US Insurance Support
Once you have decided on a bone anchored solution you must determine and verify that your benefits cover a bone anchored solution. While this may seem daunting, Oticon Medical Insurance Support is here to make the process simple and easy for you and your hospital or clinic.
Oticon Medical Insurance Support will work with you to do everything from verification of benefits to submitting the paperwork to insurance providers to request and receive pre-authorization for the procedure. We do this in a confidential and private manner to protect your healthcare information at every step of the process. In the event that your request for pre-authorization is denied Oticon Medical Insurance Support will investigate the reasons for denial and help to formulate and submit the appeal.
Frequently Asked Questions
Many questions on insurance issues can arise prior to getting a bone anchored hearing system. Please find below the most frequently asked questions regarding reimbursement for bone anchored systems. we hope that this information will be of benefit to health care providers and patients alike.
1. How do I contact Oticon Medical Reimbursement Support team?
You can call the Oticon Medical Reimbursement Support staff at 1-888-277-8014, please ask to speak to a staff member in Reimbursement Support.
If you need to submit any paperwork to our team, please send via mail or fax as listed below. Please be sure that all documents include your name and contact information and are sent to the attention of the Reimbursement Support team.
580 Howard Avenue
Somerset, New Jersey 08873
2. How do I know if my insurance plan will cover the Oticon Medical Ponto System?
Your health care provider’s office, you or Oticon Medical’s Reimbursement Support team are able to contact your insurance provider and verify your benefits. When contacting your insurance provider directly, you will want use the member services telephone number on your insurance identification card. We recommend being prepared with the proper billing code prior to making the phone call. It is important to understand what benefits you might have in place and if an authorization will be required. In addition, you may also consult your benefit handbook or other online documentation provided by your insurance provider. We suggest you review both medical and durable medical equipment (DME) coverage when determining if your surgery, device or repair is a covered benefit.
3. Should I have my insurance plan’s approval before I can be scheduled for surgery?
Oticon Medical recommends that your benefits are verified and any required authorizations have been completed prior to scheduling your surgery. We also suggest that you understand any out of pocket expense you might be responsible for. However, this is a decision for the surgery center or hospital where you will be having your surgical procedure. You can speak with your surgeon’s office as they are most likely familiar with the policy in these situations.
4. How do I go about receiving approval from my insurance provider?
Either your doctor’s office or the Oticon Medical Reimbursement Support staff can aid you in this process. If you elect to work with Oticon Medical’s Reimbursement Support team on this process you will begin by completing several intake forms, which can be sent to you upon request. Due to company policy, we require that all forms be completed and signed before we can initiate the pre-determination or pre-authorization of benefit process. In addition, we also require clinical information from the health care provider. When the completed paperwork is received, our Reimbursement Support team will then reach out to your insurance plan and begin the process. We will be certain to communicate with you and/or your health care provider when the process is complete.
5. How long does the approval process take?
Most pre-authorization cases take between 4 to 6 weeks, although some case may take longer.
6. What plans can Oticon Medical bill directly?
While Oticon Medical can assist with benefit verification and pre-authorization for many payers, we are not always able to directly bill those companies on your behalf. Currently, Oticon Medical can direct bill for patients with traditional Medicare and specific Medicaid plans. We are enrolled in the following states’ fee for service Medicaid plans: AZ, DE, FL, ID, IL, IN, IA, KS, KY, LA, ME (Medicare cross-over only), MI, MO, MS, MT, NE, NH, NV, NM, NY, OK, OR, PA, RI, SD, UT, VA, WA and WI. For these plans, our Reimbursement Support team will obtain any required authorizations, submit the bill directly to the plan and in turn receive payment. If the patient is responsible for any out of pocket payments, we will collect that as well.
For those plans where Oticon Medical cannot directly bill, we have partnered with SunMed Medical Systems – a third party company that is able to work directly with various insurance plans in an effort to assist patients seeking coverage for replacement Ponto sound processors or sound processors on soft bands.
7. What options do I have if my insurance provider denies my request?
We encourage you to speak with either your health care provider’s office or the Oticon Medical Reimbursement Support staff to see if an appeal would be an appropriate action for your case. It is important to review any denials to understand the rationale and to review your policy regarding appeal steps prior to moving forward.
8. Does Medicare cover bone anchored hearing systems and/or new processors?
Medicare does cover bone anchored hearing solutions, including the surgery and the processor. Medicare also covers a new processor once a Medicare patient’s current processor has exceeded its useful life (a minimum of five years).
9. Can I get my Medicare covered replacement processor through Oticon Medical?
Yes, Oticon Medical is an accredited Medicare provider. This accreditation allows Oticon Medical to bill Medicare directly for replacement processors on behalf of those patients enrolled in traditional Medicare.
For those patients who are enrolled in a Medicare Advantage or Medicare replacement plan, we suggest that you contact our business partner SunMed Medical at 1-800-714-7434.
10. What if I am a Medicare patient, do I still need prior approval from Medicare?
Traditional Medicare does require an authorization. If you are enrolled in a Medicare Advantage or Medicare replacement plan it is important to speak with your health care provider’s office or Oticon Medical Reimbursement Support team to determine if prior authorization is necessary under your particular plan.
11. Does Medicaid cover bone anchored hearing systems?
Coverage by the various state Medicaid plans varies; therefore, we encourage you to speak with your health care provider’s office or Oticon Medical’s Reimbursement Support team to learn more.
12. Is there a charge or a fee to utilize the Oticon Medical Reimbursement Support team’s services?
There is never a fee for Oticon Medical Reimbursement support.
13. If my insurance plan does not cover a replacement processor or repair what are my options for paying out of pocket?
Patients can pay by credit card or debit card. Unfortunately we are unable to take checks or COD orders. You may also be able to acquire financing through CareCredit, a company which specializes in financing for medical equipment. Visit www.carecredit.com.
14. How do I contact SunMed Medical Systems?
Patients have direct access to experienced representatives who can pursue insurance benefits as well as handle any applicable authorizations and billing related to obtaining new Ponto device(s). Be sure to have your insurance card ready when you call.