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 Reimbursement Support Team is here to make the process simple and easy for you and your hospital or clinic.
Oticon Medical Reimbursement Support Team 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 Reimbursement Support will investigate the reasons for denial and help to formulate and submit the appeal.
1. How do I contact Oticon Medical Reimbursement Support Team?
You can call the Oticon Medical Reimbursement Support Team directly at 1-855-400-9761 or firstname.lastname@example.org.
You may also contact our support team directly:
Natasha France - Reimbursement Representative
Phone: 1-855-400-9761 ext. 2209
Ebony Smith - Reimbursement Analyst
Phone: 1-855-400-9761 ext. 2021
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.
580 Howard Avenue
Somerset, New Jersey 08873
3. I have private insurance, would my insurance cover the device?
Oticon Medical does not contract with private insurance payers. We do have a third party biller (Sun Med) that handles our private insurance accounts. We refer all benefit verification forms to Sun Med, in turn; they take over the process of benefit verification from our Reimbursement department.
4. 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.
5. How long does a request for Prior Authorization take?
A request for prior authorization can take anywhere from 4-6 weeks (or shorter) 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 once a decision has been reached.
6. My insurance carrier denied my prior approval request, what can be done?
Oticon Medical provides a service if requesting prior approvals from patients insurance plans. Reimbursement is not responsible for the decision of the insurance carriers. If a request is denied, the patient has the right to an appeal. This appeal must be done in writing by the patient or the patient’s doctor. Reimbursement does not write appeal letters.
7. I have Medicaid, will my insurance cover the Ponto device?
Medicaid does cover the device, however it depends on the state of which the Medicaid was issued. Oticon Medical participates with Medicaid in specific states. Reimbursement will attempt to obtain a prior authorization for Non-Contracting Medicaid states, however there is no guarantee they will allow us to bill or agree to the prior approval request. In the event this happens, we can refer you to our third party biller Sun Med for an attempt of approval.
8. My insurance refuses to pay, what can Oticon Medical do for me to receive 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.
9. 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 that we notify the facility that we’ve received the benefit verification forms. If you have not received a notification from Reimbursement, a few things could have occurred. We did not receive the fax or we didn’t receive the fax in its entirety that list contact information. In the event you have not received any notification of receipt, either re-fax or call Reimbursement at 855-400-9761.
10. I have Medicare, will my insurance cover the Ponto device?
Medicare does cover the Ponto device, however 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 will collect the deductible and 20% Medicare coinsurance before the device can be shipped.
11. I have Medicare as my primary and I also have a secondary insurance, will I still have to pay anything out of pocket?
If your secondary doesn’t cover the Medicare deductible and coinsurance, then Yes. If your secondary is a Medicare Advantage plan, you may have an additional deductible and coinsurance. Every insurance carrier differs therefore, Reimbursement will verify this once we call to verify insurance coverage.
12. Does my insurance pay for any accessories with my Ponto Device?
All Ponto devices come with a free accessory. You have the choice of a black streamer, white streamer or an additional year warranty (No Loss, No Damage). Any additional accessories are not covered under your insurance plans. You have the option to pay out of pocket for the additional accessories.
13. What device does my insurance cover?
If your insurance approves the device, it covers all of our Ponto devices. Medicare does not cover Soft Bands. For example, if you have Medicare and Medicaid, the claim would reject.
14. 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.
***If you have any surgery related questions, please direct those towards 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 length of the decisions made by insurance carriers or the time allotted for the decision process.