Reimbursement & Insurance Services

Cochlear provides direct insurance billing on your behalf when insured by private insurance, Medicare, many state Medicaid plans (including HMOs), and TRICARE.

Please note: Cochlear does not direct bill private insurance for repairs, parts or accessories. To learn about obtaining insurance coverage on your own, click here.

Cochlear is currently enrolled with Medicaid programs in the following states: AZ, CA, CO, CT, GA, IA, ID, IL, IN, KS, KY, LA, ME, MI, MN, MS, MT, NC, NE, NJ, NM, NV, NY, OH, OK, OR, PA, TN, TX, UT, VA, WI, WA, WV, WY.

Cochlear accepts orders on assignment. This means that Cochlear will request approval from the applicable program as required, directly submit claims, and receive payment from the insurance companies. You will be responsible for paying any applicable co­payment, co­insurance or deductible amounts to Cochlear, as required by your insurance plan.

The quick guide below outlines the process of ordering replacement parts and accessories from Cochlear using our reimbursement billing insurance support services:

STEP 1: PLACE YOUR ORDER.

  • You can use one of the following options for ordering replacement parts, accessories, repairs and upgrades:

  • For upgrades, build your own Nucleus 6 Upgrade Kit at www.Cochlear.com/US/BuildN6Upgrade.
  • Or contact our reimbursement specialists by calling 1 800 633 4667, option 2.
  • Please Note: Cochlear does not direct bill private insurance for repairs, parts or accessories. An upgrade is referred to as a “replacement sound processor.”

STEP 2: COMPLETE NECESSARY DOCUMENTATION.

  • If this is your first time purchasing products or services from Cochlear or your insurance information has changed, you will need to complete the Insurance Intake and Assignment of Benefits Form which are available online at www.Cochlear.com/US/IIF.
  • As a Durable Medical Equipment (DME) provider, Cochlear will request a physician’s order and/or a signed Letter of Medical Necessity (LMN) from your clinician on your behalf. This serves as a prescription to state that the products ordered are needed for your cochlear implant to continuously function.

STEP 3: DETERMINE OUT OF POCKET (OOP) COSTS     *For Upgrades Only*

  • If applicable, Cochlear will work with your insurance provider, on your behalf, to identify any out-of-pocket (OOP) costs that may be due in order to satisfy your deductible (the amount of money you must pay before your insurer will pay the upgrade claim) and co-insurance amounts (the share of payment you must make for the upgrade claim).
  • Once Cochlear identifies any OOP costs, Cochlear will contact you for your approval to move forward and collect payment.
  • Please Note: If you are going to incur OOP costs Cochlear must receive your approval and collect payment before moving forward with the upgrade process.

STEP 4: OBTAIN PRIOR-AUTHORIZATION.

  • Prior-authorization is likely required if you are covered by Medicaid, Medicare HMO, or private insurance plans.
  • Cochlear will make every effort to obtain prior-authorization and satisfy any additional insurance requirements as quickly as possible.
  • If Cochlear is not contracted with your insurance provider, a onetime agreement (OTA) may be needed.
  • This process is dependent on how quickly the payer approves the OTA and/or grants prior-authorization; this process can take in excess of 30 days. Please plan ahead and allow 4-6 weeks for processing time.

STEP 5: TRACK YOUR ORDER

  • Once Cochlear has received all documentation from you and your health care professional, and after any required prior authorizations are received, Cochlear will process the order.
  • You can track your order status by logging into your Cochlear Family account at www.cochlear.com/us/family and clicking on “Manage” and then “Orders”.

STEP 6: RECEIVE YOUR ORDER

  • If we have an email on file for you, Cochlear will email you a shipment confirmation with shipment tracking details.
  • Cochlear ships most of its orders using standard two to three day delivery with a signature required upon delivery.


 

*Cochlear is currently contracted with the following Medicaid states: AZ, CA, CO, CT, GA, IA, ID, IL, IN, KS, KY, LA, ME, MI, MN, MS, MT, NC, NE, NJ, NM, NV, NY, OH, OK, OR, PA, TN, TX, UT, VA, WI, WA, WV, WY

**Reimbursement & Insurance Services is a Premium Service. Billable pricing, coverage, and out-of-pocket costs may vary.