Treatment with Baha
Insurance and Reimbursement
Unlike conventional hearing aids, the Baha is covered by many private insurance policies, as well as by Medicare and in some states Medicaid, as long as you meet certain guidelines or requirements.
You will need to check for exact requirements and coverage as benefit entitlement may differ from state to state and from plan to plan. If you are a member of a private insurance company, you should check with your healthcare policy benefits manager or the human resource manager at your place of work to determine exact coverage and reimbursement.
Your plan may require something called “pre-authorization” for certain services. If needed, your audiologist or physician may help obtain pre-authorization of coverage on your behalf.
Some companies provide services to help guide you through the insurance and reimbursement process. These companies usually have dedicated experts to assist you, even if you’re initially denied coverage. For best results, be sure to enlist these services early on in the process. If you have internet access, visit the manufacturers’ website and search for insurance or reimbursement support for more information.
If you need assistance navigating what may be a complex process, Cochlear Americas offers individual insurance support. Call Cochlear’s OMS insurance support at 1-800-633-4667 or visit www.omsinsurancesupport.org or email reimbursement@cochlear.com
Pre-Authorization
The general process for obtaining insurance pre-authorization for a Baha System is usually simple. However, there are occasions where additional steps, such as an appeal, are required. The general process is detailed step-by-step below:
- Patient’s insurance information is collected
- Healthcare provider will contact the insurance company to confirm benefits and obtain a fax number or address to send a predetermination letter request procedure an include the billing procedure codes and diagnosis. They may also include a letter of medical necessity from the physician, patient history notes, audiograms, CT scan results, etc.
- Healthcare provider/physician follows-up with the insurance company approximately 10 business days after submission to verify receipt and status of review
- Healthcare provider/physician follows-up every week to ten days until a response is received
- If a healthcare provider tells you that a denial is received, check to see what appeal options are available. If the denial letter does not specify the appeal options, check your health insurance benefit book
- Work with your healthcare provider or device manufacturer for appeal until approved or until all appeal options are exhausted
For additional information, you can explore:
- A Step-by-Step Guide to Obtaining Coverage for a Baha System
- Centers for Medicare and Medicaid Services (CMS) http://www.cms.hhs.gov
- Medicaid websites: http://www.geocities.com/CapitolHill/5974
- Medicare payments: http://cms.hhs.gov/physicians/mpfsapp/step0.asp