Audiologist and Audiology Advisor Spectrum Audiology (Physicians Hearing Network) Kerrville, Texas, United States
Abstract: Although dispensing audiologists want to help patients access benefits, estimating reimbursement is not always straightforward. “Insurance” doesn’t have to be a dirty word! This course overviews terminology and best practices for verifying benefits, estimating reimbursement, and filing claims. Learn strategies for participating within versus opting out of networks and TPAs.
Description: Hearing aid adoption rates among Americans have been shown to encapsulate fewer than a third of those who would benefit from them, even though hearing aid use is correlated with improved quality of life, reduced social isolation, and overall lower healthcare costs, among other benefits. Studies suggest that hearing aid adoption rates are better when cost is reduced by factors such as insurance coverage. Dispensing audiologists certainly want to help patients access quality hearing services though their insurance providers; however, trends show ever-decreasing reimbursement for billed charges.
Many dispensing audiology practices opt out of insurance participation for hearing aid services because their profit margins on in-network fittings are cost-preventative. Reimbursement rates and contract terms often either limit the patient’s access to higher technology and/or adequate care, or forces the provider to accept a fractional profit (or even a loss) on the fitting.
Perhaps many of us are wary of insurance because we simply have not received formal education on the topic, such that reimbursements seem unpredictable. This course will overview the essential terminology and formulas used to accurately calculate reimbursement on insurance claims. We will discuss best practices for verifying benefits, determining patients’ financial responsibility, and filing claims.
Multiple factors should be considered and weighed when determining which insurance contracts bring value to a dispensing practice. We will discuss the advantages and disadvantages of participation and the typical terms of a network contract. Common strategies for competing with networks that a practice elects not to accept will also be presented.
Don’t let insurance be a mystery or a bad word in your office! Learn the basics so that your practice can evaluate the best way to help your patients access your highest quality of care.
Supporting Research: Reference 1: Kochkin, S. (2012, March). MarkeTrak VIII: The Key Influencing Factors in Hearing Aid Purchase Intent. Hearing Review, 19(3):12-25. Retrieved from hearingreview.com.
Supporting Research: Reference 2: McKee, M., Choi, H., Wilson, S., DeJonckheere, M., Zazove, P., & Levy, H. (2019). Determinants of Hearing Aid Use Among Older Americans With Hearing Loss. Gerontologist, 59(6):1171-1181. Retrieved from ncbi.nlm.nih.gov.
Supporting Research: Reference 3: Abrams, H. & Kihm, J. (2015). An Introduction to MarkeTrak IX: A New Baseline for the Hearing Aid Market. Hearing Review. 2015;22(6):16. Retrieved from hearingreview.com.
Supporting Research: Reference 4: Trembath, S. (2012). Challenges of a University Speech and Hearing Clinic. American Speech-Language Hearing Association Access Academics and Research Newsletter. Retrieved from academy.pubs.asha.org.
Supporting Research: Reference 5:
Learning Objectives:
As a result of this presentation, the participant will be able to define terminology relevant to verifying and estimating hearing aid benefits.
As a result of this presentation, the participant will be able to implement best practices regarding filing insurance claims for hearing aids.
As a result of this presentation, the participant will be able to state the advantages and disadvantages of participating with insurance for hearing aid services.