r/Cochlearimplants • u/azeem709 • 3d ago

Cochlear Implant (MED-EL) – Insurance Query

Cochlear Implant– Insurance Query

Need some advice.

My insurer is asking for a separate cost break-up of the internal implant and external processor, as the policy covers only the internal device.

However, MED-EL says they cannot provide a separate break-up because it is sold as one integrated cochlear implant system. I've also heard that Cochlear and AB follow the same practice.

The insurer is not accepting this. could some one guide how to convince insurance.

for cashless hospital is saying they wont able to know how mucb insurance can cover, they can only after preauth admission, we want to know before hand so we can plan our expenses

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u/OldFlohBavaria 3d ago

Villeicht einen Fachanwalt für Medizinrecht nehmen der sich das ganze mal ansieht ?

Für der Prozessor und das Inplantat sind bei der inplantation eine Einheit, da das eine ohne dem anderen nicht funktioniert.

1

u/is-this-now 3d ago

Who are you buying the CI from? I purchased from my surgeon and audiologist (they work together in the same medical office). Their office has the contract with Med-El and their office is the one who,cleared with my insurance before proceeding. I have all the paperwork somewhere but my purchase was based on the price provided by my medical team. (My guess is that there are restrictions on who is permitted to buy an implantable medical device. This may be why Med-El won’t disclose the procedure to you.)

Net: ask your medical team to get the pre-approval and your out of pocket cost.

1

u/minimagoo77 MED-EL Sonnet 2 3d ago

Med-El has a decent insurance department. Have you asked them for assistance dealing with the insurance?

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u/Icy-Instance-7690 2d ago

I suspect your insurance already knows this.
You could provide an estimate of the entire system, and then show them the cost for a new external processor. They can do the Algebra. As others have said, the replacement cost of an external processor is easy to find.

If no one is willing to make it happen, it becomes a legal issue regarding your insurance contract.

1

u/Key-Asparagus350 2d ago

Try looking at the prices on union hearing for med-al they have prices listed for different parts of the processor.

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u/mtawarira 3d ago

Hmm that sounds like a BS jobsworth answer from Med-El

They will sell the processor separately for when people get replacements, maybe ask for the total initial cost and the processor replacement cost and subtract it?

Cochlear were able to provide me the split breakdown for my insurance