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Federal Blue Cross/Blue Shield Agrees to Reimburse Audiologists


We (Audiology Online) thank the Academy of Dispensing Audiologists for allowing us to reprint their ADAlert (originally dated October 11, 2000) here.

The American Academy of Audiology (AAA) placed federal employees'
reimbursement of audiologic services in the forefront of its legislative
agenda in 1996. Previously, federal insurers did not recognize audiology as
a profession that could bill for its own services. This interpretation of
federal statute by insurance carriers has frustrated both audiologists and
federal employees since the advent of independent audiologic care. The lack
of reimbursement extends to the late 1970's when a number of health
professions were specifically mentioned in the Federal statute to receive
reimbursement.

Since audiology was not included with the listed professionals, insurance carriers interpreted this 'omission' as an 'exclusion'. In 1996, AAA proposed legislation sponsored by Congressman Benjamin Gillman of New York to include audiologists as reimbursable providers for the Federal Employees Health Benefit Plan (FEHBP). This bill, HR 176, was not passed in the 104th Congress even though it attracted 34 co-sponsors. Consequently, the bill was reintroduced in the 105th Congress in 1997. Following a two year legislative effort, HR 1836 was passed and signed into law in October of 1998. This legislation became Public Law 105-266. The original legislation simply added the word 'audiologist' to the list of reimbursable providers. However, Congressman John L. Mica (R-FL), chairman of the Civil Service Subcommittee, refused to include additional professions in the current statute. Consequently, AAA agreed to compromise language. This language stated that, 'Nothing in this subsection shall be considered to preclude a health benefits plan from providing direct access or direct payment or reimbursement to a provider in a health care practice or profession ...if such provider is licensed or certified as such under Federal or State law'.

Thus, the statute did not mandate reimbursement for audiologists as it did
for other health care providers, but rather provided an opportunity for the
Federal Employees Health Care Program (FEBHP) to make use of direct access of audiologic services. Without mandated provider language, the next step was for the profession to market its services directly to the federal
insurance carriers. The federal carriers, thirteen in total, needed to
appreciate the cost-effectiveness of direct audiologic care.

The Academy of Dispensing Audiologists(r) (ADA), in conjunction with the
American Academy of Audiology, held a series of meetings with a number of
the federal insurance carriers over the past two years. Carriers annually
develop new plans for approval by the Office of Personnel Management (OPM), the regulatory agency for the federal insurance carriers. These plans are initially requested by OPM in March and the carriers must submit their
proposed plans by June. The carriers then receive feedback from OPM
concerning their proposals and the final plan is accepted by August that
will be effective on January 1st. The American Academy of Audiology and the
Academy of Dispensing Audiologists (ADA) are pleased to announce that
Federal Blue Cross/Blue Shield has agreed to reimburse audiologists for
direct care services effective January 1, 2001.

Blue Cross/Blue Shield maintains the largest percentage of federal employees with its coverage approaching 75% of all federal employees. This announcement represents the culmination of a four-year effort. The recognition by OPM and FEBHP as a provider of direct care services is a major achievement in our profession's history. A profession's autonomous practice is based upon independent reimbursement. The Federal Employee Benefit Health Plan was the largest insurance group that previously failed to recognize direct care audiology services.

The results of a Virginia State Senate report that outlined the
cost-effectiveness of direct audiologic care proved to be a persuasive
document in the effort to receive recognition from Blue Cross and Blue
Shield. This report compared Blue/Cross Blue Shield costs both before and after the addition of direct care audiology services and found that there was no measurable increase in benefits paid to providers. This important study was obtained from Linda and Dr. Danny Gnewikow of Danville, Virginia.

Many audiologists can take pride in this accomplishment that evolved from
this 4-year effort. Audiologists have contributed hundreds of letters to
Congress and have contributed financially to the political process. Through the vehicle of the academies (AAA & ADA), the profession has taken
responsibility for its future.

Particular thanks go to Dr. Craig Johnson who has been the driving force
behind this effort. Thank you, Craig, for your dedication and commitment to
the profession.

Future Directions

The twelve other federal carriers will be pursued to insure that they
follow the lead of Blue Cross Blue Shield. Lines of communication have been established with these carriers to insure that they appreciate the benefits
of direct audiologic care.

Medicaid patients need and deserve equal access to audiologic care.
Presently, the Medicaid program employs an outdated definition of an
audiologist, thereby limiting consumer access to services. Legislation
introduced by Congressmen Whitfield (R-KY) and Brown (D-OH) under the title of HR 1068 provides for the same definition of an audiologist for both the
Medicare and Medicaid programs. This legislation will insure that the Health
Care Financing Administration (HCFA) uses an appropriate definition of an
audiologist. Medicare and other current federal statutes such as Public Law
105-266 define an audiologist as an individual who is state licensed.
Physicians and other health care providers are recognized by HCFA and
federal statute by their state licensure status. An important step in the
recognition of our profession is to be defined in the same manner as other
health care providers.

Medicare currently requires audiologists to obtain a referral from a
licensed physician prior to the delivery of services. Both AAA and ADA are
working together to allow for direct access to audiologic care without the
added expense of a physician referral. These are some of the issues that the
academies are jointly pursuing to insure consumer access to hearing health
care services.

Unified Approach Equals Joint Success

The academies' unified approach has resulted in a significant breakthrough
in the recognition of the profession by federal insurance carriers and
regulatory agencies. Together, the academies can achieve a significant
impact on the daily lives of clinicians and consumers. Consumers are best
served by an independent audiology profession that can compete in the
marketplace. An open marketplace will insure that future generations of
consumers will view the audiologist as the manager of hearing health care.

 
 

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