1) How much will everything cost?
The cost of cochlear implantation in the US and Canada may vary as a result of regional differences. In general, however, the estimated total cost of assessment, surgery, the device, the surgeon’s fee, and post-operative audiology ranges from $60,000 to $100,000
2) Will my health insurance plan pay for a cochlear implant?
For private insurance, we must obtain pre-authorization before moving forward with surgery. Medicare, Medicaid, the Veteran’s Administration, and other public health care plans cover cochlear implants. Because cochlear implants are considered to be medically necessary for the treatment of severe to profound hearing impairment, the surgery is a covered procedure by a majority of US health insurers.
3) My health insurance plan has denied coverage for a cochlear implant. How can I appeal?
First, determine specifically why the cochlear implant was denied. Make sure you have the denial in writing. If you have not received a written denial, ask for one. An appeal is most effective when structured in response to the specific reason for denial of coverage. If a specific denial reason is not provided, contact the plan and ask for clarification. Next, contact your cochlear implant manufacturer, your cochlear implant center, and other advocacy groups. Ask for help.
4) Will Medicare pay for cochlear implantation?
Yes. Medicare covers at least a portion of the cost of cochlear implant surgery for beneficiaries that meet clinical guidelines. Medicare will also cover services necessary to maintain function of the cochlear implant. Although Medicare covers many services, payment is low and working with Medicare is administratively challenging.
5) Will any parts of my implant system ever require maintenance?
While the implant itself is designed to last a lifetime, there is always a possibility of malfunction. And while no special precautions are necessary, many patients find that using protective equipment such as helmets or other headgear can minimize the frequency and/or extent of damage when engaging in activities such as contact sports, bicycling, etc. If the implant does become non-functional, studies have shown that nearly all re-implanted individuals do very well.
The external components of the implant system are also very durable, but maintenance or replacement of batteries, cables, or microphones can be expected over time. As with any equipment, the better components are cared for, the better they will perform and last.
6) Will my health insurance plan pay for repairs and replacement parts for my sound or speech processor?
Many health plans do not include specific benefits to cover repairs and replacement of parts for cochlear implants. However, the policy may have durable medical equipment (DME) benefits that can be applied. Read your benefits booklet or check with the health plan administrator.
7) Will Medicaid cover parts and accessories?
Most state Medicaid agencies cover cochlear implants. Like Medicare, Medicaid has historically covered necessary parts and in some cases, accessories shown to be needed by the Medicaid recipient. The best way to find out is to contact your Medicaid office and ask about coverage for a particular item.
8) How can I insure my external equipment against theft, damage, or loss?
Contact your cochlear implant manufacturer. Often, external equipment carries a warranty and there may be options for purchasing extended coverage/service contracts. Additionally, you may have coverage through your personal home property and casualty or homeowner’s policy.
9) My health insurance plan informs me that I have exhausted my rehabilitation benefits. How can I appeal this decision and obtain coverage for additional audiology or speech therapy services?
Many health plans are hesitant to cover unlimited rehabilitation services and will have a predetermined cut-off point for post-operative cochlear implant services. However, if the recipient demonstrates a need for additional services — this may be especially true for children — many health plans will authorize extended benefits based upon medical necessity. That medical necessity must be argued by the treating clinician and supported by the recipient’s specific situation. Your cochlear implant manufacturer can often assist the surgeon or audiologist with supporting documentation or material.
10) Is there any way that I can talk to some people who have already been through this process?
Each manufacturer sponsors a website where you can find both patients and their family members who have been through many of the same situations you are now facing.