Paying for upgrades

Although the process may seem overwhelming at first, we’ll be here to support you every step of the way.

Recipient Kenny and his wife

What you will find on this page

  • Cochlear Reimbursement and Insurance Services offers direct insurance billing
  • Three ways to pay for an upgrade

Did you know many insurers may cover 70-80% of the cost of a replacement sound processor? And, the best part is we are here to make the process as smooth as possible. Our Reimbursement and Insurance Services team will work with your insurance provider on your behalf, collecting all the necessary documentation to determine and submit for coverage.

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 helps you navigate the insurance process by seeking prior authorization from these plans.1

If Cochlear is not contracted with your insurance provider, a one-time agreement (OTA) may be needed. This process is dependent on how quickly your insurance company approves the OTA and/or grants prior authorization and may take in excess of 30 days.

Three ways to pay for a sound processor

Your sound processor is an FDA-approved micro-computer with a life cycle of about five years. When it’s time for a new processor, there are three ways to pay.

  1. Self-pay for a replacement sound processor without insurance 

  2. Self-pay for a replacement sound processor and submit to insurance on your own 

  3. Use Cochlear Reimbursement and Insurance Services 

Cochlear will work to verify your insurance benefits, gather supporting documentation from your clinician, and determine your estimated out-of-pocket costs. Co-insurance must be paid before the processor ships. Generally, sound processor replacements take 6-8 weeks to process and ship. Delivery is usually 1-3 business days (depending on method). After shipment, Cochlear will submit claims and receive payment from your insurance. 

“It’s been a great experience. I feel like some people may be hesitant because they think it’s going to be a long, cumbersome process. It depends on your insurance, but it’s really not that scary. Cochlear was great at explaining things and walking me through the process.”

- Jennifer - Nucleus® recipient

Help with insurance

Navigating insurance can feel overwhelming. Let us help you – contact us today.

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Disclaimer


Views expressed by Cochlear recipients 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.

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.

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. *Cochlear is pleased to offer this discounted cash price when self-paying directly with Cochlear. This discount does not apply when placing an upgrade order through Cochlear's Reimbursement & Insurance Services. Insurance coverage and out-of-pocket expenses will vary depending on your insurance benefit coverage.

Coverage determinations and out-of-pocket costs may vary for individuals with private insurance.