Tag Archives: coverage

Voices Heard – Bone Anchored Hearing Systems Remain Covered by CMS

On October 31, after a several-month-long battle, the Centers for Medicare and Medicaid Services (CMS) ruled that Bone Anchored Hearing Systems and auditory osseointegrated implants (AOIs) will remain a covered benefit for Medicare enrollees with qualifying indications.

Oticon Medical Advocates

As many of you know and have experienced, Bone Anchored Hearing Systems (BAHS) are an important and life-changing tool to fight against hearing loss that cannot be duplicated by traditional hearing aids. More than 100,000 people are currently benefitting from a BAHS.

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Bone Anchored Hearing System Medicaid Insurance Support for Clinicians & Patients

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.

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Insurance Support: Guiding You through the Process to Get Your Ponto

No matter what kind of healthcare visit or procedure you have, insurance can be confusing—so much so that it can sometimes feel like a completely different language. In addition to various companies, each individual insurance company has many, many policies. So, what works for someone with similar insurance might not work for you. That’s why we offer free insurance support for patients and clinics. Our team acts as a trusted guide to educate, address concerns and help you ask the right questions.

Healthcare Questions

We work with you to do everything from verification of benefits to submitting the paperwork to insurance providers to requesting and receive pre-authorization. In the event that your request for pre-authorization is denied, we’ll investigate the reasons for denial and help to form and submit your appeal. We can truly help as little or as much as you need.

We sat down with Lindsay Fisk, Oticon Medical’s manager of customer reimbursement services, to learn more about how she helps hundreds of people navigate the world of insurance coverage. With over 500 authorizations complete, Lindsay and the rest of the team have a defined process that will get you on the right track for coverage.

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Angela Holley: Our Journey & How We Finally Got Insurance for Evan’s Ponto

Angela Holley wanted a sustainable hearing solution for her six-year-old son, Evan. Even when it meant calling insurance companies daily, Angela was Evan’s unwavering advocate. Now, Evan has what he needs and is a happier child who hears better than ever.

Here’s Angela Holley’s story–

Evan, who has bilateral hearing loss, started out wearing Cochlear hearing devices. We had a lot of issues and were constantly sending them in for repair. When we finally received the devices back from repair, our Audiologist was unable to program them. The Windows computer system wasn’t compatible with the device program, which caused yet another huge delay for us, and more importantly, for Evan. We were frustrated, and the Audiologist was frustrated.

During this time, our aggravation encouraged us to try demos of the Oticon Medical Ponto. We were excited by Evan’s response and couldn’t wait to get him a pair of his own. So, we sent in the order to the insurance company. To our surprise, it was denied. Because Evan had additional hearing loss from his last screening, we were truly in shock that his case was denied. So began the journey to getting coverage for devices that worked well for Evan…

What I Did to Make the Case

First, I appealed with a letter saying that the devices are not a want but a need. That they contribute greatly to him functioning as a successful individual. He needs the devices to be successful in school and to thrive with his peers. Then, I search for helpful information and made sure I knew about everything that could be helpful. Ear Community and Melissa Tumblin were an excellent resource. Finally, I collected any kind of documentation I could get to help build a case for Evan. Gather and submit documentation such as:

  • Letters from Evan’s teachers
  • Information from Evan’s ENT and speech therapist
  • Hearing Screen Results
  • Information from Evan’s pediatrician
  • Even a letter from myself explaining our own experiences in communicating with Evan—we were having to repeat ourselves more than ever

Evan HolleyI didn’t rely on others to help get the job done, and I suggest the same to other parents. Make sure that you are organized and submit every piece of paperwork in a timely manner—there are deadlines that will affect the outcome. Work with the Audiology clinic that’s pushing through the paperwork, and make sure they’re meeting deadlines. Finally, follow up and then follow up again. Make sure information was received. It is a lot of work, but it can be done. Don’t just accept the denial and don’t rely on other people to do their part.

And hopefully, as with our case, you’ll see the light at the end of the tunnel. Finally, the insurance company approved coverage for one Ponto. Even though Evan needs bilateral aids, we were only approved for one and we felt lucky for that.

Well Worth the Work

All of us moms know we need to fight for our kids, and we need to remember that. Don’t rely on anyone else to fight our children’s battles— it has to be us to do that. What kept me going? The fact that Evan’s demo devices had him hearing better than he ever had before.

The day we got the demos, Evan walked into the bathroom with his shoes on. When he came out, he said, “Mommy, my shoes—they make noise.” Now, at night, he doesn’t want to take them off. It’s still amazing to watch him explore and experience little noises for the first time.

Fighting for what we deserved has helped shape Evan’s future. It’s a lot of work, but well worth it for a positive future for my son. I couldn’t have had a better partner along the way than Oticon Medical. The experience has been fantastic, and more than anything, the people at Oticon Medical LISTENED when no one else did.

Are you working to get insurance coverage? We can help. We can also help connect you with others who have successfully navigated the insurance process. Let us know in the comments section below or on Facebook or Twitter if you’d like help or to be connected.

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.