Reimbursement

Health Insurance coverage for cochlear implants has improved remarkably over the last decade. Today, many health insurers provide coverage for cochlear implants. Medicare, Medicaid, TRI-CARE, Veteran's Administration, Blue Cross Blue Shield, CIGNA and a host of other insurers (including many self-funded health plans) provide coverage for cochlear implants.

When considering cochlear implantation, careful review of your health plan is strongly recommended to determine your health plan's coverage policy on cochlear implants. Although many health plans will not specifically list cochlear implants as a covered benefit, coverage policy on cochlear implants should be based on the plan's coverage policy related to prosthetics/orthotics. A review of your health plan for policy exclusions is as important as the plan review for coverage. Insurers may specifically exclude cochlear implants or attempt to exclude through a general categorization of the cochlear implant as a hearing aid (external or implantable). Health plans with specific exclusions for cochlear implants are the most difficult to challenge, although MED-EL Corporation has been successful in getting denials overturned on behalf of MED-EL device users. Health plans which deny access to cochlear implants on the basis of an incorrect categorization of the cochlear implant as a hearing aid (external or implantable) are less difficult to challenge due to the technological differences between cochlear implants and hearing aids, which are designed to treat very different types of hearing loss.

Please contact your cochlear implant center or MED-EL's Reimbursement Department for assistance with coverage for the MED-EL Cochlear Implant System. A request for pre-determination of benefits will be submitted to your insurance carrier prior to surgery to ascertain benefit information relating to coverage for the surgery, post-implant rehabilitative services (including programming services and aural rehabilitation), and maintenance for the external equipment. We strongly recommend obtaining benefit approval for the procedure PRIOR to surgery to assure that patients are fully aware of their health plan's coverage policy on cochlear implants and related services and associated out-of-pocket expenses.

For additional information on cochlear implant reimbursement, please contact our Reimbursement Department. Our dedicated staff is committed to serving the health insurance needs of cochlear implant candidates, recipients and cochlear implant centers.
Toll Free: 1-888-MED-EL-CI (633-3524)
V/TDD: 1-888-633-3524

Email: reimbursement@medelus.com

Mickey Matise
Reimbursement Specialist