Getting Started with Reimbursement Services

• How to place your order for replacement supplies
• Reimbursement Forms
• Review of most common health plans
• HIPAA and Notice of Privacy Practices
• Advanced Bionics Reimbursement Disclaimer

How to place your order for replacement supplies:
1.) Please contact Customer Services or go to our Webstore to place your order for replacement supplies and equipment. If you utilize the webstore and have a health plan that requires preauthorization (i.e., Medicaid, Medicaid HMO, Medicare HMO or an HMO plan), we will hold your order until our Reimbursement Specialist obtains authorization from your health plan for your supplies. This means that your credit card will not be charged until we obtain authorization and contact you regarding any applicable co-insurance or deductible that you may be responsible for.

2.) Prior to verifying your health plan benefits, providing pre-authorization support if applicable, and billing a claim to your health plan, we must have your insurance forms on file.  Please print, complete and send the following forms to our department:

• Insurance Authorization Form (PDF, 78KB)
  
• HIPPA Notice of Privacy Practices (PDF, 48KB)
  
• Healthcare Provider’s Order of Cochlear Implant Products (PDF, 115KB)
  

3.) Upon return of your forms, our Reimbursement Services Department will code and update your patient file for future orders.  If your personal or insurance information changes, you will need to supply Reimbursement Services with updated forms.

4.) Based on your health plan requirements, you may be required to provide credit card information at the time of your order and/or at the time of pre-authorization for your co-insurance and/or deductible responsibility.

5.) If pre-authorization is a requirement under your plan, your order(s) will be placed on hold until our Reimbursement Specialist obtains approval for your supply(ies).  Once we obtain the appropriate approval, we will collect any applicable deductible or co-insurance required by your health plan. 

6.) Your supply(ies) will ship the next business day to your designated mailing address.

Reimbursement Forms Required to Get Started:
Please complete the Insurance Authorization Form, sign our HIPAA Notice of Privacy Practices, both of which are found in the section above, and either fax or mail the completed forms back to Reimbursement Services.

Review of Most Common Health Plans

Traditional Medicare
Medicare is a federal program that provides specific health benefits to individuals who are 65 years of age or older, and/or are permanently disabled persons who are under the age of 65, and for children who receive transplants.  Cochlear implant supplies and replacement equipment are covered under Medicare Part B. Medicare does not require pre-authorization for cochlear implant surgery or related supplies as long as the patient meets medical criteria.  Part B has a monthly premium that changes annually and typically is deducted from the beneficiary’s Social Security payment. Part B also has an annual deductible and 20% co-insurance, as described above. Medicare Advantage and HMO plans are not the same as traditional Medicare, and they typically require pre-authorization for cochlear implant services.  Learn more about Medicare terminology.

Medicaid
TITLE XIX of the Social Security Act is a federal/state entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources.  Each state legislative branch allocates a portion of the budget on a yearly basis.  As such, they have considerable latitude in determining what services they will provide.  Many states will cover procedures paid by Medicare, including cochlear implantation, but they typically require pre-authorization for cochlear implant surgery and related supplies. Under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions of the Medicaid law, states are required to cover cochlear implantation for children (age 12 months through 18).  Please contact one of our Reimbursement Specialists to determine if Advanced Bionics is a participating provider for your state Medicaid plan. 

Health Maintenance Organizations (HMOs)
HMO members must receive their medical services and supplies from physicians, facilities, and suppliers within the HMO network to receive benefits, unless an exception is approved.  HMOs may require a referral authorization from the primary care physician (PCP) to the supplier.  In addition to a referral authorization, the plan may require a separate authorization for services and supplies.

Preferred Provider Organizations (PPOs)
These plans have coverage for both in-network and out-of-network benefit levels and they usually do not have require pre-authorization for cochlear implantation and related replacement supplies.  Members may also receive services and supplies from providers or suppliers outside the network, but different benefits may apply. 

HIPAA and Notice of Privacy Practices

Advanced Bionics respects the privacy of all of our customers, and we will not utilize your personal and insurance identifying information for any purpose other than treatment or payment.  If we want to use your information for any other purpose outside of treatment and payment, this will require a written authorization specific for that use directly from you.  Review Advanced Bionics’ Notice of Privacy Practices.  [If you have additional questions concerning HIPAA, please email HIPAA@advancedbionics.com.

Advanced Bionics’ Reimbursement Disclaimer

Advanced Bionics will obtain authorization from your health plan to reimburse your healthcare provider, you, or Advanced Bionics for services or items covered by an authorization.  However, there is no guarantee that we will receive authorization or payment.  The patient or the patient’s legal guardian remains liable for payment of services or supplies received except as otherwise provided by law.