2020 Ep. 8 Info You Need to Know

The Transcript

Dale: Can you name a medical device that changes the lives of millions of people, but isn’t generally covered by insurance? Surprisingly, the answer is hearing aids. Most private insurance doesn’t cover them. And with the price tag ranging from $1,000 to $4,000 each, hearing aids can become a luxury that few easily can afford. That’s our conversation today with Dr. Sandra Miller of Complete Hearing. Not an insurance conversation, rather an education on insurance coverage. Fair to say, Dr. Miller?

Dr. Sandra Miller: Yes. I’m going to give my very big disclaimer before we even start this conversation, that I am not an insurance specialist. As a practice, we do actually a two day seminar every single year on insurance and billing and coding when it comes to our profession. We know that we’re doing things accurately and correctly. But I also think it’s …

Dr. Sandra Miller: We’ve seen so much in this last couple of years where our patients are coming in with benefits that they don’t know how they got them or what do I do with them and how do I get access to them? For those of you who are out there with benefits that … especially when we’re talking about your Medicare patients who now have Medicare Advantage, I think it’s really important that some clarity be brought to that. Because I think that even if this doesn’t apply to you as a Medicare patient, if you have Blue Cross Blue Shield or you have United Healthcare or Aetna or whatever it might be that you’re holding in your wallet as your insurance card. Please know that we have experience with the majority of the care plans in our office. And so we can give you some information but we are not your … I would say your provider of health care. But when it comes to your benefits, especially when it comes to regards to having your hearing tested or if you need hearing devices, we can kind of help you along that way.

Dr. Sandra Miller: That’s kind of where I think the challenge has come in from many patients, is there’s so much confusion that’s happening out there. The first question we usually get is, “Really? My insurance will cover a hearing test?” A majority of them is going to. The answer’s going to be yes. With Medicare, it has to be medically necessary. And that just means we have to meet a certain criteria. But yes, you can come in for a hearing test and it can be applied to your insurance. That’s a pretty awesome thing. People don’t think it’s a covered thing. That’s just the beginning. When we get into talking about plans that now have hearing aid benefits, that’s where the challenge lies.

Dr. Sandra Miller: And so I think many of you might have questions out there as, “Hey, my insurance company says I have an up-to $5,000 benefit for hearing aids.” And I always have to say, “I know, but what is up-to mean?”

Dr. Sandra Miller: And so you and I had a great conversation, Dale, about with having your prosthetic leg and what did that mean. And you told me, “Well, they couldn’t tell me how much they were going to pay, because I hadn’t submitted a claim yet.”

Dale: Mm-hmm (affirmative). Mm-hmm (affirmative).

Dr. Sandra Miller: And so sometimes when I tell my patients, “I don’t know what your reimbursement is going to be, because they won’t tell us what the allowable amount is.” Not the allowable amount, but what they’re going to reimburse based on the fee schedule. We’re kind of sometimes shooting in the dark. And that’s challenging to people, because when they come … and if I’m going to put out significant amount of dollars, your prosthetic was very expensive. Hearing aids are not inexpensive either. But they want to know when they come to us, “I have a benefit. Is that mean I get this hearing aid, this hearing aid? Can I use that benefit and then get something outside of my benefit? Can I upgrade?”

Dr. Sandra Miller: We talk through the process of, “Okay, this as an idea where we think your benefit is, do you want to get that device or do you want something else?” We always give those options. Because if you want to be fit within what we think your benefit is, there’s definitely options for that. But you might need something different. And we want to make sure that your insurance company is allowing us to say, “That’s awesome. You have 2,500. You need a hearing aid that’s 3,500.” You may have $1,000 out of pocket. And we like to be able to walk you through that process so you understand it.

Is it beneficial to you for the person walking into your office to have a copy of their insurance?

Dr. Sandra Miller: We always take a copy of the insurance card. I would tell you, many of my patients now have something called Medicare Advantage. And Medicare Advantage has pros and cons, just like any other insurance, but now it’s one card. And many of them have a benefit for hearing aids. And so sometimes they’ll just bring them their whole entire booklet. And we’ll open up that booklet. And the booklet under the plan will say, “You have a benefit of $375 to $2,789.” And they’ll look at me and they’ll say, “Well, how much of a benefit do I have?” Right?

Dr. Sandra Miller: And so I think the challenge is navigating those waters to make sure that we send them on the right path. And sometimes what’s really challenging, I think for many of our patients, is Complete Hearing takes Medicare, we take Medicaid, we take Blue Cross Blue Shield, we take United Healthcare, we take Aetna, but now we have Medicare Advantage. And so we’ll show up on their list as a provider, but we might not be participating with the hearing aid benefit side. Because it’s a whole nother addition to their coverage.

Dr. Sandra Miller: And so sometimes my patients will call and say, “I had United Healthcare, what’s my benefit?” And I’ll say, “Guess what? Every policy is different.” If you have United Healthcare through work, which might be the state, the city, the university, the railroad, wherever you might be working, your policy is different from Joe’s down the street. Because he might be working someplace else. I will tell you, the insurance side of it from a provider side can be very challenging on our end, too.

Dr. Sandra Miller: Our goal for our interaction with our patients is to be very transparent. What we know, we’re going to tell you. What we don’t know, we’re going to tell you we don’t know. And we’re going to try to give you the best care we possibly can. But also making sure that if you do have a benefit, how can we access it and still provide you optimum care? Like we want to make sure that …

Dr. Sandra Miller: And it might be sometimes I’ve had to refer my patients out just because we were not participating. And that’s hard for me, because I want … I want to take care of them. I want them to have the best possible care they possibly can and provide it through Complete Hearing. But there might be times that, that benefit is significant enough and for some reason I don’t participate with their plan. What does that look like?

Dale: The customer that’s ahead of me is treated individually. I come in, I’m treated individually. The person after me then is treated individually. None of us three so far have ever been treated in a cookie cutter fashion?

Dr. Sandra Miller: And I will tell you that never happens in our practice. Everybody is so individualized. And even with Medicare Advantage, that is now a kind of a buzzword and it’s definitely out there that there’s Medicare Advantage that has a secondary component of … All those insurance companies I just told you about, they all have a plan within Medicare Advantage. It’s not just that I have Medicare Advantage. Well what kind of Medicare Advantage do you have? And our patients don’t know. When they get their card, they’re like, “I don’t know, it just says Medicare Advantage on it.” And so our insurance specialist, Ruthie, we just kind of joke back and forth. She goes, “Sandra, I just have to see the card and I need to call.” And because there’s many times we’re just doing verification of benefits to make sure we can best serve that patient when they come in.

Dr. Sandra Miller: There are times where we just want to make sure we have the information, so that when you do come to the practice, we can be the most educated on our side to provide you the best information we can.

Dale: Now there are things, and we’ll go back to my prosthetic, questions that have come up that I never thought about at the beginning.

Dr. Sandra Miller: Oh.

Dale: That once I have it in the experience then, well maybe I should have asked that question. Here’s an example. Does my insurance cover the loss of a single hearing aid?

Dr. Sandra Miller:
Oh, that’s such a wonderful question.

Dale: Or do I have to get two? I would have never thought of that walking into Complete Hearing, getting a hearing aid.

Dr. Sandra Miller:
Exactly. The challenge for us on the provider’s side when it comes to … I’m going to use Medicare Advantage as an example. Is that Medicare Advantage may have a policy for hearing aids that conflicts with what … Medicare rules actually aren’t cohesive with the Advantage plan now that they’ve combined. The rules don’t agree with each other. Isn’t that … It’s crazy.

Dale: That sounds confusing.

Dr. Sandra Miller: Imagine if the patient’s confused and we’re kind of going, we need to make sure that we’re staying within our contract, that we’re providing the service that we are supposed to. But now you’ve loaded something onto that Medicare Advantage plan that may not agree with our initial Medicare agreement. You can see that we on the provider’s side are in a very situation where ethically we want to make sure we follow all the rules and we’re staying within our contract and we’re treating ultimately the patient the way they need to be treated. And there are times when some of these plans limit what we’re providing.

Dr. Sandra Miller: And that’s where I think it’s not right. When they’re dictating this is the device you have to have and this is what you’re going to do. And you can only go see that provider this many times and, “Nope, you can’t.” It’s just very … The rules of engagement are very interesting, is what I would call that.

Dr. Sandra Miller: And so for us, we want to stay educated on our side to make sure we can deliver our patients the information. And it might be more information than they ever wanted to know, but at least knowledge is power. And so we can figure out how to best move forward. And again, sometimes that might mean we have to go a different route than we had planned and it’s always in the best interest of the patient.

Dale: Back to the three patient example, the person before me, me, and the person after. We all could maybe have United Healthcare.

Dr. Sandra Miller: Right.

Dale: And all three of us have different benefit levels.

Dr. Sandra Miller: And somebody had-

Dale: All three of us have Blue Cross Blue Shield and it’s all at different benefit levels.

Dr. Sandra Miller: Yeah. Yeah. It’s very challenging. I think the challenge, too, is more for when there’s not a standard benefit and we find … They’ll pay 80, 20. Well, 80, 20 of what? And so when you call your insurance company, you’re asking to verify the benefits. That person who answers the phone only knows what they can see on the screen. They don’t know the details of the policy. Or sometimes it might be that my office has contracted with that company to allow different benefits than what they’re seeing on the screen.

Dr. Sandra Miller: I think it’s when you get into insurance, it’s a very … I’m sure many of your listeners out there going, “Oh, I completely understand this. I thought my bill was going to be X and it was Y or it was Z.” I think the challenge is to make sure you’re educating yourself. I’ve listened to several podcasts on … especially because so many of my patients now do have this Medicare Advantage. What are the pros and the cons to it? Who is it right for?

Dr. Sandra Miller: And hopefully when people are signing up, they’re getting that education and making sure that, “Did I make a good choice for me?” Because it’s appropriate for some people and depending on the policy, it’s not appropriate for others.

Dale: But you need to find out if hearing aids, hearing devices, are even covered.

Dr. Sandra Miller: Exactly.

Dale: Because not all states do it.

Dr. Sandra Miller: Right. Yeah. Hearing aids are now required for up to age 18 across the nation. But what I would tell you is when it comes to hearing aid coverage in insurance, it’s been very rare. And we’re seeing it more and more and more. And that’s a good thing, because that gives people access to getting better hearing and better healthcare. But it goes back to how is that policy laid out to be to the advantage of who? And we always want to make sure it’s to the advantage of the patient. As we navigate the waters, I would tell you we’re navigating the waters together.

Dale: You can find out more by going to complete-hearing.com. Or if you are more comfortable giving them a call, (402) 489-4418. 4200 Pioneer Woods Drive in Southeast Lincoln. Or on the radio every Saturday morning at this time, the conversation starts here with Dr. Sandra Miller from Complete Hearing.