Insurance Coverage for CI Surgery and Upgrades

One great thing about having multiple cochlear implant manufacturers is that they are constantly innovating and producing new technology!  A new processor launch is thrilling, and the first question on everybody’s mind is, “When can I get my hands on it?!?”  Unfortunately, the second question is often, “Will my insurance cover it?!?”  Here are some tips for how to make the case for a CI processor upgrade:

  • *Don’t say UPGRADE.  Why would your insurance pay for the newest, fanciest processor when your current processor, in theory, works just fine?  That’s what they think when they hear “upgrade.”  Instead, say REPLACEMENT.  This new processor REPLACES your old one, which is now OBSOLETE.


  • Contact your cochlear implant manufacturer for help.  They have dedicated insurance specialists who can help you best make your case for the upgrade.  They deal with insurance issues all day and they’re on your side!  Here are links to the insurance support departments for Advanced BionicsCochlear Americas, and MED-EL.


  • Have your audiologist put your MAPs onto one of the new processors (she probably has a demo in her office) and perform soundbooth testing with your old processor and then the new “loaner.”  If you can show a difference (for example, in your ability to hear in noise), you have a stronger, data-driven case to make to insurance that this is not just a cosmetic change.


  • Emphasize the differences in the new processor.  Is it more waterproof?  Does it have improved microphones?  Are there changes in the sound processing strategies or programs?  Improved battery options or battery life?  Ease of wear?  Better connectivity with FM systems or other assistive listening devices?  List all of the reasons why this upgrade will offer improved functionality.


  • Use the word “obsolete” to describe your old processor in comparison to this new one.  The insurance company should replace obsolete medical equipment.


  • Ask for itemized bills from both your insurance company and hospital.  Look over them carefully for any services that you may not have received.  Often, hospitals have a standard “People who get a CI usually have x, y, and z service done” kind of billing template and it may include some services that you did not receive.  Don’t be afraid to call the hospital’s billing department to ask for an explanation of any extra charges.  Maybe you did receive the service and in the hustle of the day just forgot it, or maybe you were mistakenly charged for something you did not need or receive.


  • HERE is a list of resources for funding for CI surgery and processors, and well as sources of funding for therapy.  Remember that receiving the cochlear implant is just the first step — listening and spoken language therapy is KEY to getting the best results.


Check out this webinar: Insurance Basics on Cochlear Implant and Baha.

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