Monthly Archives: June 2013

Oticon Medical Insurance Support: Your Questions Answered

“My regular hearing aids do not help. My insurance doesn’t cover a bone anchored hearing system unless I fall under a certain category. How do I know if I fall into the category? How specific does my condition need to be?”

“What kind of hearing loss do you have to have to receive coverage?” 

“I am waiting to hear if I have coverage for the Ponto. It was surely a blessing when I went for the trial run. It was awesome to be able to hear after 10 years of no hearing on the left side. This could be the best present I could ever receive…”

These are real statements from our community. And, although the questions can be daunting, we are working hard to help ensure you get the coverage that you need– each of the customers whose statements are mentioned above did.

The Oticon Medical Insurance Support Service provides assistance obtaining the documentation needed from insurance companies in order to proceed with surgical procedures, soft band mounted Ponto sound processors and replacement sound processors. Below are common questions and concerns we’ve answered to help you.

Help with Insurance

My insurance won’t cover the cost of my Ponto. Now what?
There are a number of reasons why coverage can be denied, such as the Ponto being processed using an incorrect medical code. To assist, our Insurance Support Services helps find the numerical codes associated with office visits, the procedure, and the equipment. These five-digit numbers are widely used in the medical field for billing and procedure identification, and the implant surgery is the same way. We’ll provide each code and explain exactly what that code represents.

Equipped with that information, together we can identify the right questions to ask your insurance company. Some of those questions include:

  • Is this code a covered benefit under my plan?
  • How much will the insurance company contribute? What percentages will they pay for various pieces of the process—80%, 100%?

Additional resources  from our community regarding what to do if insurance is denied:

  • Ask your doctor to provide you with a letter of medical necessity to bring to your insurance company.
  • Have your audiologist do a peer to peer review with the medical professional from your insurance company.
  • Contact your states local Vocational Rehabilitation (VR). VR programs differ by state but can help with hearing care costs if the person needs them in order to perform their job responsibilities.

Does Medicaid cover the Ponto surgery?
In an effort simplify the process of obtaining replacement sound processors and soft bands, Oticon Medical has enrolled as a provider in many state Medicaid programs. Because we are enrolled providers, not only can we provide assistance in ensuring that patients have necessary coverage in place for devices, we can also bill those programs directly.

While the list of states in which we are enrolled continues to grow, Oticon Medical is currently enrolled in the following states’ Medicaid Fee for Service Plans:

Enrolled States

Who is eligible to use Oticon Medical Insurance Support Services?
Those eligible to use these services are medical providers and patients with current insurance coverage. Patients wishing to use this service will need to work with their clinic throughout the insurance process as the insurance companies do require clinical information and documentation.

What to expect from Oticon Medical Insurance Support:
Oticon Medical Insurance Support will work with you to verify your benefits, submit paperwork to your insurance company and request pre-authorization for the procedure. In the event that your request for pre-authorization is denied, Oticon Medical Insurance Support will investigate the reasons for denial and help to formulate a plan of action.

How to Begin the Insurance Verification and Pre-Authorization Process?
You can begin the process by calling Oticon Medical at 1-855-252-2777 and speaking with one of our insurance support specialist. The specialist will ask a few brief questions and will also be able to answer any questions you may have about the process. They will then send you all of the needed forms and information necessary to verify your insurance coverage.

How long does the Pre-Authorization process take?
Once Oticon Medical has obtained the needed forms and information the insurance process typically takes between 4 to 6 weeks.

How is Oticon Medical involved in the process?
An Oticon Medical Insurance Specialist will contact the patient’s insurance company to inquire as to benefit coverage under the patient’s plan and pre- authorization requirements. The Oticon Medical Insurance Specialist will work as a liaison between the patient, the care giver and the insurance company to collect the necessary information for the insurance company, who will make the pre-authorization decision.

Once authorization is obtained you will be notified of the results as well as given any documentation provided by the insurance company needed in order to move forward with the procedure.

You can visit the U.S. Insurance Support Page here.

If you have any further questions, or want to start using Oticon Medical’s Pre-authorization services today, contact Oticon Medical at 1-855-252-2777.

The Impact of Hearing Loss, Ponto Users Enjoy the Change

NBC News aired a spot on how hearing loss has such an impact on everyday life. We couldn’t agree more. So, we wanted to cover some of your struggles.

We asked, “What is or was the most difficult challenge in dealing with hearing loss? How has it changed since you’ve received your Ponto? Or, if you don’t have your Ponto yet, what changes are you most looking forward to?”

Special Education

Maurice Gerrits no longer has problems understanding others.
“The concept of a bone anchored hearing device was pointed out to me by my ENT in July 2011 as a possible solution for my conductive hearingloss. I was wearing an Oticon Vigo pro power hearingaid at that time, but it didn’t help me a lot.

My main problem was that I was unable to understand what people where saying a lot of the time. I also found it frustrating that I wasn’t able to localize sound.

After a test week with a headband and asking a lot of questions on the Baha user forum, I decided to get implanted. I chose the Oticon Medical system because of the freedom of choice and because the sound of the Ponto system was a lot better than the Baha BP100 from Cochlear. Also, the ease of use, overall durability and sturtyness of the attachment system made me go for the Ponto.

The implant procedure took place at the Radboud hospital in Nijmegen. The procedure, linear incision, went fast and without any problems. On activation day, I was absolutely amazed by the great sound quality. It was even better than with the headband.

I have no speech understanding problems anymore. Not even at a party or in other crowded environments.  When I go out jogging, I can hear everything around me perfectly. I am very happy with my Oticon Ponto Pro and can recommend it to anyone who has little to no benefit from conventional hearing aids.”

Carolyn Williamson, a special ed teacher, looks forward to hearing her students. 
“I have unilateral deafness after a labyrinthectomy in 2011 in an attempt to manage Meniere’s symptoms (it worked!). I just had my anchor implanted for the Ponto on May 23 – activation on August 16! I’m already planning my “Activation Celebration” party.

I am a special ed teacher, and the impact of my hearing loss isn’t just one big thing, it’s so many little things that, combined, add up to much more than the sum of the parts.

Colleagues who don’t know me think I’m stuck up because I don’t answer their greetings from behind me. I have to put every ounce of energy into hearing a student working on articulation (isn’t that kind of funny, me helping with articulation?). I absolutely hate faculty meetings because there is no good spot for me to hear everyone, and I don’t think they really believe I can’t sometimes. Announcements over the PA? I don’t even bother. I have headaches by the end of the school day, my eyes and brain are so tired from trying to pick up the slack. If my students are on the deaf side and I’m not looking at them, I miss the onset of seizures or asthma attacks. I now dislike talking on the phone. People don’t like watching TV with me because they’re getting headaches. With all of those negatives being said– I have no regrets because now I have a life again. I use the humorous approach to set others at ease and to guide them to an understanding of what I require if I am to communicate with them.

I had no guarantee of any hearing device when I opted for surgery, so getting the Ponto is frosting on the cake! I am so excited!”

Aaron Morris can’t wait to hear sounds he’s never heard before.
“I am looking forward to hearing sounds I’ve probably never heard before. And, I can’t wait to  enjoy surround sound like you’re supposed to. The best this will be being in a crowd of people and being able to hear the person in front of me talk better than the people ten feet away!” You can read more about Aaron’s story here.

Kristi Hurley won’t miss the frustrated looks. 
“The worst thing before my ponto pro why the frustrated looks from people when I’d say “Huh, what, can you repeat that?”

Now I don’t get that anymore…. now that I enjoy sound if only I could remember to take it off before bed, LOL!”

We know that you all have overcome struggles with your hearing loss. If you would like to share your experience, please let me know in the comments below or on Facebook or Twitter.

Aaron’s Story, Part I: The Journey to Getting a Ponto

“Well tomorrow’s the big day. I cannot wait to get this process started. I bet when it’s done I will hear noises that I’ve never heard in my whole life. My hearing has always been bad from the time I was six. I just can’t wait.” That was the first thing Aaron told me yesterday over the phone. His excitement radiating through every single word.

“See, right now I can hear the background noise in your office more than our conversation. I even tried to just understand what people were saying through lip reading in the past since background noise is so distracting. That’s just one of the things I won’t have to deal with anymore,” Aaron said.

Aaron Morris won’t have to deal with background noise, poor hearing and countless reconstructive surgeries anymore because today he’ll start the process of getting an Oticon Medical Ponto. This is part one of a three part series based on Aaron’s experience. We will join Aaron throughout his journey– today, the day of his surgery, after his surgery and then on the day that he receives his device. In Aaron’s own words, “If I can get just one person to change their life by encouraging them to get this procedure done, any amount of time and effort would be worth it. Just one person.”


Aaron’s hearing had been gone for a while when he went to the doctor in 2006. He’d always had ear problems, including tubes in both ears when he was little. A specialist worked with Aaron to identify that now he had a bacterial infection affecting his middle ear bone. As the doctor took care of his infection, Aaron’s hearing eventually returned.

Like the old saying goes, not all good things last. With a severe sinus infection, Aaron had lost his hearing again. But this time, he had also developed a hole in his ear drum. Back to the doctor again, in 2008, Aaron had surgery to repair the damage. And, once again, his hearing was somewhat restored.

In April 2009, the unexpected happened. Aaron got into a car accident. The impact of the accident caused Aaron to hit his ear. Because of the trauma, he was forced to go undergo reconstructive surgery. The surgery left Aaron with an equilibrium problem and issues with balancing. Since then, he has never regained his hearing.

Now, Aaron has decided to try a bone anchored hearing system. As his hearing continues to deteriorate, Aaron’s doctor identified the system as the best option. After demoing both products, he felt his clear choice was the Oticon Medical Ponto. Finally, after all of the ups and downs of Aaron’s journey, he’ll be undergoing surgery for his abutment today. As Aaron put it, this is the first step in his journey to hearing again.

“I haven’t heard since 2005, and I’ll hear even better now — probably like when I was young.”

Aaron is looking forward to having conversations with friends and family, going to the symphony and, most importantly, just being able to hear a conversation that’s immediately in front of him and not clear across the room.  “And, my wife will really appreciate it,” he added.

Stay tuned to hear how Aaron’s surgery goes. Aaron will be sharing the second installment of his series later this month. While no one can predict the future as Aaron’s story has so clearly demonstrated, he has a very optimistic outlook. “I don’t know yet, but when I went through testing I was blown away, and they said the real thing would be even better. I can’t even imagine.”

Wish Aaron good luck, give him post-surgery tips or ask him any questions in the comments section below, on Facebook or Twitter. Aaron will also be sharing his journey through his Twitter and Instagram accounts.