US Insurance Support

Once you have decided on a bone anchored solution, you must determine and verify that your benefits will cover it. While this may seem daunting, the Oticon Medical Reimbursement Support Team is here to make the process easy for you and your hospital or clinic.

Listed below are the insurance plans with which we are In-Network:

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    Medicaid of MT
    Medicaid of AZ
    Medicaid of VT
    Medicaid of WA (Apple Health)
    Louisiana Medicaid
    Medicaid of MI
    Medicaid of NH
    Medicaid of CO
    New Mexico Medicaid
    Kentucky Passport (KY)
    McLaren Health Plan (MI)
    Jackson Care Connect (OR)
    Health Share of Oregon
    Medicaid of OR
    Oregon Columbia Pacific
    Child Health Plan Plus Colorado
    Medicaid of ID
    Medicaid of IL
    Medicaid of IN
    Medicaid of UT
    Medicaid of WI
    Medicare of NJ
    Medicaid of KY
    Medicaid of CT
    Husky Health (CT)
    Medicaid of OH
    Iowa Medicaid
    Medicaid of NY
    Nebraska Medicaid
    Kansas Medicaid
    Medicaid of ME
    Colorado Medicaid
    Medicaid of RI
    BCBS of AR
    Child Health Plan Plus Colorado
    Heritage Health -Nebraska Total Care
    Meridian Health Plan (MO)
    Missouri Medicaid
    Wellcare (MO)
    Wellcare (NJ)
    WellCare of Kentucky
    MD Physicians Care
    AmeriHealth Caritas
    BCBS of TX
    Medicaid of TN
    Molina Health Care (FL)
    Delaware Medicaid 
    Medicaid of VA
    Medicaid of FL
    Staywell Health Plan (FL)
    Medicaid of NC
    Medicaid of NJ
    Medicaid of PA
    Highmark Health Options (DE)
    Medicaid of MD
    Horizon NJ Health
    PED-I-Care (FL)
    Well Care of NJ
    Medicaid of DE

The Oticon Medical Reimbursement Support Team will assist you with everything: verification of benefits, submitting paperwork to insurance providers, and requesting and receiving pre-authorization for the procedure. We do this in a confidential and private manner to protect your healthcare information through each step of the process. 



1. How do I contact the Oticon Medical Reimbursement Support Team?

You can call the Oticon Medical Reimbursement Support Team directly at 1-855-400-9761 or reimbursement@oticonmedical.com.



2. How do I submit paperwork to the Oticon Medical Reimbursement Support Team?

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.

Oticon Medical
580 Howard Avenue
Somerset, New Jersey 08873
Phone: 1-855-400-9761
Fax: 1-732-568-7130
Email: reimbursement@oticonmedical.com

Download Reimbursement form

Download Reimbursement form for ENT

 

3. I do not see my insurance listed on Oticon Medical’s In-Network Insurance list. Does this mean my insurance will not cover an Oticon Medical device?

Not necessarily.  While Oticon Medical might be out-of-network with your plan, we can still submit to your insurance. Many plans have out-of-network benefits.  Additionally, many insurance plans DO NOT have an in-network provider for a bone anchored hearing system (BAHS) and allow us to submit due to a gap in coverage.

 

4. How long does a request for Prior Authorization take?

A request for prior authorization can take anywhere from 4-6 weeks (or less). However, it depends on the insurance plan. Reimbursement does not control the time frame of how long it takes for a plan to make a decision. We strictly request the approval and await a decision. Once approved or denied, Reimbursement notifies all parties that a decision has been reached. 



5. My insurance carrier denied my prior approval request. What can be done?

As part of our services, Oticon Medical will request a prior approval from a patient’s insurance plan. Reimbursement is not responsible for the decision of the insurance carriers. If a request is denied, the patient has the right to an appeal. Please contact reimbursement@oticonmedical.com for additional questions or assistance regarding an appeal.


 
6. I have Medicaid. Will my insurance cover the Ponto device?

Medicaid does cover the device. However, it depends on the state in which the Medicaid was issued (please refer to In-Network list above).  Oticon Medical participates with Medicaid in specific states. Reimbursement will attempt to obtain a prior authorization for Non-Contracting Medicaid states, but there is no guarantee they will allow us to bill or agree to the prior approval request. 



7. My insurance refuses to pay. What can Oticon Medical do to help me get the device?

A request for prior authorization does not guarantee approval (or payment). Here at Oticon Medical, we pride ourselves on providing each patient with a quality product and service. However, certain situations are out of the hands of the Reimbursement department. In the event your insurance carrier denies approval, we can always discuss a payment option. 



8. I faxed the benefit verification forms over to Oticon Medical but I haven’t heard anything. Why is that?

Oticon Medical receives faxes through a fax server. Once we receive benefit verification forms, it is our process to notify the facility that we’ve received the benefit verification forms and request any missing or incomplete information (if applicable). If you have not received a notification from Reimbursement, a few things might have occurred (e.g., we did not receive the fax or no contact information was listed in the received fax). We did not receive the fax, or no contact information was listed in the received fax. In the event you have not received any notification of receipt, either re-fax or call Reimbursement at 855-400-9761



9. I have Medicare. Will my insurance cover the Ponto device?

Medicare does cover the Ponto device, but if you don’t have a secondary coverage, it does not cover the Medicare deductible and coinsurance. If the Medicare deductible hasn’t already been satisfied, Reimbursement must collect the deductible and 20% Medicare coinsurance before we can ship the device.



10. Am I covered for a bone anchored hearing system if my insurance plan does not cover hearing aids?

CMS guidelines deem osseointegrated implants (i.e. bone anchored hearing systems) are “prosthetic” devices, not hearing aids. Therefore, Medicare covers BAHS even though it does not cover traditional air conduction hearing aids. Many other insurance carriers have a similar policy. However, it depends on your specific plan. Please contact your insurance carrier for details of your specific coverage.  
**Please note this is for BAHS only. Soft bands are not included in this policy. 



11. 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 that specializes in financing for medical equipment. Visit www.carecredit.com.


CareCredit

 

 

 

***If you have any surgery related questions, please direct those to your physician.

Note: Insurance benefit verification is a service offered by Oticon Medical. It does not guarantee approval or payment. When submitting benefit verification forms, please submit all signed required documents along with copies of ID cards at once to ensure a timely process. The benefit verification can take 4-6 weeks for a decision. Oticon Medical is not responsible for the decisions made by insurance carriers or the time required for the decision process.