What About Insurance?

Getting Started	What is a CI?	Candidacy	Performance
Decision Making	Process	Insurance	Surgery
Education	Communication	Sign Language	Deaf Community
Speech Processor	Listening	Resources	Versión en Español

By Debra Nussbaum, M.A., CCC-A/March 2003
Cochlear Implants: Navigating a Forest of Information...One Tree at a Time in PDF (113 pages, 1.35 mb)
What About Insurance? in PDF (4 pages, 45 kb)

What About Insurance?

The costs for obtaining a cochlear implant, including pre-surgical testing, medical personnel services, surgery and hospital fees, and the implant device itself, can vary between $30,000 and $50,000. Most third party health insurance plans appear to provide some level of coverage for the implant process. The coverage and payment have greatly improved in recent years as use of this device is becoming more commonplace, especially for young children.

Issues Related to Coverage

In reviewing Web sites and speaking with a variety of medical facilities and implant manufacturers, the following issues related to insurance coverage emerged:

• Commercial health plans, such as Aetna, Blue Cross and Blue Shield, and Prudential, continue to be the best payers for cochlear implants.

• Managed care plans, especially HMOs, remain among the most restrictive.

• Medicare, Medicaid, Children's Special Services, Tricare, Veterans Administration, and vocational rehabilitation agencies provide a range of coverage—partial to full.

• There may be problems with insurance payment when a child is younger than the FDA guidelines suggest.

• There are employees at the implant companies whose job is to handle insurance-related problems and secure payment.

• Only a few insurance companies pay for upgrades in technology (i.e., ear-level speech processor).

• Insurance payments vary by region.

• Insurance companies have varying policies regarding payment for batteries.

Six Services Associated with Cochlear Implantation

According to the Cochlear Corporation (http://www.cochlearamericas.com/Support/42.asp), there are six separate services associated with cochlear implantation. It is important to look for benefits to cover the following:

• Assessment and evaluation—Most health plans include benefits covering diagnosis of a disease or illness.

• Cochlear implant system—Some health plans will specifically cover cochlear implants, some will consider covering the implant under the insurance clause covering "prosthetics," and a few will specifically exclude the device.

• Hospital surgical services—Most health plans cover inpatient and outpatient hospital surgical services.

• Surgeon's services—Most health plans cover surgeons' services.

• Post-operative audiology services:
  • Most health plans cover rehabilitation and generally limit, or "cap," post-operative rehabilitation, treatment, or therapy. The plan may or may not specifically mention audiology as a covered service.
  
  
  • Mapping is more often paid for compared to auditory training and speech therapy; however, coverage is inconsistent.
  
  
  • Coverage for auditory training is inconsistent among insurers. Some people have had better success with coverage when they refer to auditory training and speech therapy instead as "prosthetic device training."

• Repairs and maintenance to external components:
  • Most health plans do not specifically mention coverage for repairs and maintenance for the external components of the cochlear implant. However, not including a benefit does not necessarily mean it is excluded.
  
  
  • Information concerning this type of benefit may be found in the durable medical equipment (DME) or medical supplies section of a benefit book.
  
  
  • There are outside agencies specializing in the coverage, replacement, and repair of hearing aids and external components of cochlear implants should they be lost or accidentally damaged. For more information about this coverage, visit the Web sites of the ESCO insurance company or the Midwest Hearing Industry insurance company.