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Cochlear - Reimbursement - June 2022

The Cochlear™ Lend an Ear Program

Melissa Thompson, MS

January 24, 2022
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Interview with Melissa Thompson, Product Manager Cochlear™ Baha® Systems - Baha Lend an Ear Program.

 

AudiologyOnline: What is the Lend an Ear Program?

Melissa Thompson: Cochlear recognizes the importance of providing early access to sound to promote optimal speech and language learning. Our Baha® Lend an Ear Program allows quick access to bone conduction treatment for pediatric candidates while waiting on insurance approval.

It’s unique to Cochlear and was designed to enable clinicians to ensure their pediatric patients get earlier access to sound through a non-surgical bone conduction solution as soon as possible. This early access to sound helps lay the foundation for language and social development.

AudiologyOnline: How does the Lend an Ear Program work?

Melissa Thompson: The Lend an Ear Program is designed to provide the flexibility clinicians need to provide their patients with early access to sound in the way that works best for the clinician and their practice.

First, clinician chooses the insurance billing option that works best for their clinic and patients. They can select from two options: 1) They can have Cochlear’s Reimbursement and Insurance Services seek insurance approval on behalf of their patient or 2) They can choose to have the clinic obtain insurance approval.

Regardless of which insurance billing option the clinician chooses, it’s important that the family understands the program details and agrees to the program. Our Lend an Ear counseling resources can assist clinicians with explaining the program to families.  

AudiologyOnline: How does the Lend an Ear Program work if Cochlear’s Reimbursement and Insurance Services bills insurance?

Melissa Thompson: If the clinician elects to use Cochlear’s Reimbursement and Insurance Services, the clinician identifies a candidate and introduces the program to the family/caregiver.

The family reads the program details, agrees and opts-in to the program. We also recommend that the clinician and family fill-out the order form together to easily customize the order depending on what suits their patient the best.

The clinician then submits two forms to place the order. Cochlear will ship the loaner sound processor and Softband or SoundArc to the clinic within 3-4 days of receiving the order (after coverage and out-of-pocket estimates are determined).

Clinicians can then fit the patient with the device for their immediate use.

Once the loaner equipment ships, the Cochlear Reimbursement and Insurance Services Team reaches out to the clinic for additional documentation required for insurance approval.

After insurance approval is obtained, the ownership of the equipment is converted to the patient (after the clinician registers the equipment to the patient) and all remaining components to complete the full order are shipped to the patient.

AudiologyOnline: How does the Lend an Ear Program work if the clinic chooses to bill insurance?

Melissa Thompson: If the clinician’s practice chooses to bill insurance, the clinician still identifies a candidate and introduces the program to the family/caregiver.

Next, the clinician and family will complete the order form together and once completed, the clinician will submit the order form to place the order. Cochlear will ship the full system to the clinic after the order is received.  

During this process, we suggest the clinic contacts the patient's insurance to verify coverage– the clinic may choose to start the insurance approval process before providing equipment to the patient. Then the clinic will continue the insurance approval process on behalf of the patient.

Cochlear provides delayed invoicing terms and doesn’t require payment until 90 days after shipment of the system, allowing the clinic time to obtain approval and bill insurance.

AudiologyOnline: Who can participate in the Lend an Ear Program?

Melissa Thompson: Designed with pediatric patients in mind, the Lend an Ear program may provide medically-qualified pediatric patients age 12 and under with earlier access to sound by expediting the shipment of non-surgical Baha Start system with an appropriately-fit Baha 6 Max Sound Processor while they wait for insurance approval.

The Lend and Ear Program is intended for pediatric patients who have never used a Cochlear bone conduction solution before. If a patient is in need of an upgrade, then our Reimbursement and Insurance Services team is pleased to help them with the upgrade process.

AudiologyOnline: You mentioned “the ownership of the processor will be converted to the patient or returned to Cochlear” -  what do you mean by that?

Melissa Thompson: This program is a “loan to own” concept. When Cochlear’s Reimbursement and Insurance Services is obtaining insurance authorization, the sound processor will be set up as a loaner with the expectation that once the insurance approval is received, it will be converted to the patient’s ownership as noted above. Once we obtain insurance approval, the patient’s journey will be simplified with no further need for equipment exchanges or fitting appointments.

Essentially, all the clinic has to do is submit a complete order including supporting documents and Cochlear will take care of the rest!

If a clinic chooses to obtain insurance approval instead of Cochlear, then the clinic will manage the ownership process with the patient.

AudiologyOnline: What if insurance denies the request?

Melissa Thompson: In the event an insurance denial is received, and Cochlear’s Reimbursement and Insurance Services is obtaining insurance authorization, Cochlear will appeal the denial on behalf of the patient. Cochlear’s reimbursement team has an overturn success rate of about 85%!1 In the unlikely event a denial cannot be overturned, the family/caregiver will have the option to pay a discounted self-pay rate or return the equipment at no cost.

If the clinic is obtaining insurance approval, then the clinic can pursue an appeal on their patient’s behalf. The clinic will also have the option to return the equipment to Cochlear prior to the deadline of the delayed invoice terms.

AudiologyOnline: What happens if a patient breaks or loses the sound processor prior to receiving authorization?

Melissa Thompson: As an added benefit, patients can use our warranty services that include processor repair and access to one-time theft and loss coverage while insurance approval is pending. If the option is chosen to have Cochlear bill insurance, once insurance approval is received and the conversion of ownership occurs, the warranty dates are renewed and insurance is billed.

AudiologyOnline: Why does it take a few days for the loaner equipment to ship to the clinic?

Melissa Thompson: With the Lend an Ear Program, we’re proud to provide the patient their own sound processor from the very start, instead of just giving them a loaner that will need to be exchanged once insurance approval is received. This may take a few days up front when Cochlear is obtaining insurance authorization, but saves the patient and clinician time later by not having to swap-out the sound processor with a new sound processor later on.

AudiologyOnline: What are the steps for clinicians to kick start the program?

Melissa Thompson: To initiate the Lend and Ear Program, follow these easy steps:

Get started with Option 1: Cochlear bills insurance

  1. Discuss the program with your patient and caregiver using the Lend an Ear counseling resources.
  2. Submit the order to reimbursement@cochlear.com by completing the following two forms with your patient’s caregiver so you can easily customize the order depending on what suits your patient the best:
  3. Your patient’s sound processor will be shipped in a matter of days!
  4. We’ll reach out to you and your patient for additional documentation after we ship the device, including a Letter of Medical Necessity (LMN), clinical documentation and any other documentation necessary to complete the order.
  5. Once insurance approval is obtained, we’ll ship your patients’ system accessory and full ownership of the device will be transferred to them (after clinical device registration).

Get started with Option 2: Clinic bills insurance:

  1. Discuss the program with your patient and caregiver using the Lend an Ear counseling resources.
  2. Submit the order to procare@cochlear.com by completing the following form with your patient’s caregiver so you can easily customize the order depending on what suits your patient the best:
  3. Your patient’s full Baha Start system will be shipped in a matter of days!
  4. You’ll follow-up with insurance to obtain approval.

AudiologyOnline: How can this program benefit clinicians and patients?

Melissa Thompson: Here are a few key benefits:

  • Insurance approval times vary and can be lengthy. The Lend an Ear Program provides patients with early access to sound while waiting on insurance authorization.
  • Once the patient receives their Baha Start System with a Baha 6 Max Sound Processor and Softband or SoundArc there may not be a need for exchange or additional trips to the audiologist – the technology is theirs to keep.
  • Our Baha 6 Max Sound Processor delivers more power with a fitting range of up to 55 dB SNHL in the same small size as other 45 dB devices,* and features our most advanced sound processing technology and direct streaming with a compatible smartphone.
  • This program is designed to suit the clinic’s practice and patient needs. Get started with the Lend an Ear program by choosing the insurance billing option that works best for the clinic and patients.

If you have any questions, please reach out to: Reimbursement@Cochlear.com.

© Cochlear Limited 2021. All rights reserved. Hear now. And always and other trademarks and registered trademarks are the property of Cochlear Limited or Cochlear Bone Anchored Solutions AB. The names of actual companies and products mentioned herein may be the trademarks of their respective owners.

Views expressed are those of the individual. Consult your hearing health provider to determine if you are a candidate for Cochlear technology. Please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

*SNHL means Sensorineural Hearing level

**For compatibility information visit: www.Cochlear.com/compatibility

In the United States and Canada, the placement of a bone-anchored implant is contraindicated in children below the age of 5.

1. Internal reimbursement data on file Jan 2019 - Apr 2021.

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melissa thompson

Melissa Thompson, MS

Melissa Thompson is a Product Manager at Cochlear Americas, focusing on product marketing, product analysis, brand management, and sales experience for Cochlear™ Baha® Systems.  Melissa joined Cochlear in 2017 and has a Masters in Information & Communications Technology from the University of Denver.



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