One out of 10 Americans currently has hearing loss and sadly, for those seeking assistance from an insurance provider, getting needed help can often be an exercise in frustration.
Consider an audiologist in New Jersey whose patient believed her hearing aid benefit was for $2,000. Her health plan confirmed this, but subsequently clarified that it actually only allowed a total reimbursement of $350 for each hearing aid. The audiologist was not allowed to bill the patient for the balance, even though she was willing to pay the difference. The audiologist then counseled the patient that he didn’t have appropriate amplification for her for $350. The patient ended up being upset with both the health plan and the audiologist!
The frustrated audiologist asks, “Why don’t they just don’t set a dollar amount as their hearing aid benefit and allow the patient and audiologist to decide what is best? Patients can pay the difference if they want to. Seems to me it would be easier for them to project costs and would make for much happier subscribers.”
Welcome to the world of insurance coverage for hearing services – that is if you’re lucky enough to have any insurance benefit at all for hearing services. Among the insurance plans that do offer coverage, differences exist, so it’s important to find out how well health plans cover hearing services. Let’s take a look first at the various hearing-related services, procedures and devices, then consider some options for finding the right insurance coverage.
Hearing-Related Services and Procedures
Early Detection
Early detection of hearing loss has become the standard of care in recent years. Currently, 46 states and the District of Columbia have early hearing detection and intervention (EHDI) laws or voluntary compliance programs that provide early hearing screenings. The reported number of newborns screened before leaving the hospital has increased from 22 percent in 1999 to almost 95 percent today. In 1988, the average age at which children with congenital hearing loss were identified was over three years of age, with many children not diagnosed until they were five or six. Today, the average age is less than three months and continues to fall.
Currently Connecticut, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Oklahoma and Rhode Island require that health benefit plans in their states pay for hearing aids for children. The requirements vary by state regarding ages and amount of coverage, the benefit period, provider qualifications and type of hearing loss.
Cochlear Implants
Cochlear implants (CIs) can be expensive and health insurance plans may not cover the cost of the surgery, device and related services. Sometimes legal action is necessary to get such coverage. In Carolina Care Plan, Inc. v. McKenzie, a court ruled that a health plan acted unreasonably in denying a claim for coverage of a CI. Carolina Care Plan’s exclusion for devices such as CIs was listed under the section for “comfort and convenience,” along with items such as telephones and air purifiers. The court said the CI is different from such items because it “remedies a disability and enables the recipient to function more fully in the world.” Coverage for CIs by public plans has improved in recent years. The Centers for Medicaid and Medicare issued a coverage decision in 2005 that increased access to CIs by expanding eligibility.
Bone-Anchored Hearing Aid
Medicare covers the bone-anchored hearing aid (BAHA) but private health plans establish their own coverage policies. For example, some private health plans exclude implantable hearing aids from coverage (such as Federal Blue Cross Blue Shield), while others cover the devices when specific criterion are met. Aetna covers BAHAs because it considers them medically necessary prosthetics for persons with a unilateral or bilateral conductive or mixed conductive and sensorineural hearing loss who have a condition that prevents restoration of hearing using a conventional air-conductive hearing aid. Patients must also meet the following audiologic criteria: pure tone average bone conduction threshold of up to 70 decibels and speech discrimination scores better than 60 percent. Aetna considers BAHA experimental when these criteria are not met.
Insurance Options
According to the National Institute on Deafness and Other Communication Disorders, hearing aids are generally not covered by health insurance companies. However, to some degree both public and private health plans cover audiology services and hearing aids but the type of coverage is inconsistent.
Medicare
Medicare does not cover hearing aids for beneficiaries but will cover diagnostic evaluations ordered by a physician to assist the physician in making a diagnosis or developing a treatment plan. Medicare revised its definition of a hearing aid and, by doing so, pledged to cover the BAHA system if other coverage policies are met.
Medicaid
Medicaid coverage of hearing aids and audiology services for adults is an option for states to decide on. However, Medicaid does cover audiology services and hearing aids for children and young adults age 21 and under through the Early and Periodic Screening, Diagnostic and Treatment service. Children may also be covered by their state’s early intervention program or the State Children’s Health Insurance Program.
Federal Employee Health Benefits Plan
The Federal Employee Health Benefits Plan has given increasingly favored status to hearing services in recent years. The Federal Office of Personnel Management (OPM) recently encouraged health plans to include diagnostic evaluations and treatment by licensed hearing professionals, including audiologists, as well as coverage of hearing aids. OPM recognized enhanced newborn and pediatric audiologic benefits as one of the agency’s key initiatives for 2008.
Health Savings Accounts
Health savings accounts (HSAs), into which individuals deposit money and then withdraw it tax-free for eligible medical expenses, can cover services provided by audiologists, as well as hearing aids. These accounts were implemented in 2004 through a change in the IRS tax code to allow individuals to deduct HSA contributions. HSAs require a high-deductible health plan (HDHP) – one that features higher annual deductibles than traditional health plans. Those with HSAs are responsible for researching health coverage options and keeping track of their financial and medical records.
HSA funds can be used for a wide range of medical services, such as routine doctor appointments and prescriptions, as well as medical costs that may not be included in some standard health plan contracts but are considered tax-deductible medical expenses by the IRS. The IRS has specifically deemed expenses for hearing aids, hearing aid batteries and medical practitioners such as audiologists to be included in their definition of medical expenses. Be sure to check with your HSA carrier to be sure that the services are covered and with your HDHP carrier to confirm that the services count for the deductible under the plan.
Flexible Spending Accounts
Pretax money in a Flexible Spending Account (FSA) may also be used to reimburse audiology services, hearing aids and assistive listening devices. FSAs are separate employer-based accounts into which an employee can put a specified salary deduction. Services and assistive technology that are deductible as medical expenses for federal taxes are covered in the FSA.
Specialized Providers
Specialized preferred provider networks that cover hearing services and hearing aids, such as HearPO (www.hearpo.com), HearUSA (www.hearusa.com), American Hearing Aid Associates (www.ahaanet.com) and Epic Hearing Healthcare (see above “Hearing: A Covered Benefit at Last!”), are available for employers that wish to supplement their health benefits.
Advocacy – Another Option
If you didn’t see a viable option among these for your situation, you may be wondering if there is anything you can do to get audiology services and hearing aids covered under your health plan. Go to the American Speech-Language-Hearing Association’s Web site (www.asha. org/public) for information you can give to health plan administrators and employers on adding hearing benefits and speech-language pathology benefits.
You will find the Checklist for Getting Your Employer to Cover Speech-Language and Hearing Services, which will help you identify the person at your workplace responsible for benefits, what to say, what written materials you can offer, how to use statistics and how to get co-workers involved. You can tell your employer or benefits representative how hearing loss affects people’s lives and relate your own experiences. A wealth of information exists that shows that hearing services and hearing aids make a difference. You can also cite the Efficacy Summaries found on the Web site. Consider expressing your thoughts in a letter to your company.
You will also find the Checklist for Ensuring Coverage of Audiological Rehabilitation, which will again guide you through the necessary advocacy steps. It explains that audiologic rehabilitation is provided after a hearing loss has been identified and its goal is to maximize communication and may include such services as the fitting of hearing aids, CIs, auditory training and speech reading.
You can also contact your state legislators and request comprehensive coverage of hearing services and hearing aids in all health insurance plans issued in your state.
Health plan coverage for hearing services and hearing aids is improving but much work still needs to be done. Each individual effort to improve coverage builds momentum in establishing benefits that truly make a difference for people with hearing loss, so don’t be afraid to take action!
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