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Is my audiologist scamming me?

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Edited

Yes, I saw that, I was going on Rasmus’s statement that the cost was $1,100 per aid which would be $2,200 for the pair + dealer markup since his audi seems to think she is selling cars!

Wow, I am overwhelmed by the response. Thank you all so very much!! I wish had found this place before I got wrapped up with this audiologist. I have been trying to upload my hearing test but can’t seem to get it to work, so I attempted to post it below.

Regarding my hearing aids, my insurance says I am 100% covered with no co-pay. I selected an HMO because they cover hearing aids. They did say they have a contracted rate with the audiologist but she says it doesn’t cover the full amount of the hearing aid.

I am currently evaluating these hearing aids and when I looked at my paperwork again, it says I have the Resound Linx2 9. It’s weird because she told me they were the Linx 7 but the paperwork says 9. So, it looks like they are the Linx9. My insurance paid 5000.00. I paid the extra 2000.00. I have 30 days to return these hearing aids and, if I don’t get a different type of hearing aid, I will be charged $200.00 which is her “evaluation fee”. Before she ordered these hearing aids or told me what they would cost, she submitted to the insurance to find out what they paid, then told me the remaining balance. I thought it was strange and told her my insurance says they are covered 100% but she just said the top of the line cost more and that I could get a different one that costs less but the aids aren’t as good. I feel like such an idiot for falling for this but it is truly confusing.

The option I have now is to return these to that audiologist and go with the other provider, Connect Hearing. I’m a little worried about them because they seem to have a bad reputation as well and they don’t carry Resound hearing aids.

Thank you all again so much for the very helpful and valuable information. I’m wondering, do you think I should return these hearing aids and just take my chances with Connect Hearing? I spoke with one of the guys over there and he seems to think that I should not have to pay any money for my hearing aids given my insurance agreement.

I’m not sure if this is the correct way to post my hearing test but here’s what it seems to say…This test is from one year ago. I don’t have the most recent one from the new audiologist/possible scammer.

Right Ear 250 500 1K 2K 4K 8K
Right Ear 50 50 50 25 45 85
Left Ear 45 65 65 55 35 50

Speech Tests
/ Discrimination Masking
Right Ear 45db 100%@80db 45db 80db
Left Ear 45db 96% @ 80db 45db 80db

Evaluations and testing are at least covered 100%. Do you not mean “restocking fee”? My insurance does not cover aids but does cover all the testing, evaluations and everything in between. Did you talk to your insurance company yet? You need to know the full contract agreement and if her fee is allowed. I would have had to pay 10% of the cost had I decided to jump ship. I knew that up front but before I made that commitment I had a day in my audi’s office trying out a pair. I was impressed enough to go ahead with it. I could still return them but that would have cost me $620. I’m passed my 30 days now and I’m happy with my aids. Your aids should make you just as happy because they are premium however, you should pay only what you should pay and that seems to be, still a question. Call an explain everything. Have them call your audi.

Edited

Thank you. I have the contract from her and she calls it an “evaluation fee” in the contract. In comparison to a 10% restocking fee, $200.00 doesn’t seem so bad. I called the insurance and they basically don’t seem to care other than to say what they will pay. I guess if I want to pay more on top of what they pay, they are okay with it. I might call again and see if there is someone I can report her to. It really doesn’t seem that what she is doing is far.

Hope you at least got a kiss while they were screwing you… so, I’m confused is your insurance no co-pay or a max amount?

In reply to @plasticmary

@plasticmary said:

I called the insurance and they basically don’t seem to care other than to say what they will pay.

Not trying to be a jerk here, but why should they care? it is not their money. There is only one person in the whole word who cares about you and your money. That person has to look after you. No one else will do it. You know who that person is, look in the mirror.

@plasticmary said:

I might call again and see if there is someone I can report her to. It really doesn’t seem that what she is doing is far.

Report what? There is nothing illegal or unethical going on. You were told up front what the cost are, and you chose to go with it. What you are describing is exactly how Healthcare works in the USA. That is how the Laws and Policy are set up. No it is not fair, neither is life. But there are other ways. There is just no Instruction manual, you have to do the work yourself. No one else will do it for you. I know, I just went through it myself without Insurance, so you are lucky you have that. You just worked with the wrong person and took the wrong route IMO.

God Bless

Dereck

That’s true in my case but a contract is a contract. Healthcare providers will set acceptable prices to be charged and identify what you will only pay as a copay or percentage of the accepted charge. If the contract states that 5K is all they will pay and all other costs are yours including evaluation fees then fine but that’s the big unknown in this case. My agreement with Widex says restocking fee. The testing and evaluations were paid for by insurance. Outside of that, everything was my choice to accept. Evaluation is being treated like a medical copay which should be covered already. I would have no problem with the insurance company capping their cost at 5K and if you can get the aids you need without any additional on you then great but in this case you have to go where they send you. I doubt you could save money elsewhere and get the same premium aids at 100% your cost. The industry as a whole is a ripoff but what choice do we have.

What sounds fishy is this: If an insurance company is going to give you $5,000 toward the cost of hearing aids, why would they care where you go or what aids you get when the excess cost is yours.

Yet… they have a contract with certain dispensers. Why? What’s their benefit in doing so and yours?

Insurance companies contract with providers who are willing to accept the terms of limited payment for services. This arrangement provides customers for healthcare providers while, at the same time, saving money for the patients. Services, along with medical devices should be determined by a doctor. If you need something to correct a medical condition, the cost for both the provider and the patient is determined. This is the standard norm.

What’s going on here is a mystery, especially having to go to only one of two places for hearing aids when a 5K limit (assuming that’s correct) is imposed or allowed. Just makes no sense. You could go to Costco perhaps and save yourself and the insurance company some money. There more to this than what we know.

In reply to @dereckbc

SHOP AROUND!!!, and see if they won’t price match. I had to deal with them without insurance. I took a bath the first time, when that happens you tend to wise up in a hurry. At least I did.

In reply to @RUSS-SHETTLE

@RUSS-SHETTLE said:

What sounds fishy is this: If an insurance company is going to give you $5,000 toward the cost of hearing aids, why would they care where you go or what aids you get when the excess cost is yours.

Yet… they have a contract with certain dispensers. Why? What’s their benefit in doing so and yours?

Insurance companies contract with providers who are willing to accept the terms of limited payment for services. This arrangement provides customers for healthcare providers while, at the same time, saving money for the patients. Services, along with medical devices should be determined by a doctor. If you need something to correct a medical condition, the cost for both the provider and the patient is determined. This is the standard norm.

What’s going on here is a mystery, especially having to go to only one of two places for hearing aids when a 5K limit (assuming that’s correct) is imposed or allowed. Just makes no sense. You could go to Costco perhaps and save yourself and the insurance company some money. There more to this than what we know.

I was thinking the same thing. Any insurance company that tells you who you have to go to is setting themselves up to be scammed by the doctor, audiologist, , etc. unless they have an agreement with the practice to only pay x number of $ for a particular aid and get whatever they can from the patient. With a $5,000 limit the person selling the ’s could jack up the price to the patient by basically whatever they want and tell the patient that they are getting a deal and if they are a first time wearer or not a good shopper they will pay more than they would of from someone out of network or just get ripped off big time. These kind of audiologist are the ones who give all the rest of them a bad name. We wonder why the cost of medical insurance has increased at such a drastic rate over the last decade, perhaps this is a prime example of why it has done so.

@seb said:

Any insurance company that tells you who you have to go to is setting themselves up to be scammed by the doctor, audiologist, HIS, etc. unless they have an agreement with the practice to only pay x number of $ for a particular aid and get whatever they can from the patient.

Insurance carriers are not dumb, they know exactly what they are doing and the cost.

@dereckbc said:

Insurance carriers are not dumb, they know exactly what they are doing and the cost.

They may know the cost, but in the end they are screwing the patient, because the patient ends up paying more than they should of since they are paying their share of the cost on an drastically inflated figure. If the insurance Co. were smart they would let the patient go to someplace like Costco and both party’s would save money.

Who decides if it is a “drastically inflated figure”? If it’s the going rate among private audis then that’s what it is. Just because Costco can sell cheaper does not mean that a private audi is overcharging. They’re different business models entirely.

That is true. However, it is more a business model controlled by manufacturers. No, not all or even most clinics guilty of anything other than being in a controlled business and not their control. The weaker ones that we often discuss benefit from that.

It’s too late for me to save because I’m new to and didn’t learn about Costco in time. What I still don’t know is if Costco could have fit me up with aids comparable to my Widex Unique 330s given my profound hearing loss. I’ll know next time what to do and what to ask and where to go.

In reply to @KenP

What sounds fishy is this: If an insurance company is going to give you $5,000 toward the cost of hearing aids, why would they care where you go or what aids you get when the excess cost is yours.

Not all of them do. My provider has an agreement with Amplifon and there are some perks if you go to an Amplifon associated clinic including discount pricing. But I did not have to use Amplifon in order to get the full provided coverage. What you don’t get is the perks and discount pricing. I ended up going to a non affiliated clinic that I believed was superior to the others I researched. All the perks were the same but the discount price was gone and it did cost me 1200 out of pocket.

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