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The Managed Care of health insurance benefits is not a new concept.
A managed care company is a third-party company that the insurance company uses to help patients with specific benefits in an effort to keep their (the insurance company’s) costs as low as possible. Managed care in the hearing aid market has become a huge factor in just ten years.
When I started my business ten years ago, almost no one had hearing aid benefits under their major medical policies, and no one had benefits through Medicare supplemental coverage. Today, 65% of all health insurance policyholders have some hearing aid benefit, and 45% of health insurance plans also offer hearing aid benefits.
As insurance companies have been affected by the increasing demand for hearing aid coverage, primarily by baby boomers entering the hard of hearing age bracket, managing these benefits has become the industry standard. This means that if your insurance company uses managed care, you cannot go out of the network and use a distributor who is not part of that network.
It also means that the managed care group will guide you to their distributor, define product options and, most importantly, hearing aid prices. The audioprosthetist then becomes a “service charge” participating in the process.
The managed care model quickly gained favor with insurance companies due to the reality of very high prices.
An audiologist described it this way, “It should also be pointed out that as someone who worked for one of these entities, the very existence of these programs is partly our fault. We have vehemently refused to detail or offer any form of transparency in pricing. We failed to offer value-based or affordable solutions to consumers. We provided free assessments and did not consistently adhere to evidence-based care. And, finally, some of between us ignored our managed care agreements and played a dangerous insurance game where every fitted patient was forced to pay for an upgrade; where we charged for hearing aids we didn’t fit and we would not have accommodated until payment was received; where we charged the patient in full, upfront, even if they had a benefit; or where we billed the payer differently than what that we charged d to our general patient population. Insurers, employers, workers’ compensation plans and, most importantly, consumers, have grown weary of gambling and weary of losing. In the end, they pushed for a defined lower-cost delivery system. Now, the main losers in the current game are hearing care providers. »
Not all hearing care professionals would agree with this author’s assessment and complaint. Those who would accept would be high-end price distributors who typically cannot afford to be part of a managed care network because the managed care network service fee is much lower than what would be realized in the margin beneficiary of the sale of the hearing aids themselves. .
For example, I just heard from a new patient about a well-known regional health system with audiologists who will no longer accept her $1,500 hearing aid from an even more recognizable health insurance company in Pennsylvania. This is because this insurance company is now in a managed care administration and the practice has decided not to enroll in the managed care network.
There is another large, well-known health insurance company in our area that is not yet in managed care and honors out-of-network relationships with hearing care professionals. I’ll let you guess the names of these companies. The practice that will no longer accept patient coverage is supportive of the woman’s coverage but cannot operate at service revenue compensation contrary to the past profit margin their business has become accustomed to.
They can no longer even access the benefit billing process without going through managed care. Sometimes the overhead of practices like this can’t absorb the price reductions and stay in business as big as they are now. Hearing aid distributors who would disagree with the above article’s complaint are usually one man or family practices that have established a lower price pattern in the sale of hearing aids.
Typically, the care management fee for the service is only slightly lower than the profit margin per sale of hearing aids and is welcome. Sometimes the low-cost distributor has a dilemma with the managed care group having a higher price than what they normally sell at. The dilemma arises when a patient refers another patient who might be charged a different and slightly higher price, which would be widely known quickly in a small community.
The four largest managed care groups that administer hearing aid benefits are now involved with forty of the nation’s largest health insurance companies and have more than one hundred million policyholders. If your plan is managed care and you call your insurance company about hearing aid benefits, the operator will transfer your call to managed care and you won’t even know you’re not talking to the company you have composed. Managed care is great for the insurance company, the third-party managed care company itself, and generally the consumer. It is not perceived warmly by more expensive distributors.
With low-cost distributors, their retail prices are sometimes lower than the co-pay a patient would spend through their managed care network. It is always beneficial to obtain as much information as possible before making a decision about purchasing hearing aids through managed care. Talk to your health insurance agent because most Medicare Advantage supplemental plans offer hearing aid benefits.
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Jeffrey L. Bayliff is owner of Hear the Birds Hearing Aid Center, Lock Haven.