The Health Insurance Association of America describes Medicaid as a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.” (America’s Health Insurance Plans (HIAA), pg. 232). Medicaid also has enrollment programs for children with specific conditions, depending on state policy. Medicaid programs are funded jointly by the federal government and each state and the programs are administered under this partnership on a state by state basis.
Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States. The system can be quite complex. States establish their own systems for delivery of services under their programs. Add the fact that states have their own policies regarding coverage, and it’s more than a full-time job to keep up with federal and state regulations—especially because they’re constantly changing. It takes the time and care to look into each individual’s case to fully understand and utilize coverage.
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:
Today, we’re not just here to tell you that we are enrolled. We’re here to explain why and how both clinics and patients can utilize our support.
Simply put, because we really do believe in the mantra “people first.”
The time and resources it takes for clinics to do the administrative work relative to prior authorization and billing can be a burden.
Our mission is to take away that burden, so clinicians can focus on providing the best possible care and the best clinical solution to their patients. Sound processor choices should be made based on prescribing the one that provides the best patient outcomes, not based on administrative ease. When the administrative burden is lifted, clinicians are able to truly pick the best processor for a patient. They’re not tied to a specific system because of the ease or burden of the administrative process.
What does Oticon Medical do to help clinics?
Oticon Medical can assist clinics with prior authorizations regardless of whether or not we are enrolled in a given state’s program. In order to assist, we require basic paperwork be completed both by the provider and the patient. Then, we can contact the payer directly. We can assist with prior authorizations for the surgical procedure to implant the Ponto System, replacement sound processors and for sound processors to be worn on soft bands.
For those patients who are enrolled in one of the Medicaid fee for service programs listed above, Oticon Medical can go a step further and bill those programs directly for replacement sound processors and sound processors on soft bands. The clinic is then sent the device and can fit the patient without ever dealing with the Medicaid program to acquire the device.
Throughout the entire process, the clinic is able to focus on their expertise and mission —making sure the patient gets the best care and the device that works best for them.
How to Get Support
If you work for or with a clinic that is interested in Oticon Medical’s insurance support, please let us know here.
Are you a bone anchored hearing system user or potential bone anchored hearing system user who would like Oticon Medical’s insurance support? Here’s more information on how we can help, and you can contact us by clicking here.