Paying for upgrades

Learn about insurance eligibility, self-paying and options to cover out-of-pocket costs.

Cochlear implant recipient Kenny smiles at his wife

What you'll find on this page

  • Learn about insurance eligibility
  • Self-paying
  • Options to cover out-of-pocket costs

Did you know many insurers may cover 70-80% of the cost of a replacement sound processor? While costs and coverage vary by health plan, on average you may pay $1,800-$3,000 for an upgrade.1 And, the best part is, our Reimbursement and Insurance Services team will work directly with your insurance provider so you don’t have to.

If you are not yet eligible through your insurance, we have options if you choose to self-pay for your new sound processor.

 

Three ways to pay for a sound processor

  • If you would like to self-pay for your upgrade, you can take advantage of the discounted self-pay price of $6,775 USD when you trade-in a non-retired sound processor.2 If you prefer to keep your existing processor, the self-pay price is $9,775 USD.3,4

  • We have options to help you manage the cost of self-paying for your processor. If you are interested in accessing new technology before you are eligible through your insurance, learn more here.

 

Your upgrade may qualify for reimbursement for the purchase under your insurer’s "replacement sound processor" benefit.

  • Call the Member Service phone number listed on the back of your insurance ID card and provide HCPCS (Healthcare Common Procedure Coding System) code L8619. Refer to the upgrade as a "replacement sound processor." Before you finalize the order, be sure to confirm your insurer's required procedures. If a pre-authorization step is available, inquire the steps. Also, request an in-network exception.
  • Once you have the proper form(s) signed, complete your order form and send it, along with your preferred phone number or email address, to recipient@cochlear.com.
  • Download a Pre-Authorization/In-Network Request Sample Letter.
  • Follow your insurance plan's procedures for seeking reimbursement on your upgrade order.

 

This option applies if you have Medicare, Medicaid, or private health insurance or a combination of those coverages. Our reimbursement specialists can assist you in accessing your benefits.1

  1. Prior to accessing Reimbursement & Insurance Services, please visit our Insurance Support Center where you will find the appropriate paperwork to complete to begin your order.
  2. Contact Cochlear at 1 (800) 790-8737 or email recipient@cochlear.com with your completed order form and preferred phone number or email address.

 

Navigating your insurance

Cochlear provides direct insurance billing on your behalf when you are insured by private insurance, Medicare, many state Medicaid plans (including HMOs), and TRICARE. The Cochlear Reimbursement and Insurance Services team navigates the insurance process for you by seeking prior authorization from these plans.1

Then, Cochlear will work to verify your insurance benefits, gather supporting documentation from your clinician, and determine your estimated out-of-pocket costs.

If you are interested in accessing our latest technology and you are not yet eligible to use your insurance benefits, we have programs to help you access a new sound processor.

Disclaimer

  1. Information provided by Cochlear Americas regarding insurance coverage or reimbursement is provided as guidance only and is not intended as reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding such information or its completeness, accuracy, fitness for a particular purpose, or that following such guidance will result in any form of coverage or reimbursement from any insurer. Information presented is subject to change at any time. To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement needs. In all cases, products or services billed must be medically necessary, actually performed and appropriately documented in the medical record. Coverage determinations and out-of-pocket costs may vary for individuals with private insurance.
  2. You may trade-in one (1) non-obsolete Nucleus Sound Processor when you choose to self-pay. This offer excludes upgrade orders placed through Reimbursement & Insurance Services. Limit 1 trade-in per order.
  3. This price does not apply when placing an upgrade order through Cochlear’s Reimbursement & Insurance Services. The Reimbursement & Insurance Service is a Premium Service. Upgrade will be billed to your insurance at the existing list price for the upgrade. Coverage and out-of-pocket expenses will vary depending on your insurance benefit coverage. Please make your selections on colors, sizes, and other options prior to placing your upgrade order. Pricing subject to change at any time. The following states require that sales tax be charged on upgrade orders: Alabama, South Carolina, Illinois, and Delaware. Note: This price does not include any additional fees that may be incurred during the programming of the processor with your hearing healthcare provider. Products can be returned or exchanged within 90 days of your upgrade shipment date at no charge.
  4. Please keep in mind, if you choose to self-pay today, you may not be able to submit a claim to your insurance on your own if Cochlear is contracted with your private insurance provider. Visit www.cochlear.com/us/insurancelist to see if Cochlear is contracted with your insurance provider. If Cochlear is contracted with your insurance provider, we suggest placing your order through Cochlear’s Reimbursement & Insurance Services.

The Nucleus 7 and Kanso Sound Processors are compatible with the Nucleus Profile Series, CI500 Series, CI24RE (Freedom) Series, CI24R and CI24M implants. The timeframe for Nucleus 7 Sound Processor compatibility for other implants depends on research and development timelines, manufacturing processes and regulatory approvals.The Kanso Sound Processor will not be compatible with the Nucleus® 22 (N22) Implant due to the Kanso Sound Processor's size and coil type. The Nucleus 6 Sound Processor is compatible with all implant models.

Cochlear is currently contracted with the following Medicaid states: AZ, CA, CO, CT, DC, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, ME, MI, MN, MS, MT, NC, NE, NJ, NM, NV, NY, OH, OK, OR, PA, SD, TN, TX, UT, VA, VT, WA, WI, WV, and WY. The Reimbursement and Insurance Services is a Premium Service. Billable pricing, coverage and out-of-pocket expenses will vary depending on your insurance benefit coverage.

Please seek advice from your medical practitioner or health professional about treatments for hearing loss. They will be able to advise on a suitable solution for the hearing loss condition. All products should be used only as directed by your medical practitioner or health professional. Not all products are available in all countries. Please contact your local Cochlear representative.

Views expressed by Cochlear recipients and hearing health providers are those of the individual. Consult your hearing health provider to determine if you are a candidate for Cochlear technology. Outcomes and results may vary.

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