Hearing loss is a common problem that occurs gradually as people age (presbycusis). Aging and chronic exposure to loud noises are significant factors that directly contribute to hearing loss. Other causes of hearing loss include damage to the inner ear, excessive build-up of ear wax, ear infection and abnormal bone growths or tumors and ruptured eardrum (tympanic membrane perforation). Treatment for this condition depends on the cause and severity of your hearing loss and includes using hearing aids, removing wax blockage, cochlear implants and other surgical procedures. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), one in five people with a hearing loss actually wear hearing aids. One of the common questions asked by people who purchase new hearing aids is related to its insurance coverage. Since insurance plans differ, hearing aid insurance verification is a challenging task which can be handled efficiently by experienced audiology insurance verification companies. With about 48 million Americans (20% of the adult U.S. population) living with some form of hearing loss, the demand for hearing aids is also on the rise. Let’s discuss some of the frequently asked questions and answers about medical insurance verification and reimbursement for hearing aids –
Q: Will my health insurance cover hearing aids?
A: Medicare does not provide for routine hearing evaluation or for evaluation for the purpose of adjusting hearing aids. They will only pay for a hearing evaluation if your physician provides a referral and determines it to be medically necessary. For instance, if you have suffered hearing loss because of an accident or workplace neglect, Medicare may pay for most or all costs of a hearing aid, provided you are able to prove the same. Medicaid often covers hearing aids, but the coverage may vary from one state to another.
Nearly all private health insurance companies provide basic coverage for a comprehensive hearing evaluation which may essentially include hearing loss evaluation (type and degree of hearing loss), hearing tests and hearing aids. However, the extent of coverage varies greatly between insurance providers and may depend on the type of plan opted. For instance, the Empire Plan has $1,500.00 coverage per ear toward hearing aids, and this renews every four years. Therefore, it is always best to check with your insurance authorization company to find out the extent of coverage areas for your plan.
Q: What types of hearing aids and services are covered, including the criteria for coverage?
A: Coverage is offered for new, non-refurbished, monaural or binaural hearing aids, which include ear molds, ear impressions, batteries, special fittings and replacement parts for eligible clients aged 21 years and older. In addition, the hearing aid must meet the client’s specific hearing needs and be covered for repairs under warranty for a minimum of one year. Services covered are related to hearing aid selection, dispensing, fitting, repairs and checks following dispensing.
Q: What is not covered?
A: Coverage is not offered for hearing aid-related items and services such as the following for clients aged 21 years and older –
- Tinnitus maskers
- Group screenings for hearing loss
- Replacement hearing aid batteries and ear molds
- FM systems, including computer-aided hearing devices for FM systems
- Pocket talkers or similar devices
- Duplicate hearing aid(s) for use as a back-up
- Replacement hearing aids for items that have been – damaged or destroyed by user misuse, abuse or carelessness, lost or stolen
- Disposable hearing aids, non-electronic hearing aids, battery chargers
Q: What are the prior-authorization or prior-approval requirements for using hearing aids?
A: Hearing aids for children and adults are approved through the automated electronic dispensing validation System (DVS). A DVS is submitted in real time and checks the service limits on the procedure code requested including – frequency, units and age. If service limits are not exceeded, an immediate authorization number is returned. If service limits are exceeded, a prior approval must be requested.
In most cases, a hearing aid DVS authorization will be granted for an approved period of service of 180 days, and can be cancelled by the provider within 90 days of the authorization date. Prior-approval is required for –
- Binaural hearing aids for persons aged 21 years and older
- Special ear fittings
- Replacement of hearing aids for frequency limits
- Replacement of one aid when the beneficiary wears two
- Repairs costing $70 or more
Q: What are the documentation requirements for hearing aids?
A: The documentation requirements for hearing aids will vary and depend on the type of insurer and may include –
- Physician’s medical clearance stating no contraindication for hearing aid use
- Psycho-social statement indicating the recipient’s ability to use and care for hearing aids, and indication whether they will be assisted by a care-giver
- Audiologic recommendations – written recommendation for hearing aids (including manufacturer specifications and follow up plan for determining effectiveness of the hearing aid use)
- History of previous appliance use – including model, serial number, ear worn, year dispensed, history of repair and status of current hearing aid
- Audiogram – air and bone thresholds, speech thresholds, word recognition ability scores for both ears
- If requesting monaural fit – indicate which ear is being fit
- If requesting binaural fit (or replacement of one aid when the beneficiary wears two), provide supporting documentation to verify recipient’s qualification for binaural use
- If requesting a repair of hearing aid – make a description of the current condition of hearing aid and indicate what repairs are being done
- If hearing aid is above 5 years old, clearly indicate the reason for repair rather than replacement
Q: What are the insurance eligibility considerations for patients using hearing aids?
A: The insurance eligibility verification for hearing aids must cover the following points –
- Patients aged 20 years and younger who are receiving services under any medical assistance program
- Must have a complete hearing evaluation, including an audiogram, sound field speech audiometry or equivalent testing methods performed under the supervision of supervision of an otolaryngologist or licensed audiologist.
- A written recommendation by a licensed audiologist, otorhinolaryngologist or otologist for a hearing aid and which should include the results of pure tone and speech (clinical) audiometry conducted in a sound treated room and/or test suite meeting the American National Standard Institute’s specifications.
- Hearing aids must be dispensed within six months of the date of the recommendation
Q: Who are the eligible providers for hearing aids?
A: Eligible providers include audiologists, hearing aid service providers, otolaryngologists and outpatient hospitals, clinics, and other health care providers who employ audiologists, otolaryngologists and/or hearing instrument dispensers.
Q: What hearing screening services are offered to patients below 21 years of age?
A: Providers offer the following services to patients below 21 years of age –
- Newborn Hearing Screening – Maternity hospitals and birthing centers must screen newborns for hearing loss before discharge. Those infants who fail these screening tests must be referred for audiological evaluation as soon as possible.
- Hearing Screening for Children below 21 years – Children below 3 years of age must follow the most recent version of American Academy of Pediatrics’ (AAP) recommendations for Preventive Pediatric Health Care for age-specific intervals at which subjective history and/or routine standardized hearing testing should be performed. If these test findings indicate hearing loss or any other hearing problems should be directly referred to age appropriate hearing testing.
Q: Are hearing aid costs tax-deductible?
A: The Internal Revenue Service (IRS) has listed hearing aids and hearing aid batteries among the medical devices eligible for a tax-deduction. In addition to the cost of the hearing aid, you can deduct for the audiology visits and tests needed to obtain the device.
Insurance verification for hearing aids is extensive. Outsourcing audiology insurance verification services to professional providers could help in this regard ensuring that the patient is fully covered for the prescribed device.
To learn more about Audiology Insurance Verification read our blog on 9 July 2018, Audiology Insurance Verification to Avoid Reimbursement Pitfalls.