Alberta Health. AADL Approved Products List Hearing Aids, Bone Anchored Hearing Devices and Cochlear Implants Pricing effective April 1, 2016

Transcription

1 Alberta Health Approved Products List Hearing Aids, Bone Anchored Hearing Devices and Cochlear Implants Pricing effective Cost Share Seniors and Adult Dependents of Seniors... APL H-1 Cost Share Exempt Seniors and Adult Dependents of Seniors... APL H-3 Cost Share Exempt Adults... APL H-5 Eligible Full Time Students 18 to 24 Years... APL H-7 Children Under 18 Years... APL H-9 Bone Anchored Hearing Devices... APL H-11 Cochlear Implants... APL H-12

2 SCHEDULE A PAYMENT TERMS COST SHARE Seniors and Adult Dependents of Seniors (subject to cost-sharing 75% - Client 25%) PRICE - CANADIAN DOLLARS H048 Return Fee $150 Cannot be billed if device not trialed 1 H009 H010 H021 H011 H012 H013 H019 H022 H023 High power BTE hearing aid (HFA FOG 60 db) Behind-the-ear hearing aid Receiver In the Canal hearing aid In-the-ear hearing aid Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 3 Bi-CROS hearing aid 3 $1,200 If Specialty Supplier's advertised price is less than maximum, advertised price is then cost-shared. 2 H024 CROS/Bi-CROS microphone Manufacturer s invoice cost up to a maximum of $ H375 Assistive listening device (may only be substituted for a conventional hearing aid with Program Manager prior approval) Manufacturer s invoice cost + $100 for fitting and follow-up services. H030 Earmold (new or replacement) (not paid with H011) Manufacturer's invoice cost up to a maximum of $70 H035 Service fee for replacement earmold (not within 12 mo. of HA fitting) $40 4 H051 In-house receiver repair for a Receiver in the Canal (RIC) hearing aid. Applicable only to aid(s) registered with the program and only after the original purchase warranty on the receiver has expired. 1/yr $60 H072 Service fee for in-house RIC repair only after the original purchase warranty on the receiver has expired. 1/yr $30 5 H040 Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the Program and only after the original purchase warranty has expired. $300 6 H045 Service fee for major repair only after one year past the instrument billing date. $70 5,6 APL H-1

3 H055 Replacement bone conduction receivers for bone conduction hearing aids. Applicable only after one year past instrument billing date. Manufacturer's invoice cost up to $100 H056 Cords for CROS/Bi-CROS, body type hearing aids (audio input cords excluded) Manufacturer's invoice cost up to $30 H057 Air conduction receivers for body type hearing aids Manufacturer's invoice cost up to $25 1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is permitted. 2. Flat rate fee includes assessment, cost of instrument and service fee. Clients may choose a higher priced instrument (upgrade) but an appropriate basic entry level technology hearing aid must be offered at the maximum price. 3. H022 (CROS hearing aid) or H023 (Bi-CROS hearing aid) will always be billed in conjunction with a H024 (CROS/Bi-CROS microphone). 4. The service fee of $40 is available to all Clients who are having their earmold replaced after 1 year of use. No extra billing on fees is permitted. 5. The service fee on repairs is available to all Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to Clients of all ages. 6. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes. To calculate the exchange rate on U.S. dollars, use the rate on the first day of the month that the invoice is dated and round it to the nearest.01 Please note Seniors and Adult Dependents of Seniors who have maxed out their annual cost-share contribution of $ are eligible for $1,200 towards one (1) hearing aid from category numbers H009 H023. APL H-2

4 PAYMENT TERMS COST SHARE EXEMPT Seniors and Adult Dependents of Seniors PRICE - CANADIAN DOLLARS H448 Return Fee 1 per affected ear/5 years H409 H410 H411 H421 H412 H413 H419 H422 H423 H424 H475 H430 High power BTE hearing aid (HFA FOG 60 db) Behind-the-ear hearing aid In-the-ear hearing aid Receiver In the Canal hearing aid Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 3 Bi-CROS hearing aid 3 CROS/Bi-CROS microphone Assistive listening device (may only be substituted for a conventional hearing aid with Program Manager prior approval) Earmold (new or replacement) (not paid with H411) 1 per affected ear/5 years $150 Cannot be billed if device is not trialed 1 $ maximum per aid, or if Specialty Supplier's advertised price is less than $1200, advertised price is then billed to. 2 Manufacturer s invoice cost up to a maximum of $700 3 Manufacturer s invoice cost + $100 for fitting and follow-up services. per ear Manufacturer's invoice cost up to a maximum of $70 H435 Service fee for replacement earmold (not within 12 mo. of HA fitting) per ear $40 4 H451 H472 In-house receiver repair for a Receiver in the Canal (RIC) hearing aid. Applicable only to aid(s) registered with the program and only after the original purchase warranty on the receiver has expired. Service fee for in-house RIC repair only after the original purchase warranty on the receiver has expired. per ear per ear $60 $30 5 H440 Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the Program and only after the original purchase warranty has expired. per ear $300 6 APL H-3

5 H445 Service fee for major repair only after one year past the instrument billing date. per ear $70 5,6 H455 Replacement bone conduction receivers for bone conduction hearing aids. Applicable only after one year past instrument billing date. Manufacturer's invoice cost up to $100 H456 Cords for CROS/Bi-CROS, body type hearing aids (audio input cords excluded) Manufacturer's invoice cost up to $30 H457 Air conduction receivers for body type hearing aids Manufacturer's invoice cost up to $25 1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is permitted. 2. Flat rate fee includes assessment, cost of instrument and service fee. Clients may choose a higher priced instrument (upgrade) but an appropriate basic entry level technology hearing aid must be offered at the maximum price. 3. H022 (CROS hearing aid) or H023 (Bi-CROS hearing aid) will always be billed in conjunction with a H024 (CROS/Bi-CROS microphone). 4. The service fee of $40 is available to all Clients who are having their earmold replaced after 1 year of use. No extra billing on fees is permitted. 5. The service fee on repairs is available to all Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to Clients of all ages. 6. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes. To calculate the exchange rate on U.S. dollars, use the rate on the first day of the month that the invoice is dated and round it to the nearest.01 APL H-4

6 PAYMENT TERMS COST SHARE EXEMPT Adults *(18 to 64) covered by the Program PRICE CANADIAN DOLLARS H748 Return Fee 1per affected ear/5 years H709 H710 H711 H721 H712 H713 H719 H722 H723 High power BTE hearing aid (HFA FOG 60 db) Behind-the-ear hearing aid In-the-ear hearing aid Receiver In the Canal hearing aid Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 3 Bi-CROS hearing aid 3 1per affected ear/5 years $150 Cannot be billed unless device trialed and returned 1 $1,200 maximum per aid, or if Specialty Supplier's advertised price is less than $1,200 advertised price is then billed to. 2 H724 H775 H730 H735 CROS/Bi-CROS microphone Assistive listening device (may only be substituted for a conventional hearing aid with Program Manager prior approval) Earmold (new or replacement) (not paid with H711) Service fee for replacement earmold (not within 12 mo. of HA fitting) Manufacturer s invoice cost up to maximum of $700 3 Manufacturer s invoice cost + $100 for fitting and follow-up services. per ear Manufacturer's invoice cost up to a maximum of $70 per ear $40 4 H751 In-house receiver repair for a Receiver in the Canal (RIC) hearing aid. Applicable only to aid(s) registered with the program and only after the original purchase warranty on the receiver has expired. per ear $60 H772 Service fee for in-house RIC repair only after the original purchase warranty on the receiver has expired. per ear $30 5 H740 Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the Program per ear $300 6 APL H-5

7 and only after the original purchase warranty has expired. H745 H755 Service fee for major repair only after one year past the instrument billing date. per ear $70 5,6 Replacement bone conduction receivers for bone conduction hearing aids. Manufacturer's invoice cost up to $100 Applicable only after one year past instrument billing date. H756 Cords for CROS/Bi-CROS, body type hearing aids (audio input cords excluded) Manufacturer's invoice cost up to $30 H757 Air conduction receivers for body type hearing aids Manufacturer's invoice cost up to $25 1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is permitted. 2. Flat rate fee includes assessment, cost of instrument and service fee. Clients may choose a higher priced instrument (upgrade) but an appropriate basic entry level technology hearing aid must be offered at the maximum price. 3. H022 (CROS hearing aid) or H023 (Bi-CROS hearing aid) will always be billed in conjunction with a H024 (CROS/Bi-CROS microphone). 4. The service fee of $40 is available to all Clients who are having their earmold replaced after 1 year of use. No extra billing on fees is permitted. 5. The service fee on repairs is available to all Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to Clients of all ages. 6. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes. To calculate the exchange rate on U.S. dollars, use the rate on the first day of the month that the invoice is dated and round it to the nearest.01 *Cost-share exempt adults (18-64) include clients on AISH and EI programs, and clients who qualify for cost-share exemption based on s cost-share policy income thresholds. *Cost-share adults (18-64) who have maxed out their annual cost-share contribution of $500, through the receipt of other benefits are not eligible for hearing aid benefits. APL H-6

8 H714 H748 H709 H710 H711 H721 PAYMENT TERMS Eligible Full Time Students 18 to 24 Years (subject to cost-sharing 75% - Client 25%) PRICE - CANADIAN DOLLARS Hearing Assessment (only billed with hearing aid) Return Fee (cannot be billed unless device trialed and returned) High power BTE hearing aid (HFA FOG 60 db) Behind-the-ear hearing aid In-the-ear hearing aid Receiver In the Canal hearing aid 1 per affected ear/5 years 1 per affected ear/5 years $75 (AHS sites cannot bill) $150 1 H712 H713 H719 H722 H723 Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 2 Bi-CROS hearing aid 2 Manufacturer's unit invoice cost up to $650 H724 CROS/Bi-CROS microphone Manufacturer s invoice cost up to a maximum of $700 2 H715 General Service Fee $600 H720 Service Fee for Second Aid of a Binaural Fitting (not paid with H722, H723) $600 H730 H735 Earmold (new or replacement) (not paid with H711) Service fee for replacement earmold (not within 12 mo. of HA fitting) per ear per ear Manufacturer's invoice cost up to a maximum of $70 $40 3 H751 In-house receiver repair for a Receiver in the Canal (RIC) hearing aid. Applicable only to aid(s) registered with the program and only after the original purchase warranty on the receiver has expired. per ear $60 H772 H740 Service fee for in-house RIC repair only after the original purchase warranty on the receiver has expired. Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the Program and only after original purchase warranty has expired. per ear $30 4 /per aid Manufacturer's invoice to a max. of $300 5 APL H-7

9 H745 Service fee for major repair only after 1 year past the instrument billing date. /per aid $70 4,5 H755 H756 H757 Replacement bone conduction receivers for bone conduction hearing aids. Applicable only after one year from instrument billing date. Cords for CROS/Bi-CROS, body type hearing aid (audio input cords excluded) Air conduction receivers for body type hearing aids PRICE - CANADIAN DOLLARS Manufacturer's invoice cost up to $100 Manufacturer's invoice cost up to $30 Manufacturer's invoice cost up to $25 H700 H725 H705 H750 H760 Frequency Modulation (FM) or Digital Modulation (DM) System FM/DM Fitting Fee Major Repair to FM/DM (Same conditions as H740) Service Fee for major FM/DM repairs (Same conditions as H745) FM/DM Return Fee (cannot be billed unless device trialed and returned) 1/yr per component to maximum of 3/year 1/yr per component to maximum of 3/year Manufacturer's invoice cost up to $1,900 $450 Manufacturer's invoice to a max. of $300 $70 $75 1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is permitted. 2. H722 (CROS hearing aid) or H723 (Bi-CROS hearing aid) will always be billed in conjunction with H724 (CROS/Bi-CROS microphone). 3. The service fee of $40 is available to all Clients who are having their earmold replaced after 1 year of use. No extra billing on fees is permitted. 4. The service fee on repairs is available to all Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to Clients of all ages. 5. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes. To calculate the exchange rate on U.S. dollars, use the rate on the first day of the month that the invoice is dated and round it to the nearest.01 APL H-8

10 H108 H148 H109 H110 H111 H121 PAYMENT TERMS Children under 18 Years (subject to cost-sharing 75% - Client 25%) PRICE - CANADIAN DOLLARS Hearing Assessment (cannot be billed unless device trialed and/or returned) Return Fee (cannot be billed unless device trialed and returned) High power BTE hearing aid (HFA FOG 60 db) Behind-the-ear hearing aid In-the-ear hearing aid Receiver In the Canal hearing aid 1 per affected ear/5 years 2/5 years - binaural $75 (AHS sites cannot bill) $150 1 Manufacturer's unit invoice cost up to $650 H112 H113 H119 H122 H123 Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 2 Bi-CROS hearing aid 2 - monaural H124 CROS/Bi-CROS microphone Manufacturer s invoice cost up to a maximum of $700 2 H115 General Service Fee $600 H120 Service Fee for Second Aid of a Binaural Fitting (not paid with H122, H123) $600 H126 H128 H151 Earmold (new or replacement) (not paid with H111) Service fee for replacement earmold (not with a new HA fitting) In-house receiver repair for a Receiver in the Canal (RIC) hearing aid. Applicable only to aid(s) registered with the program and only after the original purchase warranty on the receiver has expired. 1 every 3 months per ear (0-3 yrs of age) 1 every 6 months per ear (4-17 yrs of age) 1 every 3 months per ear (0-3 yrs of age) 1 every 6 months per ear (4-17 yrs of age) per ear Manufacturer's invoice cost up to $70 $40 3 $60 APL H-9

11 PRICE - CANADIAN DOLLARS H172 H140 H145 H155 H156 H157 H500 H515 H550 H555 H560 Service fee for in-house RIC repair only after the original purchase warranty on the receiver has expired. Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the Program and only after original purchase warranty has expired. Service fee for major repair only after 1 year past the instrument billing date. Replacement bone conduction receivers for bone conduction hearing aids. Applicable only after one year from instrument billing date. Cords for CROS/Bi-CROS, body type hearing aid (audio input cords excluded) Air conduction receivers for body type hearing aids Frequency Modulation (FM) or Digital Modulation (DM) System FM/DM Fitting Fee Major Repair to FM/DM (Same conditions as H140) Service Fee for major FM/DM repairs (Same conditions as H145) FM/DM Return Fee (cannot be billed unless device trialed and returned) per ear $30 4 / aid / aid 1/yr per component to maximum of 3/year 1/yr per component to maximum of 3/year Manufacturer's invoice to a max. of $300 5 $70 4,5 Manufacturer's invoice cost up to $100 Manufacturer's invoice cost up to $30 Manufacturer's invoice cost up to $25 Manufacturer's invoice cost up to $1,900 $450 Manufacturer's invoice to a max. of $300 $70 $75 1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is permitted. 2. H722 (CROS hearing aid) or H723 (Bi-CROS hearing aid) will always be billed in conjunction with H724 (CROS/Bi-CROS microphone). 3. The service fee of $40 is available to all Clients who are having their earmold replaced after 1 year of use. No extra billing on fees is permitted. 4. The service fee on repairs is available to all Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to Clients of all ages. 5. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes. To calculate the exchange rate on U.S. dollars, use the rate on the first day of the month that the invoice is dated and round it to the nearest.01 APL H-10

12 SCHEDULE A BONE ANCHORED HEARING DEVICES APPROVED PRODUCT LIST EFFECTIVE JULY 1, 2013 Subject to COST SHARE MANUFACTURER S MAXIMUM INVOICE COST H900 Bone Anchored Hearing Device 1/6 years per affected ear $4, ,2 H910 Bone Anchored hearing Device Repair 1 per year per affected ear $ Bone Anchored Hearing Device with Softband - Maximum funding - $ Bone Anchored Hearing Device - Maximum funding - $3850 Cost-share clients are responsible for $500 cost share portion, as well as any portion over and above maximum. APL H-11

13 SCHEDULE A COCHLEAR IMPLANTS APPROVED PRODUCT LIST EFFECTIVE JULY 1, 2014 Subject to COST SHARE MANUFACTURER S MAXIMUM INVOICE COST H800 Cochlear Implant External Processor 1/7 years per affected ear $10, H810 Cochlear Implant Repairs 1 per year per affected ear $2, Cost-share clients are responsible for $500 cost share portion, as well as any portion over and above maximum. APL H-12