Frequently Asked Questions (FAQs) for Cochlear Implant Reimbursement Services

Do health plans cover cochlear implant surgery?
Because cochlear implants are recognized as standard treatment for severe-to-profound nerve deafness, most health insurance plans including Medicare, Medicaid, and other government-funded programs provide coverage for cochlear implantation.  More than 90 percent of all commercial health plans cover cochlear implants. Many insurance plans (Medicare is a notable exception) require prior authorization before the cochlear implant surgery. Therefore, it is important to contact the insurance company in advance to determine if the cochlear implantation and related services will be covered for each specific patient.  Our Reimbursement Services Department is available to assist you in this process upon request by seeking benefit information and requesting any required pre-authorizations from your health plan.

How can Advanced Bionics’ Reimbursement Services Department assist me in obtaining health plan approval for my cochlear implant surgery?
We provide focused reimbursement support for Advanced Bionics customers by serving as a liaison between insurers, providers and customers to facilitate transfer of information that may be required by insurers (sometimes called pre-authorization) prior to the cochlear implant surgery.  We can assist you in communications with your health plan to understand whether cochlear implantation is a covered benefit under your plan and to inquire about any authorizations or referrals that may be required before you can proceed with the procedure.  As part of this process, your doctor and audiologist may need to provide documentation supporting your medical need for the implant.

What is my financial responsibility for a cochlear implant?
Cochlear implants are considered implantable prosthetic devices, and the FDA carefully restricts the conditions of sale such that they can only be obtained through the hospital or surgery center where your implant will be performed. The hospital or surgery center sets the actual charge for the cochlear implant system and is typically responsible for billing your health plan.  Your financial responsibilities or out-of-pocket expenses will be dependent on your plan’s deductibles and co-insurance.  Therefore, we recommend that you schedule time with a financial representative at the facility where you will receive your implant to review your plan’s benefits in advance and understand your own financial responsibility.

Am I a candidate for cochlear implantation?
In order to determine your eligibility for cochlear implantation, you must undergo a rigorous evaluation process. The first step involves an assessment by a cochlear implant specialist to determine if cochlear implantation is an appropriate treatment for your specific needs.  Find a cochlear implant clinic in your area.

My health plan has denied coverage for a cochlear implant. How can I appeal?
First, determine specifically why the cochlear implant was denied. Make sure you have the denial in writing. If you do not receive a written denial, ask for one. An appeal is most effective when structured in response to the specific reason for denial of coverage. If a specific denial reason is not provided, contact the plan and ask for clarification. Second, contact your cochlear implant center and advocacy groups and ask for help.  Our Reimbursement Services Department is available to help upon request.

Can you assist me if I receive a denial for my cochlear supplies?
We can assist you with appealing your health plan’s denial upon request. The first step in the process is providing us with a copy of the denial letter that you received from your health plan. We can coordinate with your provider and facilitate provision of supporting information to your health plan that may strengthen your appeal.

Is a new cochlear implant sound processor covered by my health plan?
Most health plans will cover the supplies that support your cochlear implant technology, but this benefit is plan-specific.  Prior to shipping your order, Advanced Bionics can facilitate a benefit determination and coordinate any prior authorization request with your health plan to seek approval for the replacement supplies. This process typically takes 4 to 6 weeks, depending on your health plan’s requirements and utilization review process.  Your financial responsibility will be set by your health plan’s benefits and payment policies in terms of any applicable deductible or co-insurance. If you are interested in exploring insurance coverage for a Harmony product upgrade, Visit our Harmony Insurance FAQs.

Are repairs covered by my health plan?
It depends. You will not have to pay for repairs if your equipment is within the warranty period.  If you have insurance that covers repairs, you may have a copayment responsibility.  Many policies may have benefits for prosthetic implant accessories and supplies or durable medical equipment (DME) benefits that can be applied to cover repairs and replacement of parts for cochlear implants. Read your benefits booklet for prosthetic implants, prosthetic or DME repair benefits, or check with the health plan.

Does my health plan cover bilateral cochlear implants?
Coverage of bilateral cochlear implants is determined by your health plan’s medical benefits and coverage policies as they relate to your specific condition.  Advanced Bionics can assist you in requesting approval from your specific health plan upon request. 

What equipment is covered by the Advanced Bionics’ manufacturer warranty?
The manufacturer’s limited warranty covers the sound processor, the headpiece and the battery charger for three years.  After three years, the patient has the option of purchasing an extended warranty for the sound processor and headpiece equipment only. (There is no extended warranty option for the battery charger.)

Does Medicare cover the cost of the warranty for my cochlear implant equipment?
The initial manufacturer’s warranty is included in the cost of the cochlear implant. Medicare will NOT reimburse the cost of purchasing the manufacturer’s extended warranty.  However, Medicare provides coverage for replacement and repair of cochlear implant supplies and accessories that are lost, stolen, damaged or worn beyond their useful life.

What is ESCO?
ESCO is Ear Service Corporation. It offers protection plans covering replacement of lost or stolen external equipment. ESCO currently offers policies for the sound processor and the headpiece for an annual premium.  ESCO is a separate company that is not operated by Advanced Bionics.  Their service plan provides our patients with additional coverage options beyond the Advanced Bionics manufacturer warranty.

I sent my Reimbursement Services Insurance Packet to Advanced Bionics. How do I place my order for cochlear supplies?
Once our Reimbursement Services Department has confirmed that we have received your forms, you can contact our Customer Service unit to place the order for the supplies that you need.

• Depending on the type of health plan you have, you may be required to provide credit card information at the time of order.  After we verify your benefits and obtain pre-authorization (if applicable), our Reimbursement Services Department will send a claim to your health plan, and they will send you the applicable benefit in the form of an explanation of benefits (EOB) and payment for the covered amount.  Each time you order, we will submit a claim on your behalf. You will need to contact us if there is a change in your health plan coverage, your demographic information (i.e., name, address or phone number), or your primary care provider.
• If pre-authorization is required by your health plan, your order will be placed on hold until our Reimbursement Services Department obtains approval for the supplies you need.  Once we obtain the appropriate approval, we will collect payment from you of any applicable deductible or co-insurance required by your health plan.  Your supplies will then be shipped the next business day.