OMS Insurance Support

Otologic Management Services. OMS provides prospective candidates with insurance preauthorization and verification support at no charge for CI and Baha devices and related procedures. OMS also helps patients appeal denials for coverage. It does include bilateral implantation for both CI and Baha. It is not specific to Cochlear America products.

OMS Insurance Support can help you file an appeal to your insurance company.

Cochlear America’s Otologic Management Services
OMS@cochlear.com
13059 East Peakview Avenue
Centennial, CO 80111
(800) 633-4667 phone
(303) 524-6765 fax

You can call your insurance company directly or OMS Insurance Support can help you navigate the pre-authorization and verification process.

1. Verify Benefits
1. Determine level of benefit payment (deductible & co-pay amounts)
2. Check for pre-existing
3. Is pre-certification required?
2. Verify correct address and/or fax # to send predetermination
3. Submit description of procedure
1. Billing codes
2. Medical documentation

1. Audiogram
2. Patient history
3. CT scan

4. Follow Up
1. Contact insurance company within 10 business days to check status of review
2. Obtain approval in writing
3. If denied, submit appeal
5. Review denial reason – obtain written denial
6. Verify denial reason in benefit book
7. Write appeal letter
1. Based on denial reason
2. Include additional information

• FDA approval
• Additional testing
• Articles

Candidates can contact OMS at any time in the process.

Once you call OMS Insurance Support they will inform you of the necessary information required.

Each insurance company operates differently, so timing is very much a case-by-case basis. Generally 4-6 weeks.

The service is free of charge.

No. OMS Insurance does partner with its outside law firm to help provide patient advocacy services during the appeal process, but neither OMS Insurance Support nor the law firm can represent a candidate in a lawsuit.

Over the past year, OMS Insurance Support is proud to have achieved a consistently high success rate in obtaining coverage for unilateral cochlear implant, bilateral cochlear implants, and Baha.

OMS expects to handle over 600 cases this year.

The OMS Insurance Support team is comprised of insurance experts and reimbursement specialists who have all worked for insurance companies in the past. They have in depth knowledge of the best ways to navigate the insurance industry.

If necessary, OMS also involves its external legal counsel, to assist in coverage appeals.

Yes, it is a specialized unit of their Reimbursement Department.

Cochlear Americas has offered preauthorization services since 1988.

You will need to see an audiologist to first learn if you indeed are a candidate for a Baha or cochlear implant. You can find a clinic at www.cochlear.com.

No, OMS Insurance Support is for candidates of Baha or cochlear implant devices only.

Reimbursement handles billing services for Medicare and Medicaid, and (on a much more limited scale) commercial plan agreements. OMS handles preauthorization and benefit verification services.