- Hey guys, welcome back to
the Doctor Cliff, AuD vlog.
This is vlog number 35.
And today I am going to rant to you
about hearing aid insurance.
And when I talk about
hearing aid insurance,
I'm talking about hearing aid insurance
as part of a health insurance benefit.
This is a pretty loaded topic,
and there's a couple different things
that I wanna share about
hearing aid insurance.
I probably won't make any
friends from this video.
I'm totally okay with that,
but I just want to express my
opinion, from my perspective,
as to how hearing aid insurance functions
inside of my clinic,
and how it dictates the quality
of care that I can provide,
so on, so forth.
So let me first start by saying
when it comes to hearing aid insurance,
there is this aspect
of in-network provider
versus out-of-network provider.
An in-network provider
with an insurance company
means that that provider has contracted
directly with that insurance company,
and has agreed to provide
care to their members
at a certain allowed amount.
So, each thing that you
would do inside of a clinic,
each hearing aid,
each service has a certain amount
that can be charged and billed
to the insurance company.
If you're an out-of-network provider,
you are not directly contracted
with a particular insurance company.
So you charge the patient
whatever the usual and customary is.
You give that patient an invoice.
And then if they have
hearing aid benefits,
or hearing benefits with
their insurance company,
they can take that invoice
and send it to their insurance
company to get reimbursed.
Now I am in-network with
some insurance companies,
and out-of-network with
other insurance companies.
A lot of the ones that
I'm out-of-network with
is because I am new to the profession,
and all of the insurance
contracts are taken,
meaning they're completely locked out
to new providers coming in.
So even if I wanted to
be an in-network provider
with some of these insurance companies,
I wouldn't be able to become one,
because they're literally not
allowing anyone to come in.
Now, you also have this other aspect
of hearing aid insurance, which
is considered managed care.
Now, managed care is basically
a third-party entity,
and that's why they call
them third-parties as well,
but it's a third-party entity
that a insurance company
will contract with,
and give them a certain amount of money.
And then that company is responsible
for handling all of the insurance
benefits for the members
of this particular insurance company.
Now I can tell you this.
My days of being an in-network provider
for insurance companies
and for managed care
are coming to an end.
And the reason they're coming to an end,
and we'll first start with the
insurance companies directly,
is when I sign a contract
with an insurance company
to be reimbursed a certain
amount for certain products
and certain services that
I give to their members
and I offer to their members,
and when I submit those claims
to the insurance company,
and they don't end up paying,
or they end up trying to do
everything in their power
not to actually pay
what they're contractually
obligated to pay,
for whatever excuse they come
up with out of left field,
it really starts to eat at me.
And the funny thing is I
have not been an audiologist
for very long.
I can only imagine these
other clinics out there,
how they feel when they've been fighting
with insurance companies
for years and decades.
And it's just, it blows my mind
how anyone could be in this
industry for any length of time,
and still be okay with dealing
with these insurance companies.
It just, it boggles my mind.
You can tell that the
rant's starting, right?
So, I've had a number of patients
where we do a insurance
verification for them.
So they call and say,
hey, I wanna come in,
get my hearing tested.
If I need hearing aids,
I wanna get those too.
So we're like, okay,
well, what's your insurance information?
We'll call the insurance company.
We'll get the estimate of benefits.
And then we'll share that with the patient
when they come in for their
visit for their hearing check.
And then yeah, you know,
a lot of the times
they'll make the decision
to pursue treatment.
And we're like, great.
So, we'll fit you with devices.
We'll submit this off to
the insurance company.
We'll get paid. Everybody's happy.
Well, what happens is that
these insurance companies
will verify one thing,
but actually pay out
another, or not pay out,
which is really what happens here.
And it creates a situation where, like,
we can't trust what the insurance company
actually tells us anymore.
So, if they say that a patient,
and this has happened several times,
where they see a patient is covered 100%.
So, they have a hundred percent benefit,
which means the patient, once
they've met their deductible,
they've paid their copay,
whatever, that the rest of
their hearing aid devices
and their care is covered 100%.
And so we tell the patient this,
and everybody's happy, 'cause
like, well, great, good.
My insurance is actually
doing what I want them to do
as a member of this
particular insurance company.
Anyway, and then they come in,
they get fit with the devices.
We submit the claim to
the insurance company.
And then the insurance company is like,
oh, this patient doesn't have coverage.
Like, what? What do you mean
they don't have coverage?
We spoke to you on this date.
We spoke to this person, this
was the reference number.
They said that this patient
had a hundred percent benefit,
and they're like, ah, sorry?
I mean, they don't.
So, that's not our fault.
That's not our problem.
And that's really kind
of just how it goes.
It's this nonstop battle with insurance,
when we're in-network with insurance,
to get them to pay
what they're contractually
obligated to pay,
and get them to actually
give us the right benefits
so we can tell the
patient the right thing.
And when that doesn't
happen a number of times,
it becomes an issue.
In fact, it's been an issue so many times
that we've actually had to file complaints
with the state insurance commission.
What's gonna happen
with that, I don't know.
I mean, I try to focus
more on the providing care
to my patients, and I
have other staff members
that are spending hours
and hours and hours
trying to get this stuff sorted out
with insurance companies.
So, what does that do?
That increases costs, blah, blah, blah.
Anyway, then you have the, so
we'll set the insurance stuff
to the side from a direct in-network
with insurance companies.
Let's go to the managed
care side of things.
So managed care really
came along to control costs
for these insurance companies.
And, you know, I can
understand this aspect
of controlling costs.
I like to control costs
inside of my own clinic.
I don't like money being wasted anywhere.
That being said, that being said.
That being said, the situation at hand
with managed care companies is that
unless you are in-network
with the managed care company,
a patient cannot access their
insurance benefits with you.
So if I'm, you know considered
this out-of-network.
Out-of-network means nothing
when it comes to managed care.
So, a patient has a
certain insurance company
and they're like, oh, but
we do all of our insurance
benefits through this third-party.
And to give you an idea,
Amplifon, True Hearing,
you have Epic.
There's a bunch of other ones out there
that will do this third-party managed care
that are designed to control costs
for the insurance company.
And so a patient will come in and say,
hey, I have this insurance.
And we're like, oh, we really can't.
We can't do anything for you.
We can't even give you
an out-of-network bill
that you can send to them
and get some kind of reimbursement.
You can't do anything like that,
which is why I strongly urge you
to look at your insurance contract
when you do sign up for your insurance,
and find out if you have
managed care as a part of that,
because if you do, you have to
go to whoever the provider is
inside of that managed care network.
And I can tell you that
there's a strong possibility
that you would not be able
to come into my clinic,
which totally stinks because
if you wanna come to me
if you live locally in
the area that I'm in,
you just can't come to me.
You gotta go to someone else.
And then the quality of
care that they provide
is totally up to them.
And that's the other
problem with managed care
is that they have, how it works
is that when you get contracted
with the managed care company,
what'll happen is that
they will say, okay,
well anytime that you
fit a premium level set
of hearing devices, we will
pay you a fitting fee for that.
And that fitting fee will
be X amount of dollars.
If you fit them with the
second tier technology,
we'll give you a certain
amount of money for that
for a fitting fee.
And then it goes down and down and down.
And so what happens is, is
that you're really incentivized
to sell the highest level
of technology possible
because the reimbursement,
or that fitting fee,
is already extremely low.
And it's really low if you're a provider
who provides best practices,
meaning that we're doing
all of the necessary things
to ensure that you received
the highest level outcome
with your devices.
But, when it comes to the managed care,
some of them will even say, okay,
and you cannot charge them
any more than this amount
for any followup visits
that they come in for,
which is, what that means
is that if that number
is not high enough for
us to actually provide
a quality of care, then we
have to make a decision.
We either have to either
take a loss on it,
or we can basically just cut corners
and not provide best practice care.
So it's one of the two.
So it really comes down to this aspect
when it comes to working
with insurance companies
is the quality versus quantity dilemma.
So anytime that you work
with an insurance company,
you know that you're going
to be paid less money,
and that's okay.
You know, I do believe that
individuals who have insurance,
I mean, I have health insurance, right?
I want my health insurance
to cover the things
that I need from a health perspective.
But, you know,
I want to receive high quality care.
I want to give high
quality care to patients
who come in my clinic.
But, if I accept insurance,
if I'm in-network with
their insurance company
or their managed care group,
I am basically saying, okay,
quality is gonna take
a back seat to quantity
unless I'm willing to
lose money for my clinic.
And I know it's not a popular topic.
Anytime I bring up
money, someone complains,
Cliff, you're just a greedy guy.
So be it. I'm okay with that.
You can say whatever you want.
I have to run a business here.
If I'm going to be providing
a high level of care,
I need to charge accordingly
for that to keep my doors open,
but nothing else
they will ever convince anyone otherwise.
Basically it comes down to
that question right there.
It comes down to,
am I willing to forego
quality to do quantity?
And the quantity side comes from, okay,
I'm gonna be getting these
referrals, potentially,
from these insurance companies.
And I'll have a lot of patients to treat,
and I will be accepting
a lower reimbursement
from the insurance company
that I would otherwise,
but because I'm getting
so many more people in,
it makes it worth it
at the end of the day.
And my business just
doesn't run like that.
Like, we don't run this, like,
conveyor belt of patients
who just keep coming in and
we do a really quick fit
on them and get them out the door,
and we get this chunk of money.
And like, it's just not how we do it.
There are clinics out there
that do do it that way.
And you know, to each their own,
but from a moral standpoint,
and from an ethical standpoint,
I just can't do that in my clinic.
And it's starting to get to the point
where I'm so busy with
my existing patients,
and with the new patients coming in,
that I don't think that I can justify
spending this time that
I'm not being paid for,
with these individuals who I'm in-network
with their insurance company.
And so it's gonna reach a breaking point
where I'm just not able to stay in-network
with these insurance companies anymore.
Now, I'm a big fan of if I have a problem,
I had better have a solution as well.
And so I'm gonna offer
what my solution is.
And my solution that I have
is something that's actually
being done right now.
So there's the federal employee program,
which is the insurance program
that's run by Blue Cross Blue
Shield for federal employees.
And how that works is that
each one of these employees
gets a $2,500 allotment that they can use
for hearing care every three years.
So, if you're the type of individual
who only wants to spend that $2,500,
and you don't wanna
spend a penny over that,
you can go and find a clinic.
And it doesn't matter,
in-network, out-of-network,
does not matter.
You can go find a clinic
that will find you a solution
inside of $2,500.
And every three years,
you can have that done.
So, whether it's, you know,
third or fourth tier technology,
they'll do a quick fit on you.
They might not follow
best practices, but hey,
if cost is the number one goal here,
you can find a clinic
that will do that for you.
And then you just basically
submit that invoice
to the insurance company.
And you can get reimbursed
that 2,500 bucks.
Of course, if they're in-network
with Blue Cross Blue Shield,
they can submit it directly
to Blue Cross Blue Shield
and get that benefit done for you.
If you are the type of person
that you want a higher level
of care, if you want a better technology,
if you want best practices
to be followed to a T,
you can pay whatever
additional cost it would be
to get that level of care inside
of that particular clinic.
So that $2,500 will take a
bite out of the amount of money
that you would owe that particular clinic.
And then you're happy, right?
Like, you've got to use
your insurance benefit.
This is the only way that
I see things working.
And I do think,
I think honestly that the
$2,500 should be higher,
but this is all dependent
on the type of insurance
that you have, right?
If you have a very low premium insurance,
then your hearing aid coverage
is probably not gonna be that
good and vice versa, right?
So, but it really, I mean,
I can't see any other way for
this insurance game to work.
Not for the clinics
who really wanna uphold
the really high quality of care,
who are not willing to
sacrifice on best practices.
I mean, it's going to be a losing battle.
I don't think that insurance
companies are going to agree
to do something like that.
I don't think that managed
care companies are going away,
even though ultimately
at the end of the day,
they may not be the best
option for consumers
to receive a high quality of care.
But it is what it is.
So, boy, this is just like
a Debbie Downer video.
It pains me to actually
record this right now.
Actually, maybe I don't wanna post this.
Nah. If you're watching this, I posted it.
So, that being said, if
you, for some reason,
did like the video, go ahead
and give it a thumbs up.
I'm expecting to get a lot
of thumbs down on this one,
but nonetheless, if you liked it,
go ahead and give it a thumbs up.
Leave a comment if you have any questions
about the insurance game.
It is so convoluted.
I will try to do my best
to answer your questions,
but you know, as always,
I'll see you next week.
(upbeat music)
