Is Balance Billing Atypical?

@TambourineMan said:

Most hearing centers want a copy of my health card. But most that I went to want me to pay the cost of the HAs in full and then seek reimbursement for the portion covered by my hearing aid benefit ($3,000 - I have a Blue Cross Blue Shield PPO). So why do they want a copy of my card?

What is the usual and customary practice for someone that is “in network”?

In addition to what dr.amy said, balance billing, unless it’s stipulated somewhere in their contract with the insurance provider, is generally not allowed. If you are “in network” for hearing aids, you usually have to accept whatever insurance pays. This is why you will find a lot of audiologists who are not in network with anyone.

Double-check about whether this is allowed for your policy before paying anything.

I checked with the audi’s office from whom I decided to get my HAs and they said they would bill BC/BS for the portion they would pay. I know the audi herself is “in network” as I am able to go online and put in a health care professional’s name and check. The benefit I have is just $3,000 every 4 years - it is not a benefit for HAs per se.

The type of benefit is not the issue. When a hearing aid is billed for using the appropriate diagnosis and CPT code, the insurance company will reimburse based on the contracted amount (if the provider is “in network”). It doesn’t matter how the benefit is classified. The only exception to this rule is things like FSA accounts, because they don’t require CPT codes. So when the provider is reimbursed and accepts payment for the hearing aid, they are not legally allowed to balance bill the patient for remaining balances. It is in the contracts we sign to be in network.

This is a factual example: A patient of mine came in and we had this very discussion. But she was a longtime friend of the ENT I was working for. So she didn’t want to go anywhere else for her aids, but was doubting what I was saying. I called BC/BS and verified her $3000 benefit. I did her evaluation, completed a recommendation, chose a pair of aids, and fit her. I billed BC/BS for her $3000 pair of aids and we waited for the check. 2 weeks later, a check came in from BC/BS for $60.00….$60.00!!! So instead of depositing the check, I showed it to her at her follow up appt. She was shocked. I sent the check back and she happily paid in full for her aids. Because I did not accept their payment and reversed the billing charge, I was not obligated to not balance bill her.

I know that it is disappointing that most insurance transactions are this way, but it isn’t because I don’t WANT to bill insurance for aids. It is because I would have to close my doors. The aids are billed as durable medical equipment and reimbursed as such. I am reimbursed more for a hearing test than I am for hearing aids. It can’t be billed as a “general reimbursement”.

dr.amy

Only $60 for a hearing aid. They’ve got to be kidding. Actually that is not just a joke; it’s outrageous.

My prior sort of similar experience was with a CPAP machine for which BC/BS would have had to pay the dispenser multiples more than what I could buy the machine for on the internet. Even though it would not cost me anything I refused to get it in network because I did not want BC/BS to get ripped off.

I am a little suspicious about the HAs. I called one day and they told me the person I needed to speak with wouldn’t be in until the next day. The next day I spoke fist with my audi who is an owner/partner of the firm and she confirmed I should speak with this other persons which I did and she immediately said they would bill the insurer and bill me the balance and then after that she asked what insurer I had (I had previously given them a copy of my card but she must not have been looking at my file). I guess I’ll find out next week.

@TambourineMan said:

Only $60 for a hearing aid. They’ve got to be kidding. Actually that is not just a joke; it’s outrageous.

My prior sort of similar experience was with a CPAP machine for which BC/BS would have had to pay the dispenser multiples more than what I could buy the machine for on the internet. Even though it would not cost me anything I refused to get it in network because I did not want BC/BS to get ripped off.

I am a little suspicious about the HAs. I called one day and they told me the person I needed to speak with wouldn’t be in until the next day. The next day I spoke fist with my audi who is an owner/partner of the firm and she confirmed I should speak with this other persons which I did and she immediately said they would bill the insurer and bill me the balance and then after that she asked what insurer I had (I had previously given them a copy of my card but she must not have been looking at my file). I guess I’ll find out next week.

Well I certainly wish you luck with the journey, and hope that it works out well for you!

dr.amy