How much do implants cost?

The cost of a hearing implant may be covered by insurance. Every health insurance plan is different. Coverage varies by insurance company, plan benefits, the type of hearing implant you may need and your hearing loss. Potential out-of-pocket costs associated with receiving a hearing implant will include any coinsurance, copay and deductible according to your insurance plan. You should contact your insurance provider to determine coverage as well as estimated out-of-pocket expenses prior to surgery. Some services that you will want to discuss with your insurance provider are:

• Hearing evaluation and test costs
• Implant components costs (hearing implant and sound processor)
• Implant procedure costs (hospital, physician, surgery, anesthesia)
• Battery costs
• Follow-up visits and care
• Rehabilitation

For private or commercial health insurance plans:

• Most private insurance plans cover hearing implants.
• Individual coverage, benefits and out-of-pocket costs will vary.
• Please contact your insurance provider or clinic for more information.

For Medicare and Medicaid/CHIP plans:

• Medicare typically covers hearing implants, both cochlear implants and bone conduction implants.^††
• After completing your hearing evaluation, your audiologist will compare your results with the Medicare coverage criteria to determine your eligibility for coverage under Medicare.
• Medicaid/CHIP covers hearing services for beneficiaries under age 21, and adults may be covered in some states.
• Please contact your insurance provider or clinic for more information.

Download Medicare Guide

For Tricare plans:

• Tricare covers hearing implants, both cochlear implants and bone conduction implants.
• Individual coverage, benefits and out-of-pocket costs will vary.
• Please contact your insurance provider or clinic for more information.

 

Your coverage and out-of-pocket costs will be determined by your insurance provider and your specific plan benefits. Your insurance provider can give you details specific to your plan. You can contact them by calling the number listed on the back of your insurance member ID card. Download the worksheet below for additional questions and billing code information that you can provide to your insurance provider.

Some common questions you may want to ask your health plan include:

• Is a referral required?
• Is my physician and/or hospital in-network?
• Am I covered for surgery for a hearing implant?
• Can you provide me with an estimate of out-of-pocket costs including any coinsurance, copay, or deductible costs for all providers related to the hearing implant surgery?
• Do I need predetermination or precertification?

To see the full list of questions to ask your insurance provider, download the insurance worksheet.

 

Before obtaining insurance approval, you will need to visit a Hearing Implant Specialist to determine if you are a candidate for a hearing implant. It’s important that you find an audiologist who is trained in all hearing loss solutions, including hearing implants, as he or she will be doing a comprehensive evaluation and recommending the best treatment for you. The evaluation, which is covered by most insurance plans, typically consists of medical and audiological assessments, including X-rays and an MRI if needed.

Once it is determined that you are a candidate for a hearing implant, providers will begin to arrange for your surgery. This typically includes verifying your insurance benefits and obtaining any required authorization. Once authorization has been obtained, your provider or insurance company should notify you. You can also call your insurance provider to confirm you have authorization.

If it is necessary for you to obtain authorization, you should:

• Contact your insurance provider and ask the question noted in the ‘Questions to ask your health plan’ section above.
• Obtain the following from your hearing implant surgeon or specialist:
  • A written description of the procedure
  • A letter of medical necessity
  • Medical records
• Submit a predetermination of benefits request to your insurance provider. Insurance companies often provide a predetermination form or request form. This form should be completed and submitted along with the information you have obtained from your hearing implant surgeon or specialist.
• Follow up with your insurance provider every ten days.
• If denied, verify the denial reason and your appeal options.
• Initiate an appeal based on your denial reason.
• Continue to follow up with the insurance provider until they render a final written decision.

 

To make the process easier, our Pre-surgical Insurance Support Team is available to help you obtain the necessary insurance approval and provide assistance in appealing denied coverage for Cochlear Nucleus Systems and Cochlear Bone Conduction Solutions.

For pre-surgical insurance questions, please contact:

Insurance Support Team
Phone: (800) 633-4667 (Option 4)
Email: OMS@Cochlear.com

 

Review the written response provided by the health plan and consider appealing the denial if:

• The health plan defines the procedure differently than your physician has defined it.
• The requested procedure was denied for medical necessity, and your physician has reviewed the medical policy and feels the criteria has been met.

Contact our Insurance Support Department for assistance with the appeal process.

Insurance Support Team
Phone: (800) 633-4667 (Option 4)
Email: OMS@Cochlear.com

 

Occasionally, health plans do not provide coverage for hearing implant solutions. In that instance, we have compiled a list of established funding sources for Cochlear Implants and Bone Conduction Solutions. Other sources of funding or small local programs may be available in your area. We recommend you contact your audiologist or hearing health specialist to find out information regarding current federal and state programs and resources that may be available in your community.

Some options to explore include:

• Employer-Sponsored Health Plans: Check to see if your employer offers other health insurance plans and if those plans provide you with coverage for your hearing implant. It may be possible to switch during your open enrollment period.
• State Health Insurance Marketplace: Research and explore the option of purchasing an individual plan that may provide you with hearing implant coverage.
• Medicaid Coverage: Coverage for hearing implants vary by state and eligibility is subject to change. Some states have expanded eligibility under the Patient Protection and Affordable Care Act. Contact your hearing implant specialist or your state Medicaid program for more details.

Ask your insurance provider if your Heath Savings Account (HSA) or Flexible Spending Account (FSA) can provide you with financial support for your hearing implant.

To see the full list of funding options, download our Alternative Funding Worksheet.