AB is here to help you navigate the process of choosing, financing, and living with cochlear implants.
Insurance coverage differs depending on your health plan. Please contact Advanced Bionics for more information.
Evelyn’s AB Insurance Support
“Both my implants were covered by insurance. I did not pay anything for them, nor do I pay for any replacement parts if needed.”
— Evelyn Gardner, implanted at age 63, bilaterally implanted at age 64
AB Serves Your Needs
AB’s Reimbursement Services and Insurance Authorization team exclusively serve anyone considering AB cochlear implants and AB recipients. That means they are well versed in AB’s medical device and know how to advocate on your behalf.
We offer the following services on your journey to hearing:
A dedicated Reimbursement Call Center that answers your authorization or reimbursement questions for cochlear implantation, cochlear implant replacement supplies, and equipment as well as billing.
Facilitation of the approval process from start to finish. We exclusively serve as your liaison between your cochlear implant center and your insurance company.
Verification of your or your child’s benefits. Taking care of this step gives you one less phone call to worry about.
Coordination of insurance-related information requests about cochlear implant surgeries and related services.
Courtesy billing of replacement supplies and equipment to facilitate your reimbursement.
Appeals assistance for candidates and recipients who were denied coverage for their unilateral or bilateral implantation requests, replacement supplies, or equipment.
AB must have your insurance forms on file to fully advocate on your behalf.
Print, complete, and submit the Insurance Authorization Form, HIPAA Notice of Privacy Practices, and Healthcare Provider’s Order of Cochlear Implant Products. Once AB has these documents on file, we can help verify your health benefits, provide authorization support if applicable, and bill claims to your health plan.
If your insurance information changes, you will need to update these forms and resubmit to AB’s insurance authorization and reimbursement team. All of your information remains confidential and will be added to your patient file.
This form authorizes AB Insurance Reimbursement Services to act as your representative and on your behalf to secure all authorization necessary from your insurance company regarding a procedure or order involving an AB medical device, including, if necessary, any appeal of a denial of benefit and in billing to your insurance carrier for replacement parts, if necessary.
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. If you have additional questions concerning HIPAA, please email HIPAA@advancedbionics.com.
AB Insurance Reimbursement Services will assist you at every step of the insurance approval process. If you would like help securing authorization, this dedicated team will advocate on your behalf, providing these important services:
Obtain insurance documentation
Verify information for pre-authorization
Submit insurance and medical documentation required for authorization
Follow up with insurance company to check status of review
Obtain approval in writing
Upon approval, re-verify benefits to confirm authorization
Some health plans require pre-authorization of cochlear implant surgery and replacement supply orders(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. Depending on your health plan, the pre-authorization process can take between five and 30 business days.
After our Reimbursement Specialists perform the required benefits verification and applicable pre-authorization your order will be shipped. We will then 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. In cases where coverage is considered out of network or denied, we will assist you with the appeal process.
Our Reimbursement Services and Insurance Authorization team provides support for both assigned and non-assigned claims.
Advanced Bionics can provide appeals assistance for you and your cochlear implant center when there is difficulty in obtaining approval for the cochlear implant surgery or cochlear implant replacement supplies from your health plan.
Upon request, our Reimbursement Services Specialists will review the reasons for non-coverage of a claim for your replacement supplies and equipment. Many times these denials are related to the health plan’s misclassification of cochlear implant supplies as hearing aids, and they will require further clarification for reprocessing your claim appropriately.
Please contact one of our Reimbursement Specialists to discuss your particular situation so that we can provide you the appropriate level of assistance. Our Reimbursement Services and Insurance Authorization team provides support for both assigned and non-assigned claims.
Prior to verifying your health plan benefits, we must have this healthcare provider’s order form completed on file.
Review of Most Common Health Plans
Most healthcare plans cover cochlear implantation and replacement supplies. If you’re unsure whether your plan will cover your costs, contact Advanced Bionics Insurance Reimbursement Department. We’re committed to helping you through your journey to hearing.
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. Our Reimbursement Services and Insurance Authorization team provides support for both assigned and non-assigned claims.
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.
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.
These plans have coverage for both in-network and out-of-network benefit levels and they usually do not 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.
How to Place Your Order for Replacement Supplies
In order to ensure your hearing goes uninterrupted, AB fulfills your replacement supply requests as soon as possible and works directly with your insurance company. Follow these step-by-step instructions on placing your order for replacement supplies. Be sure to visit our Insurance and Billing FAQ for an explanation of basic terms and our Customer Service FAQ for answers to common shipping and order fufillment questions.
Complete or Update Required Forms
Make sure AB has your most recent insurance information on file. We must have the completed forms before we can verify your health plan benefits, provide authorization support if applicable, or bill a claim to your health plan. Based on your healthcare 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.
Contact Customer Service
Place your order for replacement supplies and equipment with AB’s Customer Service. We may be required to place your order on hold 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 for which you may be responsible.
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 supplies. Once we obtain the appropriate approval, we will collect any applicable deductible or co-insurance required by your health plan.
Unsure of Your Coverage?
Contact Advanced Bionics if you’re uncertain whether your plan will cover your cochlear implant, processor upgrades, replacement supply, or other AB product. We’re here to help you hear your best.
Reimbursement Services and Insurance Authorization Contact
For questions regarding pre-authorization, follow-up for replacement parts, or pre-surgical cases, contact:
28515 Westinghouse Place
Valencia, CA 91355
Attn: Reimbursement Services Department
Hours of Operation: Monday – Friday from 5 a.m. – 5 p.m. Pacific Time
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.