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I have insurance...now what?

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I have very good insurance through my district. My coverage reads 90% coverage for in network. I spoke to the plan administrator office today and they told me “one hearing aid per ear” but I think it is “one hearing aid per year”. They did not budge and kept repeating one per ear.

I don’t know what their contracted prices are that they base the 90% on. five years ago, I went shopping for hearing aids and was apalled at the $6,000 or so price tags. I ended up at Costco and real happy with their hearing aids at less than $3000 per pair. I had no insurance coveerage at that time. Now I am back at square one, as I am replacing receivers on my Rexon hearing aids too often and Costco says I am due for a new pair. My insurance covers 50% out of network but only one per calendar year and Costco’s latest hearing aid is only sold in pairs.

I hate the thought of going to an in-network provider only to have it be a come’on or a bait and switch kind of deal. I am in Orange County CA. My insurance is covered by an outfit called Pinnacle Claims Management. Blue Cross claims that I am not a member of theirs, but Pinnacle uses the Blue Cross website to show me providers and coverage. I work for an enterprise of around 30,000 members.

Any recommendations for a company that would give the straight scoop in my area? If I am able to get only one per calendar year, I want one in December and one in January. The insurance is OK with that but Costco only wants to sell me a pair of their new 5.0’s.

Sorry to be so long-winded.

Thanks in advance,

Mirko

4 people in this conversation8 min readJump to latest
Edited

I think you might be misunderstanding your benefit. Your insurance must have a book of benefits that specifically states whether hearing aids are covered and lists the benefit. For example, I have Regence Blue Cross/Blue Shield and they cover $2500 every three years. No co-pay, no deductible, no network. I went to Costco and got my aids, then submitted a claim form with my receipt to Blue Cross. Thats it.

is there a website for your insurance where you can look at the details of your benefit coverage? That’s where I would go first.

I went back and read my coverage. I had been reading one per year, when in fact it reads one HA per “ear”. The coverage is as follows:

HEARING AIDS FOR EMPLOYEES ONLY:
MAXIMUM BENEFIT PER CALENDAR YEAR - 1 HEARING AID PER EAR. IMPLANTABLE
HEARING DEVICES - NOT A COVERED EXPENSE.
PAID BY PLAN AFTER DEDUCTIBLE:
IN-NETWORK - 90%
OUT-OF-NETWORK - 60% (1)

COINSURANCE, UNLESS OTHERWISE STATED BELOW:
PAID BY PLAN AFTER SATISFACTION OF
DEDUCTIBLE 90% 60% (1)
(1) PLAN PAYMENTS FOR OUT-OF-NETWORK SERVICES ARE SUBJECT TO U&C FEE
ALLOWANCES. WHEN USING OUT-OF-NETWORK SERVICES, COVERED PERSONS ARE
RESPONSIBLE FOR ANY DIFFERENCE BETWEEN THE ELIGIBLE EXPENSE AND ACTUAL
CHARGES, AS WELL AS ANY DEDUCTIBLE AND COINSURANCE.

I have met my deductible so it looks like they will pay 60% (of a known quantity) at Costco, out of network, o 90% somewhere else in network. I have always been happy with Costco and I inclined to stay there even if I pay a higher percentage. I have a friend the has recently gone to a private audiologist and been happy with her services through insurance so I am consulting with him as well.

I am looking at the new Kirkland Signature HA at $1,899 and they sound pretty good. Costco also carries Rexton, ReSound and Bernafon according to their webpage. The Kirkland has remote but in fact I have never used remote in 5 years even though I always have it in my pocket.

Any opinions on Costco HAs or whether I should consider going somewhere else?

Thanks in advance,

Mirko

Edited

Yes I agree it looks like you are interpreting your coverage correctly. I understand most insurance companies dont cover hearing aids at all, so your coverage seems quite good.

Its really going to come down to which hearing aid you prefer and cost/benefit. 40% of $1899 is $760 out of pocket for the KS 5.0. That same $760 at a private audiologist gets you $7600 hearing aids (well, maybe less since you will pay 10% of all expenses - exam, consultation, etc.).

Either way, you’ll get a top of the line hearing aid for just a few hundred dollars. That’s not a bad deal at all!

FWIW, I’m wearing my KS 5.0 hearing aids right now and I’m very pleased with them.

@palmfish said:

Yes I agree it looks like you are interpreting your coverage correctly. I understand most insurance companies dont cover hearing aids at all, so your coverage seems quite good.

Its really going to come down to which hearing aid you prefer and cost/benefit. 40% of $1899 is $760 out of pocket for the KS 5.0. That same $760 at a private audiologist gets you $7600 hearing aids (well, maybe less since you will pay 10% of all expenses - exam, consultation, etc.).

Either way, you’ll get a top of the line hearing aid for just a few hundred dollars. That’s not a bad deal at all!

FWIW, I’m wearing my KS 5.0 hearing aids right now and I’m very pleased with them.

The big question is when will the insurance companies that have coverage that cover ’s come to their senses and realize they will save a bunch of money by paying for HA’s bought at Costco or Sam’s Club?

Maybe you can buy now at Costco, and reimburse one now, one in Jan?

Costco makes you pay anyhow, then seek your own insurance reimbursement.

And, ?! Maybe it’s one per EAR.

Elijah

@mirkee said:

I have very good insurance through my district. My coverage reads 90% coverage for in network. I spoke to the plan administrator office today and they told me “one hearing aid per ear” but I think it is “one hearing aid per year”. They did not budge and kept repeating one per ear.

I don’t know what their contracted prices are that they base the 90% on. five years ago, I went shopping for hearing aids and was apalled at the $6,000 or so price tags. I ended up at Costco and real happy with their hearing aids at less than $3000 per pair. I had no insurance coveerage at that time. Now I am back at square one, as I am replacing receivers on my Rexon hearing aids too often and Costco says I am due for a new pair. My insurance covers 50% out of network but only one per calendar year and Costco’s latest hearing aid is only sold in pairs.

I hate the thought of going to an in-network provider only to have it be a come’on or a bait and switch kind of deal. I am in Orange County CA. My insurance is covered by an outfit called Pinnacle Claims Management. Blue Cross claims that I am not a member of theirs, but Pinnacle uses the Blue Cross website to show me providers and coverage. I work for an enterprise of around 30,000 members.

Any recommendations for a company that would give the straight scoop in my area? If I am able to get only one per calendar year, I want one in December and one in January. The insurance is OK with that but Costco only wants to sell me a pair of their new 5.0’s.

Sorry to be so long-winded.

Thanks in advance,

Mirko

In reply to @mirkee

Costco rocks

Ks5 is very good.

Elijah

@mirkee said:

I went back and read my coverage. I had been reading one HA per year, when in fact it reads one HA per “ear”. The coverage is as follows:

HEARING AIDS FOR EMPLOYEES ONLY:
MAXIMUM BENEFIT PER CALENDAR YEAR - 1 HEARING AID PER EAR. IMPLANTABLE
HEARING DEVICES - NOT A COVERED EXPENSE.
PAID BY PLAN AFTER DEDUCTIBLE:
IN-NETWORK - 90%
OUT-OF-NETWORK - 60% (1)

COINSURANCE, UNLESS OTHERWISE STATED BELOW:
PAID BY PLAN AFTER SATISFACTION OF
DEDUCTIBLE 90% 60% (1)
(1) PLAN PAYMENTS FOR OUT-OF-NETWORK SERVICES ARE SUBJECT TO U&C FEE
ALLOWANCES. WHEN USING OUT-OF-NETWORK SERVICES, COVERED PERSONS ARE
RESPONSIBLE FOR ANY DIFFERENCE BETWEEN THE ELIGIBLE EXPENSE AND ACTUAL
CHARGES, AS WELL AS ANY DEDUCTIBLE AND COINSURANCE.

I have met my deductible so it looks like they will pay 60% (of a known quantity) at Costco, out of network, o 90% somewhere else in network. I have always been happy with Costco and I inclined to stay there even if I pay a higher percentage. I have a friend the has recently gone to a private audiologist and been happy with her services through insurance so I am consulting with him as well.

I am looking at the new Kirkland Signature HA at $1,899 and they sound pretty good. Costco also carries Rexton, ReSound and Bernafon according to their webpage. The Kirkland has remote but in fact I have never used remote in 5 years even though I always have it in my pocket.

Any opinions on Costco HAs or whether I should consider going somewhere else?

Thanks in advance,

Mirko

It is indeed one per ear, so the claim for a pair is no longer an issue. My old policy was one per year, hence the confussion on my part. I dread the thought of having to deal with other audis. My experience with Costco for five years has been very pleasant. Wish I could go to another audi that would make it short and sweet, like Costco. A few dollars either way don’t really matter.

Edited

You really have a win-win situation knowing that your cost will be more or less the same whether you go with a private audiologist or Costco. You can research in-network audiologists at your leisure and visit a few to see how they treat you, what products they offer, and how much it will cost and compare them to Costco.

It’s your quality of life and it’s worth shopping around not only for the best price, but also the best care. My opinion anyways…

In reply to @seb

@seb said:

The big question is when will the insurance companies that have coverage that cover HA’s come to their senses and realize they will save a bunch of money by paying for HA’s bought at Costco or Sam’s Club?

Some do understand Seb. Like I mentioned, Blue Cross has a flat $2500 allowance every three years. No co-pay, no deductible, no network. Nothing. Just buy them and submit a claim for reimbursement.

This not only saves Blue Cross money because $2500 is a lot less than them paying 90% of $7000, but it also encourages consumers to shop around knowing that they are paying out of pocket for any costs above the allowance. If my benefit was more like Mirko’s, I might have never gone to Costco knowing that I’m on the hook for only 10%.

@palmfish said:

Some do understand Seb. Like I mentioned, Blue Cross has a flat $2500 allowance every three years. No co-pay, no deductible, no network. Nothing. Just buy them and submit a claim for reimbursement.

This not only saves Blue Cross money because $2500 is a lot less than them paying 90% of $7000, but it also encourages consumers to shop around knowing that they are paying out of pocket for any costs above the allowance. If my benefit was more like Mirko’s, I might have never gone to Costco knowing that I’m on the hook for only 10%.

True. But Mirko is going to Costco based on the quality treatment I have received there for the past six years. I have thought about it and figured I will spend the difference between 10% of $5,000+ and 40% of $2,800 by having to pay for adjustments, cleanings etc. over the next five years, or at least 4 out of those 5 years. Besides, I have 4 Costcos within 20 minutes of my home in North Orange County, CA. It’s just more convenient and less stressful for me. Looks like the Rexton Quintra 18’s for me. Read my post elsewhere about my experience visiting three different Costcos, including two doday.

@mirkee said:

True. But Mirko is going to Costco based on the quality treatment I have received there for the past six years. I have thought about it and figured I will spend the difference between 10% of $5,000+ and 40% of $2,800 by having to pay for adjustments, cleanings etc. over the next five years, or at least 4 out of those 5 years. Besides, I have 4 Costcos within 20 minutes of my home in North Orange County, CA. It’s just more convenient and less stressful for me. Looks like the Rexton Quintra 18’s for me. Read my post elsewhere about my experience visiting three different Costcos, including two doday.

I wasnt putting Costco down Mirko. I was pointing out that not everyone knows that Costco even sells hearing aids and they certainly dont know how significantly more affordable they are nor how high quality the service is. 90% sounds so much better than 60% so for many the thought of going to Costco will never enter their mind, and that’s a shame.

I have done the 60% vs. 90% calculations in my head so much I’m getting dizzy. The 90% is just not real transparent. If I feel unconfortable about a transaction I just walk out and I’m afraid of that hapenning with 90% in-network local audiologist. Costco is transparent. I’m just going on experience and gut feeling. I understand you were not putting Costco down as I have read enough of your posts to know better. I hope you did not take it that way. Thank you all for all your help and advice. I’m not affiliated with Costco in any way.

You might like alsip magistrate, somewhere south of LA

He writes a lot on pissedconsumer.com2 Hearing aids

I like what he writes.

← Previous 21 of 186 Hearing Aids Reviews Next →
Company Hearing Aids
Location Huntington Beach, California
Category Eye and Ear Care
Views 25
http://www.pissedconsumer.com/reviews-by-company/hearing-aids/hearing-aids-its-not-the-hearing-aid-manufacturer-its-the-hearing-aid-dispenser-attitude-skill-exper-20080623124980.html

I have noticed over the past year that everyone that complains, always seems to blame the Manufacturer of the Hearing Aids.

It has been my experience, over the past 25 years, that there is little or no difference in the quality of hearing aids, or for that matter, in the difference in the features and options, and actually in the performance of the products.

The Warranty Provisions may be different, but usually they aren’t.

Some Manufacturers are more flexible and lienent in the performance of all their policies, but usually not that different.

Some Customer Service Personnel, usually dependent upon how much experience they have in the Industry, may be more understanding and flexible.

Some Employees know more about Industry Policies and Practices than others, and some have even had experience in dispensing Hearing Aids, which always has an influence in their thought process,and understanding.

They all have a sense of whats fair.

The Hearing Aid Manufacturers all make as fine as Product than can be produced. What they really are, are Product Assemblers.

They buy Component Parts, and put Hearing Aids together.

Then they market, and sell them.

Most of the Complaints, and Comments, that I have read on this Blog, are not really with Product Failure, but with Poor Customer Service, or unethical or immoral practices, by Hearing Aid Providers.

There is 10 times the difference in Hearing Aid Dispensers, as there is in Hearing Aid Manufacturers.

I am talking about Experience,Integrity,Compassion,Empathy, Communication Skills,and technical qualifications?.

Hearing Aid Purchasers should really spend their time seeking out Qualified Honest Dispensers, than concerning themselves with the Product?.

There is a Dramatic Difference in Hearing Aid Providers, and that is the Challenge".

Search, and research…

Interview the Dispenser…

Do you feel comfortable with the Dispenser?

Do you trust Him or Her?

Do you trust the Organization dispensing the Aids?

What is your gut feelings?

Have you sought referrals?

Buyer Beware and concentrate on the right areas, not the product?.

Here he writes…

Any questions call toll free: (800) 432-7114 TELL US IF YOU TRY HIM elijah

Alsip Magistrate 4357a0

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