear implants and Baha devices and appeal denials for coverage.

MED-EL:

  • MED-EL's Reimbursement Department for assistance with coverage for the MED-EL Cochlear Implant System—(888) MED-ELCI (633-3524) (Toll-free), (888) 633-3524 (Voice/TTY), reimbursement@medelus.com (E-mail)

Other Cochlear Implant Financial Assistance Resources:


Revised May 2012