Cochlear's Reimbursement Insurance Support
Cochlear™ is pleased to provide direct insurance billing on behalf of our Cochlear implant recipients who are insured by Medicare, many state Medicaid plans (including HMOs) – alone or in combination with a commercial health insurance plan, TRICARE and Kaiser.
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, ND, NE, 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 co-payment, co-insurance 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: Placing your orderYou can use one of the following options for ordering replacement parts, accessories, repairs and upgrades:
We may need to contact you to verify your health plan benefits. Once we have verified your insurance plan eligibility and benefits, we will let you know whether we are required to obtain a credit card number from you to cover any co-insurance and/or deductible amounts that you may be responsible for. We will not charge the credit card until we have confirmed the co-insurance or deductible amount.
Step 2: Documentation required for processing your order
a) Documentation needed from you
If this information is required, we will need you to complete, sign, and return the Insurance Intake and Assignment of Benefits Forms. Completed forms can be returned to Cochlear in any of the following ways:
NOTE: We cannot continue to process an order until we receive these completed forms.
b) Documentation needed from your Health Care Professional
If Cochlear does not already have a physician's order on file, we will request that the patient's physician complete and return a signed physician's order form (NOTE: stamped physician signatures are not accepted according to Centers for Medicare and Medicaid Services (CMS) regulations).
In order to obtain prior authorization, Cochlear may require a specific parts order and justification, also known as a Letter of Medical Necessity. Cochlear will notify both you and your associated health care provider if this is required by your insurance plan.
Step 3: Obtaining prior authorization
Although traditional Medicare plans do not require prior authorization, most Medicaid, Medicaid HMO, Medicare HMO or commercial insurance plans (including TRICARE and Kaiser) require prior authorization for purchases of replacement parts, accessories, or repairs. As part of this process, Cochlear may need to request a specific parts order and justification (Letter of Medical Necessity) from your health care provider.
Cochlear will make every effort to obtain prior authorization as quickly as possible. However, much of this process is dependent upon how quickly the payer grants prior authorization. In some cases, this process can take in excess of 30 days.
In the event that an order pending prior authorization is outstanding across a change in calendar month, Cochlear will need to re-verify your plan benefits and may need to contact you. Cochlear will provide you with updates on the status of the prior authorization request every 14 days.
Step 4: Shipping of 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 ship the order. If we have an e-mail on file for you, a shipment confirmation with shipment tracking details will be sent. Cochlear ships most of its orders using standard two to three day delivery with a signature required upon delivery.
For more information regarding the above steps, please contact our reimbursement billing insurance support team by:
• Phone 1 800-633-4667 Opt. 2
• Fax 1 866-706-8875
• Email firstname.lastname@example.org