"I wish all the information about insurance payment for cochlear implants could be found in one place."
This comment is often heard from cochlear implant candidates and users. And that is the goal of this website. To provide individuals with a free resource for questions about third-party health insurance reimbursement for cochlear implants and related services.
It is a privately-maintained site and serves no commercial purpose. The owners receive no compensation of any kind from manufacturers or providers. We are simply trying to establish a consumer service that the cochlear implant industry is not willing to provide.
The information and views provided on this website are solely those of the owners or authorized contributors. All questions relating to the maintenance of this website should be addressed to destin@cochlear.org.
Coverage and Payment for Cochlear Implants
Most third-party health insurance health plans now provide some level of benefits for cochlear implants. This has not always been the case. Both coverage and payment have greatly improved in the past 5-7 years.
This improvement mostly resulted from better understanding of the costs and outcomes of cochlear implants, and the application of the Americans with Disabilities Act and other laws.
However, research by RAND Corporation confirms that low payments for all cochlear implant services continue to prevent certain individuals from taking advantage of this near-miraculous technology. Out of roughly 160 to 260 persons per 100,000 in the United States with severe to profound hearing loss, only 2-3 persons per every 100,000 have actually been implanted (click here for more information.)
One of out of every ten congenitally deafened children currently are implanted, according to the Atlantic Coast Ear Specialists. This number should eventually be one out of three if barriers to access can be removed.
Commercial health plans, such as Aetna, Blue Cross and Blue Shield, and Prudential continue to be the best payers for cochlear implants. Managed care plans, especially HMOs, remain among the most restrictive.
The Project Hope Center for Health Affairs estimates that 71 percent of cochlear implant candidates and users are covered under a Federal or State health plan, such as Medicare, Medicaid, Veterans Administration, or Vocational Rehabilitation. RAND demonstrated that reimbursement under these plans are often so low that they fail to cover the costs for cochlear implant services--especially the post-operative aural rehabilitation services that are so critical to the effectiveness of the procedure.
In fact, RAND estimates that centers lose at least $6,000 every time they simply purchase a cochlear implant device from the manufacturer. These losses will only increase as the manufacturer costs for new generation devices skyrocket. In fact, Wisconsin Medicaid data shows that cochlear implants are often the most expensive procedure covered by Medicaid programs. Average total charges for cochlear implant procedure under Wisconsin Medicaid shot up 68 percent between 1999 and 2000 to over $62,000.
These dramatic cost increases and continued low reimbursement (combined with the monopolistic practices in the cochlear implant market) create a financial disincentive to perform cochlear implants for most physicians and audiologists. As a result, centers that currently provide cochlear implants are concentrated in large, urban areas among hospitals that can afford significant financial losses. For many cochlear implant users, this means they have to travel great distances several times a year to undergo the surgery and lengthy aural rehabilitation.
Despite the expense, cochlear implants rank among the most cost-effective medical technologies. Studies by Johns Hopkins University and the University of California-San Diego (both funded by Cochlear Americas) show that cochlear implants can result in a net savings to society of over $53,000 per child, compared to the average expected lifetime cost of prelingual, profound hearing loss at over $1 million.
The worldwide market for cochlear implants is estimated at well over $200 million. Over two of every three implants are still sold by a single company, Cochlear Limited (or Cochlear Americas in the U.S.), that reaps over $85 million in annual profit according to 2007 filings on the Australian Stock Exchange.
However, despite such enormous profit from selling roughly 16,000 units of a single product, Cochlear does little to improve the low levels of reimbursement and lack of comprehensive access to cochlear implants in the U.S. Cochlear refuses to lower its roughly $25,000 price tag for the device in order to expand access, nor does not share in the huge financial losses that physicians and audiologists must absorb in order to restore hearing to thousands of near totally deafened individuals. And Cochlear donates only about two devices per year for who lack adequate health insurance to access their miraculous technology, after refusing to do so for several years.
In fact, Cochlear policies are designed specifically to drive down competition and maintain barriers to access for cochlear implants. Cochlear continues to control the referral patterns of physicians and actually punish those that refer patients to competitors.
The information provided on this website is intended to help cochlear implant consumers overcome some of these barriers to access, and ensure that the invaluable benefits of hearing are available to everyone.
