ORS 743A.140 Bilateral cochlear implants

A health benefit plan, as defined in ORS 743B.005, shall reimburse the cost of:

Bilateral cochlear implants if medically appropriate for the treatment of hearing loss; and

The fitting, programming and reprogramming of bilateral or unilateral cochlear implants or other assistive listening devices performed by licensed audiologists.

For purposes of ORS 746.230, a reasonable investigation of a claim for bilateral cochlear implants must include a request to the treating surgeon for a written recommendation based on peer-reviewed medical literature and for the medical findings that support the recommendation.

A health benefit plan shall reimburse the cost of repair and replacement parts for a cochlear implant if the repair or parts are not covered by a warranty and are necessary for the device to be functional for the user.

A health benefit plan shall reimburse the costs described in this section when prescribed by a licensed health professional even if over-the-counter items and services are available without a prescription.

An adverse determination on a claim for coverage under this section must include a prominent notice to the enrollee of the enrollee’s rights to file grievances and request appeals and reviews under ORS 743B.250 and must provide a toll-free telephone number or chat line for enrollees to seek assistance in contesting the denial of or limitation on coverage.

Coverage under this section may not be subject to a deductible, except as provided in ORS 742.008.

The provisions of this section are exempt from ORS 743A.001.