By: Kalisha Barrett
Health insurance policy change happens, but how? Patients, parents, advocacy organizations, professional organizations, state representatives, and manufactures all have a role in shaping insurance policy and driving change. Patients and parents who are willing to share their stories and explain the value of the implantable hearing technologies in their lives, call local legislators, and write letters can support policy change. Providers and professional societal organizations can share their clinical expertise and empower patients by educating them on how to address lack of insurance coverage. State Legislators work with patients, societal organizations, and providers to sponsor bills and push for legislation which impacts health insurance policies. Successful policy change is enacted with the help of all of these parties working together to change unfavorable insurance coverage.
Providers are often unclear about the level of commitment required for “payer advocacy.” However, successful policy change has been implemented time and time again, with the help of providers who help patients gain fair access to insurance coverage.
Providers who are involved in payer advocacy recommend staying involved in national organizations as well as their local and state professional organizations. In an effort to stay in tune with local legislative initiatives, providers can participate in the various committees within those professional organizations or on state appointed boards through Health and Human Services or state public health agencies. By staying involved in local professional organizations, providers also gain access to resources available to members.
Cochlear Americas understands the importance of assisting patients and providers with payer advocacy and navigating the health insurance landscape. We have a dedicated health economic and reimbursement department staffed with reimbursement managers and specialists to support payer advocacy. We know the challenges candidates face with accessing cochlear implants and hearing technologies. Cochlear has put together a Quick Tips for Obtaining Insurance Coverage to offer some best practices providers can implement to help successfully maneuver through the insurance web.
Otologic Management Services (OMS) is another service available to provide support for candidates and healthcare providers seeking to obtain necessary insurance approval and to support appeals where coverage has been denied for Cochlear™ Nucleus® or Baha® Systems for medically qualified candidates. OMS can assist candidates and providers with obtaining an optional process called predetermination. This is the process that allows a provider to request services to determine coverage prior to surgery. The health plan will review the patient’s health benefits and medical policies to determine if the treatment will be covered.
OMS Contact Information
Phone: (800) 633-4667 option 4
Email: OMS@Cochlear.com
For the latest information, visit www.Cochlear.com/US/Professionals and click on Resources-Reimbursement Solutions-Coding and Billing Support for Professionals/Facilities or call the Cochlear Coding Support Hotline at (800) 587-6910.
About our guest author:
Kalisha Barrett is the Health Policy Manager on Cochlear Americas Health Economics and Reimbursement Strategies team. In her role, she assists with executing strategies aimed at expanding patient access to hearing implants and related services through both state and national advocacy efforts. Additional reimbursement support offered by Cochlear’s Regional Reimbursement team can be found on the Reimbursement Support page of Cochlear’s US Professional Resources Website. Please do not hesitate to reach out to Kalisha or the Regional Reimbursement Manager associated with your geography for reimbursement assistance or for questions related to this article. Cochlear offers coding assistance through the Coding Support Line accessible by calling 1-800-587-6910 between the hours of 8 AM – 3 PM Mountain Standard time zone or via email at codingsupport@cochlear.com. For pre-surgical insurance support, OMS is available to assist with pre-authorizations and appeals and can be reached at 1-800-633-4667 option 4.
