Question
What happens when the insurance company will not tell you how much they will reimburse?
Answer
Again, the two magic offices are provider liaison and the provider education office. You do want to call them to find how much information they would give you:
Number one: If there is a measured benefit for example $500 maximum. Would that would go toward the hearing aid or $500 covers everything involved for the price of the hearing aid and the cost of your services? Is this a benefit that applies on a per hearing aid basis or would include binaural hearing aids? Is it a hearing aid for each ear every three years? These qualifications change a lot.
If they will not tell you at all, anything at all, about what you will be reimbursed, what eligibility, what restrictions there are, then what I suggest is to turn the patient loose on them because that patient can be his or her own advocate and really does carry a lot of weight in order to get things revealed.
If that provides no good fortune to you in learning what's appropriate and what's not, what's eligible and what's not, then you have some heavy decision making to do to decide if you really want to participate in this program.
I am aware of some plans where it is indeed better to let your competition down the street, take the loss than for you to take the loss where $500 is expected to cover the cost of a high end digital and your services and also all of your follow up services forevermore. There is a cost benefit risk factor there that sometimes just doesn't make sense for us get involved in.
Robert Fifer, Ph.D., is the Director of Audiology and Speech-Language Pathology for the Mailman Center for Child Development at the University of Miami School of Medicine. He is also an Audiology Online Contributing Editor in the area of Coding and Billing. He is the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee.
Editor's Note - The above is a partial transcript from the Coding and Billing QNA Live e-Seminar that was conducted on Audiology Online on June 27, 2007. (The recorded version is available here - Also the complete edited transcript is available here. The format of the session was different from most traditional presentations as we solicited questions ahead of time and also solicited questions during the event and had Dr. Fifer focus on answering those questions during the live session. We have published the transcript from the seminar in a semi-rough format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers. Submitted questions are bolded, followed by Dr. Fifer's response. Dr. Fifer is a frequent Contributing Editor for Audiology Online in this area, look for additional Coding and Billing QNA sessions on our home page in the near future. - Paul Dybala, Ph.D. - Editor
