What Happens after the
Processor Warranty is Up?

By Liesel Thomas, CO Families for Hands & Voices

Many families struggle to pay huge out of pocket costs for CI processor and replacement parts as a child grows, especially following the end of the three year warranty period after activation that all three companies provide. After the recipient’s three-year warranty expires, a recipient must either purchase extended warranty coverage, a service agreement, or pay for repairs or replacements.  After the three-year period is up, a broken or non-functioning processor may be partially covered by health insurance. Based upon plan, the CI user may have to pay up front and be reimbursed afterwards as Blue Cross Blue Shield plans require.

Cochlear implant processors are considered external prosthetic or durable medical equipment (DME).  The DME benefit on your plan may cover repairs and replacement pats that are not under warranty. Check with your insurance company to learn about possible benefits, copays and deductibles surrounding this claim.  The code is L8619.

If a recipient has Medicaid, Medicare or the military’s TriCare insurance, all costs are covered.  (There have been reports in Colorado that Medicaid is no longer covering costs for CI ongoing needs for those over age 21.)

For recipients with other types of insurance coverage, the costs and trade-in values of the old processor differ from company to company.  When an insurance company covers a cost, the recipient must still meet their deductible and co-payment cost.  

Advanced Bionics

Advanced Bionics bills all insurance companies directly. Advanced Bionics reports a very high success of insurance companies covering the cost of paying for replacements, repairs and upgrades after a warranty has expired and the device is broken. They report it is very rare and only a handful of insurance company plans will deny coverage. In fact, they said that it is almost unheard of that an insurance company will not pay for a replacement on a broken device out of the initial three-year warranty period.

Advanced Bionics, like all cochlear implant companies, is an out-of-network provider and at the same time the only provider for the recipients.  As such, Advanced Bionics works with the insurance company to get an exception and coverage equal to in-network provider benefits. This process takes two to four weeks, but can save the consumer hundreds or thousands of dollars.  Preauthorization is recommended.

For information, Advanced Bionics would be happy to answer questions through their insurance department at 877-779-0229. 

Cochlear Americas

There is a wide variety of service plans, advance processor purchase plans and a new family plan.  For more information about existing equipment coverage, plan features, payment options and more Cochlear’s number is 1-800-523-5798 (V/TTY) or email serviceagreement@cochlear.com.

The newest plan is the family plan.  For one year, the cost for the first processor (including repairs, loss and damage) is $2,250 or $208 per month.  Each additional processor is $500 or $46 per month. 

Cochlear does not bill your insurance directly.  However, Access Mediequip is contracted with Cochlear Americas to bill insurance for you.  Access Mediequip reports that they can submit to insurance for all except the following insurance plans nationwide: Aetna, Blue Cross Blue Shield of Colorado, Blue Cross Blue Shield of Florida, Health Med. Oregon, Kaiser Permanente, Medical Mutual Ohio, Preferred Health System (PHS), Progressive Medical, Teacher’s Health Trust, United Health Care and Zenith.

They said the benefits and success rates vary widely from company to company and even from plan to plan.  The Cochlear Replacement Team phone number is 1-866-586-8083 and their website is www. cochlearupgrade.com. 

If you have an insurance company that they do not work with they recommend trying to submit on your own or using a company called Care Credit to finance the costs of cochlear implant repairs, plans or upgrades.  Care Credit’s website is www.carecredit.com.  ~

Information printed in the summer of 2010 and may have changed since publication

Information printed in the summer of 2010 and may have changed since publication