Serving patients in Wakefield, MA and Wilmington, MA
The Children’s Hearing Aid Bill was intended to help families purchase hearing aids for their children. The bill provides one hearing aid every three years for hearing-impaired children in the state of Massachusetts, as well as payment for hearing tests, fittings, adjustments, and other related supplies prescribed by a licensed audiologist.
Unfortunately, there are loopholes in the bill that hearing providers and patients need to be aware of. The loopholes are not legislative, but are based on the Massachusetts Division of Insurance and individual insurance company policies.
Your Child May Not Be Covered by the Children’s Hearing Aid Bill
The first problem with the bill is that insurance plans that are self-funded by companies are not required to follow the mandate. Many businesses hire insurance companies to administer their claims. For example, Tufts may just administer a plan, so a family “thinks” they have Tufts Coverage because all the claims are submitted to Tufts. If you work for a large corporation, it is wise to check your provider with the human resources office.
Also, if an insurance plan is administered outside of Massachusetts, they are not required to follow the mandate. Some people have plans where claims are submitted to another state for processing (i.e. BCBS NJ). There may still be a level of benefit if those states also have a mandate, but it won’t necessarily be the same as Massachusetts.
Another problem is that the patient benefit is not the same as the allowable amount for each service or product. Some insurance plans insist that providers accept a discounted rate for reimbursement. If an audiologist bills the insurance company $2000 for a hearing aid, in all likelihood they will not receive the full $2000 from the insurance company. Insurance companies may discount that $2000 charge by up to 20%. Some patients will receive as little as $542 for two hearing aids after billing the insurance company $4000, leaving them to make up the difference on their own.
The other tricky thing is that insurance companies are applying this new mandate differently. Families and providers have called insurance companies to try to understand the reimbursement rates. However, what the families and providers are told on the phone prior to the purchase seem to have little to do with the reimbursement check that is sent to the provider—and sometimes families get a bill for a larger share of the cost than they were originally told.
Finally, almost every insurance policy has an individual and family deductible amounts. Most of the amounts range from $500 – $2000 per person. Co-pays are also in effect, placing more of the burden of payment on the patient. To make matters worse, some charitable organizations that have helped families purchase aids have stopped funding these efforts because they assumed that children are now covered by the Children’s Hearing Aid Bill.
At Atlantic Audiology, our goal is to make purchasing a hearing aid as painless as possible. Our board-certified audiologists help patients of all ages find the right device at a price point that works for them, and can find all available ways for you to finance your new device. Call the number on this page or fill out our online contact form to make an appointment today!