Services & Support
by Jamie Schwartz

Best practices for hearing implant surgical approvals, appeals and advocacy

April 11, 2019
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Reimbursement

By guest author: Nicole Craig

Obtaining commercial insurance coverage for implantable hearing solutions can present unfamiliar challenges for your office as this may be a limited portion of your practice. Although most commercial plans cover cochlear implants and osseointegrated bone anchored systems, each plan follows their own medical policies and prior authorization requirements. In addition, each plan may have different coinsurance, deductibles, and out of pocket maximums based on each individual member’s benefit coverage.

A division of Cochlear Americas, Otologic Management Services (OMS) is a dedicated team of reimbursement specialists who are available, at no-cost, to help healthcare providers and candidates obtain the necessary insurance approval or to support appeals where coverage has been denied for Cochlear’s Nucleus® Cochlear Implants or Baha® Systems for medically qualified candidates.

As experts in medical insurance advocacy, OMS has an extensive knowledge of health insurance plans. With over 56 years combined industry experience they understand that not all insurance policies are the same. OMS partners with candidates and healthcare providers to provide navigational support of the health insurance maze.

Join us for a webinar to learn some best practices you can implement to help navigate through the insurance maze successfully and effectively advocate for insurance coverage for your patients. Each session will have an OMS representative as well as a Regional Reimbursement Manager available to answer questions.

OMS for professionals

Surgical Approval, Appeals and Advocacy Best Practices Webinar Dates:

4/30 11 am MST

8/20 12:30 pm MST

12/20 1 pm MST

Email OMS@cochlear.com with the specific date to register.

 

About our guest author:

Nicole Craig is the Senior Manager of Managed Care and Market Access for Cochlear Americas. She oversees OMS and managed care contracting for Cochlear’s external DME replacement parts and accessories. 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 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.

Author

Jamie Schwartz

Jamie is the Associate Marketing Manager in the Product and Professional Marketing Department at Cochlear Americas. Jamie is responsible for ProNews blog content as well as professional social posts and calendars. If you are interested in being a guest author for the ProNews blog please contact Jamie by email at jschwartz@cochlear.com.

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Abraham Joacob

Why aural rehabilitation following cochlear implant surgery is key

February 11, 2021

By Abraham Jacob, MD

Aural rehabilitation, or hearing therapy, following implant surgery is instrumental to auditory redevelopment. We see with our brains, we smell with our brains and we hear with our brains, but unfortunately our brains can overcorrect in areas when utilization isn’t warranted. If an individual isn’t applying the areas of the brain devoted to hearing, the brain may in fact dedicate those resources normally committed to such to address other needs.  It may even revert to support other senses such as vision.  Many seeking cochlear implantation have retreated into silent worlds – for many years and perhaps even a decade.  Dedicated, daily listening practice after implantation is required to push the brain forward and reconnect to sound.    

Therapy approaches may vary from patient to patient depending on the severity and timing of the hearing loss. With any type of therapy, it may take some time to see improvements and the length of time devoted to such varies depending on whether the individual was able to use a hearing aid in their ear before cochlear implantation.  The availability of opportunities patients had for listening and conversation with the hearing aid is also integral. 

Impact of consistent aural rehabilitation

Regular hearing therapy during the first few months following surgery can be beneficial and should be started immediately after initial activation of the sound processor. Just like knee or hip surgery, if one does not tend to the appropriate physical therapy, especially early on, the ability to achieve full range of motion with a new joint and walk affectively are simply not as good as if the effort is put in at the onset. 

Patients should be directed to expose themselves to sound-rich environments, particularly environments with much speech input.  This is critical to making progress with their cochlear implants. If patients don’t re-engage orally with their friends, family and other loved-ones, the implant may not be as effective. For example, if one spends only 30-60 minutes of time in sound-rich environments in a 12-14-hour day, there may still be no progress.  

There needs to be a concerted effort by the individual to expose themselves to sound a good portion of the day. The device alone will not provide the long-awaited sound the patient will appreciate.

Insights

The data logging feature of the sound processor will provide the patient and audiologist with insights into the actual “air time” or use of the device and the patient’s exposure to sound enriched environments, making it easy to track therapy efforts and optimize further clinical practice or direction. 

There may be times when an implanted patient will want or need to do some refresher therapy as well, such as following an upgrade to new cochlear device technology, or when adding additional accessories to improve their listening experience in various environments such as noise or music appreciation.

For more information about aural rehabilitation, download Cochlear’s adult home-based hearing therapy manuals and subscribe to Cochlear ProNews.

About the author:

Abraham Jacob, MD

Medical Director – Ear & Hearing at Center for Neurosciences
Medical Director for Otology/Neurotology Services – Tucson Medical Center

President – Arizona Society of Otolaryngology – Head & Neck Surgery

reimbursement

Navigating the insurance landscape quick tips

October 3, 2018

Reimbursement

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.

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