(upbeat music) – We want you to Hear now. And always Occasionally, insurance providers deny coverage for claims submitted, it’s rare but this can happen to a claim for a Cochlear product. In case that happens, we’ve outlined common reasons for denials and the various appeal levels. You may want to ask your insurance provider if there are any out-of-pocket costs. Some plans have annual or lifetime limits on hearing benefits and durable medical equipment, also known as DMEs, that may impact what is covered. Knowing what your plan offers should help avoid a denial. Unfortunately, there still may be a situation when insurance denies coverage. To prepare for the appeal process, it may be helpful to know the five most common reasons for denials. One, the requested equipment is listed as non-covered under the terms of your insurance plan. Two, the equipment may be covered, but only under certain circumstances. For example, you may be required to use a physician that is in-network. Three, your physician is requesting equipment using technology that your insurance plan considers to be an experimental or investigational procedure. Four, your insurance plan determined the equipment being requested is not medically necessary, based on the diagnosis and medical documentation that was submitted. And five, your insurance plan misunderstands the technology and denies it. If you receive a denial for one of our products, we recommend following the appeals process that your insurance provider outlines. You can find your plan’s step-by-step instructions in your benefits handbook, or you can give your insurance provider a call. To help you navigate the process, it’s helpful to know the various levels of appeals. Usually, there are three levels. A first level appeal is typically reviewed by your plan’s appeals department and possibly the medical director. Second level appeals are reviewed by medical directors and the appeals department staff that were not involved in the original denial. Third level appeals are usually completed by an independent reviewer. A physician who is board certified in the same specialty as the requesting physician is asked to review. At this level, you can be charged for this service, but it’s rare. Now that you are equipped with information about common reasons for denials and how to appeal a denial, we truly hope that it’s smooth sailing from here. And of course, that you hear now and always. Please keep in mind that if you choose to self-pay for an item generally covered by insurance, you may not be able to submit a claim on your own if Cochlear is contracted with your private insurance provider. Please visit us here to see if we are contracted with your insurance provider. If we are contracted with your insurance provider, we suggest placing your order through Cochlear’s reimbursement and insurance services. If you seek reimbursement on your own, you will be solely responsible for any amounts to include contractual or discounted payments that your insurance provider does not cover. (upbeat music)