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.
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