If you have cochlear implants included in your policy cover, your health fund is required by law to cover 100% of the cost of the implant(s) and sound processor(s). Therefore, understanding your health fund policy is vital. Some private health funds will include cochlear implants in their basic hospital cover, and some won’t. Upgrading your policy to include cochlear implants may incur a waiting period before a claim can be made, but if you already had comprehensive cover you should be able to switch to a lower level of cover and not have to wait. This is something you should check with your health fund. Cochlear implants are covered under implantable prostheses, which is different from the type of cover applied to hearing aids. It’s therefore important to check your health fund policy if you think that a cochlear implant is something you might need in the future. When checking with your health fund you need to ask three basic questions:
1. Will my insurance cover the total cost of one or two cochlear implants?
2. Will my insurance cover the total cost of subsequent upgrading of my external components (sound processors)?
3. If so, how often am I eligible for an upgrade? Down the track, some health funds will only cover partial payment of an upgrade to your sound processor, and some private audiology clinics may ask you to make a payment for your appointments.
Some manufacturers work very closely with the health insurance industry and with various health funds, to ensure that you receive the best entitlements possible when claiming for cochlear implant surgery and device upgrades. Your cochlear implant clinician may call upon the experts within the industry to enlist support and advocate on your behalf. But remember – please check the fine print and the product disclosure statement. You have a cooling off period when you enrol in a health fund or make changes to your existing policy, so please check everything and take the appropriate action if required. If you do have private health insurance cover for cochlear implants and go through a non-profit cochlear implant clinic that doesn’t charge a gap fee, you will not pay a single cent in out-of-pocket expenses.