One of the most commonly asked questions about cochlear implants is about how much they cost. Oftentimes, the assumption is that since hearing aids are so expensive, cochlear implants must be even more so. The assumptions and confusions are also fueled by the fact that finding a straightforward answer to the question is much harder than a simple Google search.
This is because here in the United States, cochlear implants are often covered by an individual’s healthcare insurance plan, unlike hearing aids. Therefore, the out-of-pocket cost of CIs differ depending on the patient’s health insurance coverage. But the fact is, for many people, a CI costs a lot less than you might think.
This article answers some of the most commonly asked questions around this topic. Note that the information contained here only pertains to the United States.
When a patient undergoes cochlear implantation surgery, the implant is billed as a complete system that includes both the internal (implant) and external (sound processor) components. The CI system is billed directly to the health carrier, along with all the other services that the surgical center or hospital provided during the surgery, including the operating room, medical supplies, anesthesia, etc. Since every facility, surgeon, audiologist etc., bills differently, there is no straight answer on what CI costs may be.
Health insurance plan design, coverage, network status and benefits are all key to understanding potential out-of-pocket costs. So the goal is to understand the details of a health plan so it’s possible to ensure the highest plan participation, resulting in less out-of-pocket cost.
For example, maybe a plan pays 100% if in-network providers are used. In this case, make sure that all care providers are in-network. If not, try to apply to the health plan for an in-network exception. The plan may decline the request for exception, but at least you will have a clear understanding, going in, of what this decline may mean for the bottom line.
Once your hearing care professionals determine that you are a candidate for CI surgery, the first step is to apply to the health carrier for pre-approval for the surgery and related costs. This includes the cost of the CI system itself, as well as the post-surgery programming. Your hearing center, surgical center or hospital, and even the device manufacturer, will all have insurance specialists on staff who can help you navigate the process.
During the pre-approval process, the specialist can help determine potential costs, network status, and potential out-of-pocket costs, and can assist in fulfilling any health carrier requirements, like pre-approval or precertification, or securing needed medical records and documents.
One of the best ways to determine how claims may be handled is to look to the past. The EOB or Explanation of Benefit is the statement your health carrier provides that details how claim were processed. The EOB is a great way for you to get firsthand knowledge of what you can expect from your health carrier plan including level of service, how previous claims were handled, what was paid out of pocket, and how much copays and deductibles were applied.
The hearing center is your frontline resource in helping you move from CI questions to possible CI candidacy and surgery. They are an amazing source of information and support in all aspects of the CI process.
While the implant is designed for life, technology improvements mean that you always have the possibility to upgrade your external components, such as the CI sound processor, to the latest model. This can help improve your hearing even more in the future.
Every health insurance carrier handles upgrades differently. Some plans require preapproval in advance while others refuse to preapprove deferring a decision until the claim is billed. Some health carriers require that the current processor be five years or older, while others require it to be broken and beyond repair. The key is to determine which criteria may apply, then collect the applicable medical records and supporting documentation.
Advanced Bionics has an experienced team of insurance specialists, all very well versed on all types of health insurance plans, from Medicare to commercial to Medicaid. They will work to secure preapproval as well as coverage and benefit information so that no part of this is a mystery. You can learn more about what they can do for you, and enlist their assistance for free here.
There are numerous organizations that may be able to assist candidates who do not have health insurance. Your state Medicaid plans may have some coverage options. Also check with the Lions Club, Rotary Club, Sertoma Club, United Way, and your local faith-based organizations. Hear the World Foundation is a nonprofit organization founded by AB’s parent company Sonova, and is another resource. Cochlear implant or hearing centers may also have access to grants, so you can always ask.
Health insurance companies rely on the data provided by hearing centers and hearing care professionals when determining coverage. So it’s important to keep the audiologist abreast of any changes, or hearing concerns you may have, including any broken equipment, hearing challenges, need for new or updated equipment, etc. These updates lead to the creation of documents that more and more carriers are requiring to support coverage for the replacement of supplies and equipment.
Choosing to get a cochlear implant is a big life-changing decision, and the financial aspect associated with it can also make the whole process seem overwhelming. But when you understand the process, and take advantage of the professional help available to you, the cost of cochlear implant doesn’t have to be a mystery and a deterrent to improving your or your loved one’s hearing.
Rochelle has worked for 23 years with AB in the Insurance Department. When she first joined AB, health insurance coverage for CI surgeries and supplies was rare. She used her past experiences as an insurance claim adjustor to help health carriers learn about and finally extend coverage for CIs. To this day, Rochelle continues to be amazed and humbled by the true superheroes who have the courage to improve their hearing and their lives by choosing cochlear implants.