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Audiologists Billing - ethical or not?

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A month ago, my wife and I had back to back appointments for a hearing test at the local audiologist's office. We were referred by our . They were 30 minute appointments and we were done with testing in about 15 minutes, each. After exiting the booth, the audiologist took us to a different room and tried to sell each of us $6600 hearing aids. Twice I said we were there for just the test and wouldn't be making a purchase decision. I also expressed low confidence in the test since we were rushed through - even during the test I interrupted saying I wasn't confident when I pushed the button. Hoping for a repeat, the audiologist simply said "I can tell" ... I expressed interest in a half shell (?) type aid because I've had domes stick before ... that was ignored and she continued to push the types ...

Finally I cut her off when she turned the hard sell on my wife. We left saying we needed to talk and decide what we wanted to do.

A few weeks later, we got the eMSN from Medicare and the Audiologist billed them for hearing tests - our copay was about $10. What shocked me is, they billed Medicare for $1000 in additional uncovered charges - EACH - for fitting and programming hearing aids, etc. Medicare bounced all of that of course as are not covered.

The bill from the Audiologist has not been received yet; I intend to pay the $10 hearing test copay only and will refuse the remainder.

What I want to know is whether such is typical business practice in this industry? I wouldn't expect to pay to test drive a car and certainly don't intend to pay to test a HA - especially when it was just a hearing test appointment. TIA. Jack

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Edited

$6000 for a pair of premium does not sound excessive - that price is aligned with other prices I've seen that include bundled services. You have to take into account the fact that includes multiple fittings, supplies, etc. It's like prepaying doctor visits for three years. I've heard of providers wanted to charge $10K!!

It’s pretty common for providers to bill the insurance more than what insurance will cover. I’ve noticed this often with my dentists and doctors. The EOB (Explanation of Benefits) usually shows the amount billed, the negotiated rate set with the insurance, and the patient’s copay. It’s not that Medicare rejected it, but rather that when a provider is in-network, there’s a fixed amount tied to that specific procedure code.

You were not testing a car: You went for a clinical evaluation, you used the time of a doctor (if you were seen by an ), you used their facilities, etc just like when you visit an MD. You weren't happy with them and walked away, but you still used their time. And they are allowed to charge what they believe their services are worth.

Just like with a car, you’re free to shop around. Costco and Sam’s charge $1600 because they can sell hundreds of times more aids than a local private practice.

Sounds like a good deal for me: you saw them, decided you weren’t interested, walked away with an and other results, and only got charged $10, which is the cost of two coffees at Starbucks.

I'm not saying $6000 is a good price, this is debatable, but they told you the price and you declined. That does not sound unethical to me.

To clarify, we had appointments for a hearing test only. 30 minutes each, which they rushed us through in 15 each. Cost of the test was about $100, covered by Medicare, leaving us with a $10 copay per the eMSN from Medicare. On the same eMSN from Medicare, they billed MC for an additional $1000 in hearing aid fitting services - which exceeds the purpose/scope of the hearing test appointment. It was not explained nor expressly offered as an additional service and we did not consent.

Is the responsible to tell me "this concludes the scheduled hearing test, would you like to proceed to a fitting session at $1000 in additional costs whether you buy the HA or not?" I'd have said "no". It is shocking to me that this was done so I'm asking advice (?) before they bill me for the $1000 that Medicare rejected? Actually, $2000 with my wife getting the same bill.

I would definitely complain about them. They are crooks for sure. I remember once getting a receipt from medicare for medical procedures done on my father. He had died 6 years earlier. I sat down and wrote a letter about it and sent it to Medicare fraud. They went after that guy!!

In reply to @ILBlues

@ILBlues said:

n the same eMSN from Medicare, they billed MC for an additional $1000 in hearing aid fitting services - which exceeds the purpose/scope of the hearing test appointment. It was not explained nor expressly offered as an additional service and we did not consent.

This would be medicare fraud if it were intentional. The best approach is to contact the provider first to ensure that it isn't a simple billing error. Ask for an explanation of the charges and request a correction if a clerical error has been made. If you don't feel comfortable doing this alone you could reach out to your local Senior Medicare Patrol office for free guidance. It is a federally funded agency designed to assist people who suspect medicare fraud is taking place.

In reply to @ronshere

@ronshere said:

I would definitely complain about them. They are crooks for sure.

Billing errors happen so it's best to make sure this hasn't happened in this circumstance. Their practices aren't good ones though. I'd definitely feed back to the specialist that referred you with the concerns you had about their service.

Also, just to clarify @ILBlues was the person you saw an audiologist or another type of hearing care professional like a hearing instrument specialist? There are many grades of hearing care professional in the USA.

Per their online bio/credentials: Au.D., CCC-A, Doctor of Audiology.

PS - hard to know whether a goof or intentional - on the way out the door I was assisting my (handicapped) wife, but saw the Dr lean in and say something unkind to the receptionist on our way out the door. I couldn't make it out though - just caught the look ...

By comparison, Costco was a wonderful experience - good folk, affable, respectful and helpful ...

Well, the pathway to follow is in my previous reply to you. I hope you're well supported through the process. It's safest to keep the rest of the details private unless there's a public judgement by a legal authority that is publicly accessible so you don't open yourself up to litigation. I'm sorry you're going through this, but you're doing the right thing so stay strong.

In reply to @ILBlues

This sounds a little like my first evaluation with an and CI audiologist. It was a rush through appointment and I was treated like a dog. Later I looked at the Medicare documents about this appointment. I was charged a couple thousand dollars for non treatment and results. Like you I was fit to be tied about this.

I contacted Cochlear America about this and showed them the paperwork I received. They referred me to another ENT and audiologist. That appointment went fantastic.

There are fraudsters our there. Many are very smooth about it.

In reply to @ILBlues

ILBlues, Yours is a disturbing tale. I'm familiar with Clallum County, population approx. 78,000. Yes, it is possible that billing Medicare for services clearly not provided, for either you or your wife, was an innocent error. I hope you return to this forum once the audiologist presents you with a bill. If they attempt to bill you with the erroneous charges, I would call them and tell them you will contest the charges in the most public way possible. I would tell them you will contact, besides an attorney, the Attorney General of Washington State, the Clallum County prosecutor, Yelp review, local friends and acquaintances etc. A bad reputation in a small county can be devastating. If they are smart, and after consulting with their attorney, they will probably drop the whole thing.

In reply to @ILBlues

One can ask for a good faith estimate in advance. It doesn't guarantee this won't happen but it can help. This sounds like a possible billing error so wait to see if you are billed more than $10.

that sounds like a frustrating experience, especially when you clearly said you only wanted the test and needed time before making a purchase decision.

Unethical, for sure. IMO - I'm not a pro in this - it's not fraud because Medicare does not cover hearing aids, and the practice should have someone in billing who knows this.

If you get a bill for services they didn't provide, I'd recommend complaining to your state's licensing authority. That's easy to do, but still easier said than done. If they go to collections, though, I'd countersue for everything they own.

In reply to @sasha3398

I guess that's the point - it was a hearing test appointment - half an hour, billed to Medicare - I'd have a small copay - which I consented to when making the appointment. The actuals were: 1) Comprehensive hearing and speech recognition test (92557) $96; 2) Test to assess middle ear function (92567) $51. My Medicare copays were $7.35 and $3.30 respectively.

Anything more than that, was added by them, without informing me and obtaining my consent for the additional treatment. Those services totaled $945 all of which MC denied with "Medicare does not pay for this item or service.

It's possible that's just their boilerplate billing to Medicare - and when we didn't buy they just forgot to delete all but the hearing test charges. It's the comment the doc made to the receptionist and the way they looked at us when we left without buying that makes me wary of their intent.

What's strange about charging me for hearing aid fitting and programming (less than 5 minutes), the body was clearly stenciled DEMO.

I'll report back when I receive the bill from the audiologist. Thanks for all the reassurances.

As was mentioned earlier, it is possible the billing was simply an error. All billing is done today electronically through billing codes, often by an outside firm (my son works for a firm that does billing for many medical facilities). While it could have been an intentional fraudulent billing, it could also have been a typo in the billing code. A call to the billing office would quickly confirm if it was a simple error or a possible fraud attempt. Since Medicare doesn't pay for hearing aids, which the Audiologist would know, I suspect an error.

That does not, however, justify the treatment in the office.

I think it's unethical to bill a patient for service that you provided without being transparent about the associated costs.

But I also think that much of the American healthcare system seems unethical, so I'm probably a poor judge.

In reply to @viffer

2 codes and charges for the hearing test; the extra services were 8 separate codes ... 8 separate charges ... totaling $945. Hard to imagine a typo. Even so, my wife's eMSN is identical to mine. My daughter, a lead/instructor for medical coding, is looking over the eMSN for me.

It seems as though there is a serious problem with Medicare Fraud in the USA. This investigation was quite the eye-opener. There is a short discussion of merch, skip to circa 2:30 to bypass this.

Coffeezilla3Investigating $100 Billion in Healthcare Fraud

I've had a similar experience recently, but mine was covered by insurance.

Was just a validation before I went to COSTCO where I have purchased 3 sets of aids. My appointment there last week included a full hour of testing with two professionals evaluating my tests and suggesting alternative new aids. Then a programmed set to try in the store before I left. My Costco is 65 miles away but well worth the trip, close to what you would need to travel.

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