by Michaela Coon

7 resources for safely getting back to business

June 4, 2020

Looking for a one-stop shop for COVID-specific information? Refer to these publicly available resources for in-depth tips on safely returning to your practice and caring for your patients:

American Cochlear Implant Alliance (ACIA)

ACIA provides guidance regarding various COVID issues. Topics include:

Medicaid/Medicare telehealth
Telehealth resources
Patient information
Advocacy and policy

American Academy of Audiology (AAA)

AAA focuses on communicative resources including information on best practices conducting hearing tests, reopening the office safely and other medical intervention strategies.

Academy of Doctors of Audiology (ADA)

ADA hosts a variety of third-party resources such as the World Health Organization and clinic-specific guidelines for a safe return.

American Academy of Otolaryngology – Head and Neck Surgery (AAO-NHS)

AAO provides guidance for returning to practice for Otolaryngology – Head and Neck Surgery. This two-part series contains recommendations pertaining to general and specific safety considerations. Note these are working documents and will be updated accordingly.

American Speech-Language-Hearing Association (ASHA)

ASHA has updated its website and social media with the latest COVID information. It equips professionals with telehealth guidelines, public policy updates, setting-specific resources and more.

Centers for Disease Control and Prevention (CDC)

The CDC provides a framework for healthcare systems providing non-COVID-19 clinical care during the pandemic.

Fuel Medical

Fuel Medical offers a COVID-specific webinar series, designed to provide crisis response, reopening planning strategies and tools, as well as updated information.

Cochlear ProNews also features a number of articles detailing how clinicians around the country are addressing patient care. Read the latest here.

Help your patients maximize 2024 insurance benefits with Cochlear

July 23, 2024

We’re past the half-year mark—it’s a great time for eligible patients to consider using their 2024 insurance benefits to replace their Cochlear^TM sound processor.

Cochlear will be reaching out to recipients who have been in their current sound processor technology for more than five years, one of the main criteria for determining eligibility for a sound processor replacement through insurance, and who have provided consent for communications from Cochlear.

Encourage your patients and their caregivers to plan ahead if they want to use their 2024 insurance benefits. The insurance approval process can take 6-8 weeks and benefit qualification by the patient’s insurance company is dependent on when the order is shipped from Cochlear, not when the order is placed. Insurance companies require replacement order claim submissions in 2024 to ship by the end of the calendar year, and the last day that Cochlear will be shipping orders is December 27, 2024. We recommend placing replacement sound processor orders no later than October 31, 2024.^†

We know that patients will reach out to you for help in this process. Cochlear is here to help you both.

Eligibility

The first step is to determine if your patient might be eligible for a sound processor upgrade. Did you know you can use Custom Sound Pro to identify if your CI patient has been using their sound processor for five years or more, which is one of the main criteria for determining eligibility?

Order Placement

If your patient is ready to place an order and does not need pre-upgrade counselling, they can:

Log into their Cochlear account and place an order via the online Cochlear Store, which is recommended for patients who are active users of the Nucleus Smart App.^* Orders can be billed to insurance.
Call Cochlear at 1-800-483-3123.

Pre-Upgrade Counselling

If your patient has been in their sound processor for five years and wants help along the upgrade journey, they can schedule a virtual Upgrade Consultation with Cochlear’s team of experts. Upgrade Solution Specialists can help your patients learn more about eligibility, what sound processor is optimal for them, the upgrade process and potential costs, and benefits of new technology. Cochlear will keep you informed via a Clinic Patient Report for patients who provide consent.

CI Upgrade Resources for Professionals

To help make this as seamless as possible for you and your patients along each phase of the replacement sound processor journey, Cochlear created resources and support for professionals, including a detailed protocol.

Programming Upgrades for CI and Baha

Ready-to-Wear (RTW) for Nucleus Sound Processors

RTW is free of charge and allows your patients to begin wearing their device immediately without a separate trip to the clinic.⁺You can learn more about Ready-to-Wear here.

Remote Assist for Baha 6 Max Sound Processors

Audiologists can program new sound processors remotely using Remote Assist. For more information about our Connected Care resources, visit our webpage.

Cochlear is here to help you and your patients navigate the sound processor replacement process.

†Orders placed on or before October 31, 2024 are not guaranteed to be approved by an insurer or shipped on or before December 27, 2024, the last available shipping date to meet the insurance deadline. Placing an order through Cochlear’s Reimbursement and Insurance Services does not imply approval from an insurance carrier.

* The Cochlear Nucleus Smart App is available on App Store and Google Play. For compatibility information visit www.cochlear.com/compatibility

+ To participate, recipient must be age 5 years or older. The Ready-to-Wear service is not available for hybrid externals, Kanso to Nucleus 8 Sound Processor upgrades and certain implant types. For clinics utilizing Cochlear™ Link, you can review and adjust your Accepted Map Age (AMA). Patients requesting Ready-to-Wear service with their upgrade will automatically receive the service if it falls within the AMA. For clinics who do not use Cochlear™ Link, or for patients with a MAP that exceeds the AMA, you will be receive notification within myCochlear Professional to approve a RTW request. For more information on Cochlear™ Link or to update your clinic’s AMA please contact CochlearLink@cochlear.com Upgrading bimodal ReSound patients: for recipients with a compatible ReSound hearing aid^# to take advantage of smart bimodal streaming, they will need to visit their clinician to have the hearing aid and sound processor re-linked.

1. Information provided by Cochlear Americas regarding insurance coverage or reimbursement is provided as guidance only and is not intended as reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding such information or its completeness, accuracy, fitness for a particular purpose, or that following such guidance will result in any form of coverage or reimbursement from any insurer. Information presented is subject to change at any time. To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement needs. In all cases, products or services billed must be medically necessary, actually performed and appropriately documented in the medical record.

2. As of Feb 1, 2018, Cochlear provides direct insurance billing support for many major private insurance plans, Medicare, Medicaid† (including HMOs) and Tricare for repairs, parts and accessories. Cochlear’s full-service billing support is available for recipients who are covered under one of the plans with whom Cochlear is contracted. If you would like to place an order for a replacement part or accessory, please keep in mind orders may take up to 2 weeks to process and ship, so please plan ahead.

‡ Cochlear is currently enrolled with Medicaid programs in the following states: AZ, AL, CA, CO, CT, DC, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, ME, MI, MN, MS, MT, NC, ND, NE, NJ, NM, NV, NY, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, and WY.

A Reimbursement Support Success Story

July 25, 2019

By Nicole Craig, Senior Manager of Managed Care and Market Access, Cochlear Americas

At Cochlear, we are committed to ensuring patient access to implantable hearing solutions, extending from the earliest days of candidacy through a lifetime of service and support for our recipients.

Last month we posted information on best practices for obtaining commercial coverage for cochlear implant and bone anchored systems. This month we’d like to share a real-world success story that demonstrates how Cochlear’s Otologic Management Services (OMS) team works collaboratively with other stakeholders to ensure patient access to Hear now. And always

Patient story: Richard, age 35, Missouri

Becky Berkley, Sr. Reimbursement Specialist for OMS, recalls receiving an appeal request in October 2018 from the provider clinic of patient Richard. His unilateral Cochlear™ Nucleus® Profile Implant surgery was tentatively scheduled for December 12, 2018. His insurance carrier had denied his cochlear implant as a plan benefit exclusion, stating that his employer only covered cochlear implants for persons under age 27 – a criteria that Richard did not meet.

Richard remembers receiving the denial. “I received a letter in the mail that stated there was an error made and my surgery was denied. My heart broke. Receiving this implant was going to be a life changer for me and my family. At that moment I felt like that future had just been ripped away from me. But I was not going to let that denial letter stop me.”

Becky explained to Richard that the insurance plan elected by his employer was self-funded and suggested he reach out to his company’s Benefit Plan Administrator in the Human Resources department to inquire if they would be willing to review the procedure and pursue a benefit exception on his behalf.

“I was able to go to the headquarters to meet with the Director of Human Resources. After meeting with her and sharing my story, she said she would do whatever she could to help me. She suggested that I schedule an appeal hearing and my case would be presented to the board,” recalls Richard. Meanwhile, Becky worked with Anne Anthony, Cochlear’s Sr. Manager Regional Reimbursement for the Central region, to gather and provide supporting literature and documentation and was able to present this information to the board members in the review of Richard’s case. OMS received notification in November that the board approved the cochlear implant. In addition, they committed to removing the age restriction on medically necessary cochlear implants for all health plan members.

“I am so grateful that they understood that receiving a cochlear implant would greatly impact my life, both professionally and personally. Not only did they approve my surgery but they changed the plan for all employees starting January 2019. I honestly believe that all things happen for a reason. If this wouldn’t have happened, then maybe there wouldn’t have been a change in the policy and others wouldn’t get the chance to improve their quality of life,” remarked Richard.

As demonstrated by Richard’s story, OMS will work with recipients, professionals, HR representatives and employers to assist in providing information to obtain approvals which can sometimes lead to a policy change. Let us know how Cochlear’s reimbursement services have worked for you – send us your story! rsteinke@cochlear.com

For more information on services provided by OMS, visit our webpage or contact via email at OMS@Cochlear.com.

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.

Information provided by Cochlear Americas regarding insurance coverage or reimbursement is provided as guidance only and is not intended as reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding such information or its completeness, accuracy, fitness for a particular purpose, or that following such guidance will result in any form of coverage or reimbursement from any insurer. Information presented is subject to change at any time. To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement needs. In all cases, products or services billed must be medically necessary, actually performed and appropriately documented in the medical record.