Did you say Hearing Aid Insurance Coverage?

Third party administrators are not transparent and the greed is taking over

How are things in the world of Hearing Healthcare?

I just wanted to take a moment to talk to those of you who are interested in this topic.  2022 was a significant year for many reasons.  The Build Back Better (BBB) Bill passed the House, but not the Senate.  Over-the-Counter (OTC) hearing aids made their debut in October, 2022.  Let’s look at these more closely, so that you can understand why we are doing at Hears, Hearing &Hearables is so important.

You will recall that the Build Back Better (BBB) Bill had several provisions that would have made a big difference to those who care about hearing.  A few high points would have been adding services to an audiologist to their list of covered services, categorize hearing aids as a prosthetic device, and add coverage for hearing aids once every five years.  Unfortunately, these provisions were not put into action because the bill did not pass. 

This means that hearing aids are still not covered by Medicare or by Medigap supplemental plans. 

Medigap plans (supplemental insurance) are those meant to help pay for costs not covered by Medicare (like your copays).  However, if Medicare does not pay for the service, then Medigap supplement doesn’t either.  People then hear and turn to look at Medicare Part C plans; also known as Medicare Advantage Plans.  The services these plans provide and their costs vary widely.  Not only do they vary by insurance company but they vary from plan to plan.  The average cost for these plan is over $50/month.

Many Medicare Part C plans use a Third Party Administrator (TPA) to take on the administrative burden usually done by HR or a finance team; ie:  enrollment, insurance claims, reimbursement, record-keeping etc.  Within hearing health care, they negotiate discounts, coverage, and benefits with the manufacturers.  These plans ask Audiologists and hearing aid dispensers to sign up to be a provider.  The third party administrator refer their “members” to registered, in-network providers.  For instance, Aetna’s Medicare plans use NationsHearing while Anthem Blue Cross plans use TruHearing.  UnitedHealth Care owns their own TPA and has some kind of contract with a manufacturer. As we have discussed in other blogs, these types of plans can severely limit your options.  They are often sold to you as a benefit, but what you receive is a discounted hearing aid. 

What is also difficult to discern is who owns these TPAs?  Some of these are owned by insurance companies along with hearing aid manufacturers.  When you go to these providers, you are sometimes asked which level of technology you would like; not between hearing aid manufacturers or models of hearing aid.  It is not true that one hearing aid sounds the same as another, just like any other product choice, they are all a bit different.  And sadly the choice of the hearing aid product has already been made.  The plan has also already decided how many visits they will cover to your network provider.  Choices and transparency are no where to be found.

The Over-the-Counter hearing aid is still a new product.  

Several came available in October, with more coming out each month.  Few articles have been written about the impact of OTC aids on users and the market; it is early days yet.  More research is coming and we will let you know more as we learn more.

While I know that many House members and their Senate colleagues worked hard to pass the BBB Bill, they were unsuccessful.  Having OTC aids available should not stop us from writing our Congressmen to ask for better hearing aid coverage within Medicare.  Yes, it will increase government spending.  However, I cannot help but think that the increased cost to Medicare would be outweighed by the cost savings if people were able to get hearing aids when they were needed.  It has long been shown that preventive care is less expensive than care required when treatment is delayed; pro-active care is less expensive than reactive care.

Hears Hearing & Hearables was created to provide accessible and affordable products and services. 

We also had in mind to create a company with a network that is not owned by a manufacturer or a hearing aid vendor manufacturer.  We don’t want to have a conflict of interest and we want to provide the most transparent services.  Not only are we trying to help the customer, we are also trying to help the audiologist or the hearing care professional to earn a decent fee for the work they do to help the client hear better.  The TPA model gives a little fee to the “in-network” provider if and only if the hearing aid(s) are not returned. The providers do not make money if the customer returns the aid even after all their work.  It is true that if you are pushed a product, you the consumer, may not like the aid and rightfully so should return the hearing aid.  But it isn’t the fault of the provider in this case, who can not offer you anything else for fear of a bait and switch.  And after all the providers work, they do not earn their fee.  

I know some customers are looking for the least expensive option for them to hear.  This search for the “cheapest” hearing aid that you can find is part of the problem. Because of this search, these TPAs have set up to offer the most discounted hearing aids they can possibly negotiate.  This is coming at a cost not only to the customer because of the lack of transparency but also significantly impacting audiologists and hearing care providers around the United States.  Clinicians need to have a decent wage.  We, the people in the US have been talking about increasing minimum wage so people can make a decent living.  The field of audiology is hurting because of these low paid service fees. 

We also believe there are anti-trust laws being broken in this field.  

The unfair competitive act states the following:  “Generally, unfair competition consists of two elements: First, there is some sort of economic injury to a business, such as loss of sales or consumer goodwill. Second, this economic injury is the result of deceptive or otherwise wrongful business practices.”   Let us break this down for you.  The economic injury is hurting the private practice, ENT and other independent hearing professionals.  The consumer is wanting the lowest cost hearing aid they can find, thinking that it is a benefit, which is a deceptive practice from these advantage plans.  I believe all the Medicare advantage plan wants is your monthly premiums.   

These above points explains why we are trying to do what we do at Hears, Hearing, & Hearables.  

First of all, we are not owned by an insurance company or a hearing aid manufacturer.  We offer all styles of hearing aids and hearables with our prices listed on the website.  We carry OTC hearing  aids for those people who have a mild hearing loss and just want a little hearing help. You know exactly how much everything will cost.  We offer competitive FAIR pricing; payment plans are available.  Keeping in mind, it is possible that a pair of hearing aids will cost what you pay in monthly premiums; depending on the level of technology you want.  

We also are supporting our fellow peers.   

We are offering them a service fee, revealed to you so that you know how much their fee is and how much the product costs.  We call this an unbundled model so that you, the customer, can see the fees and get what you need, and what you can afford.  Then we will help you find a provider near you, if we don’t have someone near you in our network, that will accept fees for service at a fair and reasonable cost to our customer.  Sometimes we may not find a provider near you.  Many of the independent providers are already gone.  Sadly some providers do not understand what we are trying to do and don’t want another TPA.  We are different I tell them. I too don’t want another TPA.  You will get paid for your time and your service fees are non refundable.  Service rendered is non refundable just like any other service industry, like a chiropractor, a physical therapist and even a dentist.  Why should service to audiology and hearing instrument dispensers be any different.  Often audiologists and service providers bundle their fees in the cost of the hearing aid.  The fees are too much for what many people need.  We get it and support a transparent unbundled model.  We also get that the provider needs to be paid and not part of a bundle.   

Until Medicare covers hearing aids or the congress people figure out that these TPA are creating a monopoly and hurting other businesses, we will try and do the best we can for the customer and the provider.  We hope you all will understand and will support the mission.  Walk the walk with us as they say to support the hard workers instead of the greed by our broken health care system.

Please join us and write your Congressmen.  Medicare needs to address all the needs of an aging population and the clinicians that serve them .  We are hopeful.  

by Karen, edited by Kim 

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