Hearing Aid Health Insurance 101 With Dr. Jill Copley

Insurance and hearing aids don’t always speak the same language and that gap can cost you time, money, and a lot of peace of mind. We sit down to translate the basics of hearing aid insurance coverage so you can walk into your next audiology visit knowing what to ask, what to expect, and how to avoid the most common billing surprises.

We break down the five big buckets of coverage people run into: Medicare, Medicaid, commercial health insurance, military insurance like TRICARE, and workers’ compensation. We also tackle the myths we hear every week on the commercial side, especially the belief that plans cover either nothing or everything. The reality is often somewhere in the middle, and we explain how terms like medically necessary can shape what level of hearing technology your plan supports and what happens if you decide to upgrade beyond the allowed benefit.

From there, we get practical about the numbers: deductibles, copays, coinsurance, allowed amounts, and maximum out-of-pocket. We also explain why some plans require referrals or prior authorizations, and how that can affect timing for fittings, including common situations where medical records have to be sent in before approval. Finally, we share how our clinic verifies benefits ahead of time and uses clear written waivers so you understand your costs before you commit.

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To learn more about Total Hearing Care visit:
https://www.TotalHearingCare.com

Total Hearing Care
Multiple Locations Across the DFW Metroplex
(469) 809-4487

Transcript

Welcome And What To Expect

SPEAKER_00 0:00

Welcome to the Total Hearing Care Difference, where we help you experience life through better hearing. Hosted by the Experts of Total Hearing Care, a leading private audiology practice serving the DFW Metroplex, we are here to provide guidance on hearing loss, tinnitus, and the latest advancements in audiology. Transform your life through better hearing. Let's get started.

The Five Insurance Types Explained

SPEAKER_01 0:28

Insurance and hearing aids don't always speak the same language, but understanding the basics can save patients confusion, stress, and a lot of money. Welcome back, everyone. I'm Sophia Yvette, co-host and producer back in the studio with Dr. Jill Copley. Dr. Copley, it is lovely to be back on here with you today. Now, I know insurance can feel overwhelming for anyone trying to understand what's covered and what isn't. Can you walk us through hearing aid, health insurance 101 and what patients really need to know?

SPEAKER_02 1:03

Yes, so like you said, this can be a confusing and complicated topic. So I'll try to make this kind of general for everybody out there. Um, but certainly things will be specific if we check your insurance. Um, there are about five different kinds of insurance, and one of them is Medicare. Now, Medicare does not have hearing aid coverage on it. So that that kind of is easy. There it's kind of a none none. And then there's Medicaid, and Medicaid insurance is kind of determined by the state. And primarily in most states, it will cover hearing aids for children, sometimes for adults. There's also commercial insurance, which we'll be talking about most of the time. There is military insurance, like TRICARE, and sometimes TRICARE will have benefits for veterans. And then there's workers' compensation. So workers' compensation is if they will pay for services if you have an injury on the job. And sometimes you could have a hearing loss due to working um like in an industrial setting, or sometimes police officers from shooting um guns and things like that. But we're gonna go, we're gonna talk mostly about commercial insurance today.

SPEAKER_01 2:35

All right. Now getting deeper into commercial insurance, what is the biggest misconceptions patients have about hearing aid insurance coverages on the commercial side?

SPEAKER_02 2:48

So commercial insurance is um what you might get online in the marketplace, or what your employer is going to cover for you. And so it's kind of the most common insurance for people who are of working age. Um, typically the most common misconception is that insurance doesn't cover anything. Or on the opposite side, it could be that people think it is shouldn't should cover everything. Um, and it might be somewhere in the middle. So when we check benefits, one of the things we're doing is asking if there is hearing aid insurance. Hearing aid insurance will typically cover something called medically necessary insurance or um services. And that means typically they don't pay for the best products, but they don't pay for the least expensive products either. They're usually somewhere in the middle. And then we can have people, if they want to upgrade, um, we will let them know and they can sign a waiver saying that they understand that they're upgrading and they'd have to pay the difference.

Deductibles Copays And Allowances

SPEAKER_01 3:58

Wow. Now let's get into some more about those deductibles, co-pays, and maximum allowances. What does it typically uh look like for hearing aids?

SPEAKER_02 4:11

So with insurance, typically you will have um a deductible, and a deductible is an amount that you pay before the benefits kind of kick in and start. And so with most insurance, you when you have a deductible, that deductible needs to be met first, and hearing aids will typically go towards that deductible. So if you have um$4,000 in hearing aid benefits, but you have a$4,000 deductible, that$4,000 would go towards your deductible and you'd complete your deductible for the year. So then everything else would fall under either coinsurance, which is after your deductible is met, there's a certain percentage that you pay until you reach a maximum out of pocket. And I can go into that further detail later. Um, but the other type is typically something with an HMO. And HMOs um require you to have a physician that refers you for specialists versus a PPO, which you don't need referrals as long as you go to somebody in network. So with an HMO, often it's just a copay. So we'll have people that their benefit is 100% up to an allowed amount. So the insurance company determines how much they'll pay, but they just have to pay a copay, like$60,$100, or something like that. So it really depends on which type of insurance you have.

Medical Necessity And Authorizations

SPEAKER_01 5:50

So since we're keeping things more generalized right now, you know, generally speaking, what role does documentation or medical necessity play in getting coverage approved?

SPEAKER_02 6:05

So that's a great question, too. It and again, it depends on the insurance. So a lot of times, at least for us in Texas, because each state is different and each state can create their own rules. Um, for us in Texas, typically, unless it is an HMO, we really don't have to have an authorization or referral. But I'll give you an example of a common one where we do have to have authorization and medical records sent in, and that is the federal Blue Cross Blue Shield. So that's the most common insurance for federal employees, and they do require us to send in medical records and get an authorization. So that means that typically we can try to fit hearing aids the same day you come in, but with federal blue cross blue shield, we cannot do that. We have to wait for the authorization to come back and then we can fit you. So that's a common one. Workers comp, I mentioned, also requires authorizations and requires medical records to be sent in.

SPEAKER_01 7:10

Now, final question for you today: how can clinics help patients avoid surprise out-of-pocket costs?

SPEAKER_02 7:19

So, one of the things we do is we actually check the insurance before you come in, or hopefully before you come in, and try to explain the benefits. Now, again, it can be complicated, but we try to kind of give you a sense of what you would owe out of pocket before you come in. We also, and I mentioned that people can upgrade above what their insurance might pay. And we have a form, a waiver that you have to sign where we explain what the difference in that cost would be. We get your, excuse me, verification that you understand what you're going to have to pay above and beyond what your insurance would give. So we want to be very clear about that. Um, and so I think it's as easy as that. You know, we we want to let you know it has to be written down. We need you to sign something that you understand it. And um, we also want to make sure you understand what your costs are going to be before you actually determine if you want to purchase anything.

SPEAKER_01 8:22

Well, Dr. Copley, thank you for simplifying something that can feel so complicated for so many people. This kind of clarity really helps patients make confident decisions. We'll see you next time. Thank you so much.

SPEAKER_00 8:39

Thank you for listening to the Total Hearing Care Difference. If you're in the DFW Metroplex and ready to take the next step toward better hearing, call 469-809-4487 to book an appointment. Or visit totalhearingcare dot com because when you hear better, you live better. See you next time.