Rhode Island State Mandate
Rhode Island is fortunate enough to have a mandate regarding hearing aid coverage. Adults have a minimal benefit of $700 per ear.
Important to know:
- This is a *state* mandate. It does not apply to plans such as Medicare and Medicare supplemental plans as these are federal.
- Deductibles and co-insurances apply
Federal Employee Blue Cross
Typically patients with FEP insurance have a $2500 benefit toward the purchase of hearing instruments..
BCBS – URI
Patients with BCBS Health coverage who work at URI typically have a $4000 benefit toward the purchase of hearing instruments.
Our position regarding Managed Care Plans (such as NationsHearing, TruHearing, EPIC…)
There have been many commercials advertising that health insurance companies are beginning to cover hearing aids. With treatment cost being such a big concern in hearing health care, we understand this seems like great news. Treating hearing loss can mean an investment in the thousands of dollars. Insurance companies know this, too, and the result is that hearing aid coverage is rare for adults leaving the patient to pay out of pocket or go untreated.
When considering if signing up for one of these plans is something you want to sign up for it is important to find out what they are actually offering. Is it a traditional benefit or is it a third-party company providing the coverage?
A traditional benefit is when a health care provider provides a service to a patient, the provider submits for payment for those services and the insurance company pays the provider directly.
Third parties have offered insurance companies a way to provide hearing aids or hearing aid discounts to their insured. Often, these benefits look like they are being provided by the insurer, but in reality, the insurer contracts with a third party that the patient must go through in order to receive discounts or specific pricing. The patient will generally pay the third party directly for the hearing aids and the third party then pays the audiologist a fixed fee to fit and service the hearing aids for a specific amount of time. The third party contracts directly with hearing aid manufacturers which allows them to obtain discounts for purchasing hearing aids in bulk. Sometimes the third party and the hearing aid company are owned by the SAME parent company (for example, Sivantos owns TruHearing and Signia). These entities limit the professional care provided to patients because they only allow patients to see a provider that has enrolled in their program. They may also limit the number of visits provided and require patients to select from a limited list of equipment that may fail to fit their specific needs and lifestyle. Furthermore, if an audiologist is being paid a low, fixed reimbursement rate, they may have to sacrifice the quality of care in order to make the fitting financially feasible.
Unfortunately, the fixed fee offered to audiologists for their role with a third party doesn’t allow for a sustainable business (most of the money remains with the third party and the manufacturer). Your local audiology practice also isn’t likely to be able to secure the same bulk discounts from the manufacturer as the third party. Successful hearing aid outcomes require professional expertise, aural rehabilitation, and adherence to best practice guidelines, including verification of the fitting measured in the patient’s ear canal with calibrated verification equipment.
At South County Hearing Services our mission is to help patients stay connected and live strong by improving their ability to communicate to the best of their ability. We are a small business with a strong commitment to making sure that every patient receives the amount of care necessary in order to achieve success. In order for us to be able to maintain our standards for care, we do not participate in any third-party entities.
Our pricing is structured in such a way that patients only pay for the care they need and we make every effort to keep our charges reasonable. We will continue to evaluate the third-party programs. If they evolve and do not require us to compromise the care we give our patients we will reconsider our position of not participating.
