“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.

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:

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.