Introduction to Reimbursement Services Department

Who are we?>>
What services do we provide?>>
Overview of health insurance process>>
Overview of pre-authorization/pre-approval process>>
Overview of reimbursement process for replacement supplies>>

Who Are We?
Advanced Bionics’ Reimbursement Services Department is a component of our Customer CARE program. We understand that the health insurance process may seem complicated and confusing, so we provide support to customers with reimbursement questions concerning the initial cochlear implant process and the replacement accessories and externals needed to support your cochlear implant technology.
If you have questions, contact Reimbursement Services.>>

What Services Do We Provide?
Our Reimbursement Services Specialists are committed to providing you and your cochlear implant center with information and support to navigate the health insurance process. We provide the following services:

• Dedicated Reimbursement Call Center to answer questions about obtaining pre-authorization for cochlear implantation and cochlear implant replacement supplies and equipment, as well as coding
• Benefit verification
• Coordination of insurance-related information requests about cochlear implant surgeries and related services
• Courtesy billing of replacement supplies and equipment for customer reimbursement
• Appeals assistance for denials of replacement supplies and equipment

--back to the top—

Overview of Health Insurance Process
Most health plans cover cochlear implantation and their related replacement supplies and equipment.  As part of your cochlear implant counseling, your cochlear implant center will advise you about obtaining coverage information and benefit levels from your health plan.  Sometimes, they may request the assistance of our Reimbursement Services Department in navigating through this process and coordinating the requirements of your health plan.

After the cochlear implant surgery, our customers often request our support in submitting claims for reimbursement of their replacement supplies and equipment to their health plan.  Once you place your order(s) through Customer Service, our Reimbursement Services Specialist will contact your health plan to confirm the applicable steps for submitting your order through the insurance process. Our dedicated Reimbursement Specialists are trained to provide you with assistance in explaining benefit levels, verifying coverage and obtaining applicable pre-authorization for your supplies.
You may find your questions addressed through our FAQs about Cochlear Implant Reimbursement Services.>>

Overview of Pre-authorization/Pre-approval Process
Some health plans require pre-authorization of cochlear implant surgery and replacement supply order(s).  Pre-authorization or pre-approval is a process that some health plans use to ensure that a procedure, service, or supply is medically necessary prior to treatment.  This process allows providers and suppliers to obtain advance notification from a health plan that medical necessity and other coverage criteria have been met.  In addition, it may also provide useful information from the plan, such as the benefit category and claims processing requirements that may apply for requested services.  Depending on your health plan, the pre-authorization process can take between five and 30 business days.

Overview of the Reimbursement Process for Replacement Supplies and Equipment
After our Reimbursement Services Specialists perform the required benefits verification and applicable pre-authorization, we will submit a claim to your health plan for payment consideration.  Upon receipt of the claim, your health plan will take up to 15 to 30 business days to process it. They will send you their payment decision in the form of an Explanation Of Benefits form (EOB), which shows the supplier’s charge, the allowed amount, the payment or denial, and the patient’s financial responsibility.  Our Reimbursement Services Department provides support for both assigned and non-assigned claims.
You may find your questions addressed through our FAQs about the Billing Process.>>