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  Tennessee Medicaid (TennCare)

email: reimburse@cochlear.org




TennCare is the statewide Medicaid demonstration project for Tennessee. Since 1993, the Federal government has permitted Tennessee to enroll nearly all of its Medicaid beneficiaries in managed care plans.

BCBS Tennessee is the largest TennCare plan, at one time enrolling over 80 percent of beneficiaries. It also was among the worst paying of any private or public plan, reimbursing less than $5,000 for the entire cochlear implant procedure.

In 1995, Mark Hobratschk of Cochlear Corporation met with the TennCare Director to advocate for increased payment levels that did not force Tennessee centers to lose over $25,000 for a Medicaid surgery. He objected to TennCare's tying arrangement with BCBS Tennessee that required any center that did cochlear implants for BCBS' private plan patients to automatically accept their TennCare patients. This caused the vast majority of TennCare patients to be enrolled in BCBS versus other TennCare plans.

Since that time, TennCare payment has improved signficantly. In 2001, TennCare paid $14,499.58 for the cochlear implant device and $6,281.98 for replacement of the speech processor. These amounts are roughly comparable to Medicare Part B fee schedule payments for cochlear implants.

However, TennCare generally still does not cover cochlear implant services for adults. For existing users, it has covered repair and replacement of speech processors.

Please click here for e-mail documenting that Cochlear Corporation knowingly inflated their invoice price for replacement speech processors in order to receive a higher payment than that which was owed them by TennCare.