Questions About Insurance for Tinnitus and Hearing Aids
We understand how confusing insurance can be. It is for all of us – especially when dealing with reimbursement for tinnitus and/or hearing services! These challenges are not for everyone, but we are here to help you get the most out of your benefits. We have a dedicated insurance team to help navigate and determine insurance for tinnitus and hearing aids.
Below are the top insurance questions we hear every day:
Do you accept my insurance?
This is the #1 question. Most of the time, we do. The more important question is, “Does my insurance have hearing or tinnitus benefits?” Your coverage, of course, depends on if you have a benefit for hearing on your policy. From our experience, the best way to handle this is to provide us with your insurance information so that we can verify your benefit(s) to review at your first visit.
Are you “In-Network” with my health insurance?
We are considered “In-Network” with United Health Care and UMR commercial insurance plans. Out-of-network benefits are often the same as in-network benefits for audiology services.
Does it matter if you are “In-Network” with my insurance company?
The answer is probably “no”, but please understand why. Because in most cases, in- and out-of-network benefits for audiology services are the same.
That is one reason we have a dedicated insurance team. We work with your insurance on your behalf to determine what benefits you have that will apply toward treatment.
In fact, our “Out-of-Network” status has proven beneficial to our patients. In those cases, we can negotiate with the insurance company to get the most coverage possible.
Also, as an “Out-of-Network” provider, we are not tied to contracts or set rates for treatment and devices. Therefore, we can offer the best technology without any pre-determined limits.
How much is this going to cost?
Understandably, everyone wants to know how much tinnitus treatment or hearing aids will cost. For the initial evaluation, we charge $80 – $185 for tinnitus and $60 – $165 for hearing which we will bill to your insurance. In our experience, insurance companies typically pay – at least a portion – for services. We need to perform an evaluation to properly diagnose and make our recommendation.
Full testing requires approximately 60 – 90 minutes of our doctors’ time. Depending on your diagnosis and your doctor’s recommendation, we will be able to review costs. We will also be prepared to review your insurance benefits with you as it relates to our recommended treatment plan. We do not give “ballpark” figures before we see each patient and fully understand their needs.
Do you accept Medicare?
We do! However, Medicare will not cover the cost of treatment for tinnitus or hearing loss. Many Medicare supplement plans follow Medicare guidelines and therefore do not cover treatment as well.
Medicare does not cover tinnitus treatment – neither do Medicare Supplements. Medicare does not consider hearing-related disorders to be “life-threatening”. Instead, they classify audiology services as “cosmetic” or “elective procedures”. Medicare does not even have specific procedural codes for tinnitus.
Medicare will reimburse approximately $38 for an annual hearing exam. For us to submit the claim to Medicare, we must have a referral from your primary care physician (PCP) on file. We can easily give you a fax number to the clinic you wish to visit so you may request a referral from your PCP. They will usually fax a referral for you without having to visit them.
What benefit do I have with my insurance for tinnitus and hearing aids?
Commercial health insurance carriers like United Healthcare, Cigna, Anthem, etc. will typically cover an annual hearing test and/or tinnitus evaluation without a Primary Care Physician (PCP) referral. They may also have a benefit for treatment available. We will not know exactly what they cover until we check your insurance.
Effectively treating your tinnitus or hearing loss is an investment in your health, wellness, and happiness. Once your evaluation is complete, we can make a diagnosis, give our treatment recommendations, provide cost estimates, and determine how much your insurance will cover.
Click here to schedule an appointment or give us a call for more information.
Why should I trust Sound Relief Hearing Center to check my benefits and not just call my insurance carrier’s customer service line?
We are experts at audiology benefits! We understand why you need our services! We care!
We know the Current Procedural Terminology (CPT) codes and the questions to ask so that we can get the most out of your benefits. It is not uncommon for the customer service representative to just be reading a prompt based on your question and not fully understand the coverage you are looking for, or the full information that you need to make an informed decision. It is better for us to work on your behalf to see if there are any “hidden benefits”, or any alternatives to standard coverage, such as gap exceptions when our doctors write a letter of medical necessity to accompany the claim.
Audiology services are unique when it comes to insurance coverage, which is why you should trust our team to do all the work instead of you trying to decode the medical jargon they use to confuse people. We also provide everything we find in writing to our patients so there is no question regarding insurance coverage before starting treatment.
Medicare does NOT cover treatment for tinnitus or hearing loss
Many Medicare supplement plans follow this same exclusion policy. Considering this, we charge $60 – $165 for a hearing test or $80 – $185 for a tinnitus evaluation which we need to perform to properly diagnose and make our recommendations. Full testing with a diagnosis and treatment plan requires approximately 60 – 90 minutes of our doctors’ time.
Medicare will pay approximately $38 for an annual hearing exam when it is prescribed by your primary care physician (PCP) as “medically necessary”. Even if you do not require a referral for other services, you must have one specifically for a hearing exam.
Since we are a “Non-participating Medicare Provider”, we can, at your request, submit to Medicare for reimbursement of approximately $38. (We must submit this with the referral from your primary care doctor and we can NOT solicit this referral on your behalf.)
If you have Medicare and will seek reimbursement for the hearing exam, it is advised that you speak with your doctor about obtaining a referral to us before your first appointment. You will be responsible for full payment at the time of your appointment. Medicare will reimburse you directly if the claim is approved.
Why is coverage for tinnitus and hearing so bad?
Medicare classifies tinnitus and hearing aids as “non-essential”. Medicare’s position is that tinnitus and hearing loss are not “life-threatening”. Ask anyone with severe tinnitus or hearing loss if they would agree with that statement.
Unfortunately, Medicare’s classification of hearing health as a luxury instead of a need allows many commercial insurance plans to take this same position and not offer any coverage either.
Furthermore, 48 million Americans are known to have hearing loss, and only about 10 million currently own hearing devices. Tens of millions of Americans with tinnitus and decreased sound tolerance (hyperacusis and misophonia) live with these hearing disorders without seeking help. These numbers are overwhelming and may be partly why Medicare refuses to take the issue seriously.
Congress ignores this problem and recently halfheartedly attempted to remedy the situation by approving Over-the-Counter (OTC) hearing aids. Unfortunately, OTC hearing aids are not meant for people with tinnitus, decreased sound tolerance, severe hearing loss, or children. OTC hearing aids cannot provide the level of clarity, customization, and comfort that prescription hearing aids can because of their “self-fit” design.
Despite the evidence showing that hearing loss is a major modifiable risk factor as it relates to dementia, our government officials continue to do nothing. In order for change to happen, Medicare patients and commercial insurance subscribers must demand better coverage for tinnitus and hearing-related products and services. Hearing is not a luxury; it is a necessity in life and should be treated and covered as such instead of dismissed as non-essential.
Are Hearing Aids Covered by Insurance?
Hearing loss is an incredibly common health problem. According to the Centers for Disease Control and Prevention, around 37 million people suffer from hearing loss, and that number is only rising as the population ages. Hearing loss is a frustrating and expensive condition, leading many individuals to spend thousands of dollars on treatment and devices like hearing aids.
However, according to many private medical insurance providers, moderate hearing loss isn’t technically considered a disability. That’s just one of the reasons why having hearing aids covered by insurance can be a challenge.
Hearing Aid Coverage
According to the American Speech-Language-Hearing Association (ASHA), 20 states currently require health insurance companies to cover hearing aids for children. Those requirements don’t apply when it comes to adult hearing aid coverage. In some states, private insurance does cover hearing exams, but it typically does not cover hearing aids.
Currently, there are only five states that require insurance companies to provide coverage for hearing aids for both children and adults.
These are seen below:
- New Hampshire
- Rhode Island
So why don’t most insurance providers include coverage for hearing aids? They’re not considered essential medical devices. Instead, they’re deemed “elective” – chosen, rather than urgently necessary.
The Trouble with “Elective” Coverage for Hearing Aids
More than 50 percent of people over the age of 75 suffer from hearing loss, and for these individuals, hearing aids are far from elective. Hearing aids are a lifeline, helping people with hearing loss communicate with loved ones, stay sharp on the job, stay safe in everyday situations, and stave off depression and cognitive issues as they age. They can improve a person’s quality of life, affecting nearly every aspect of their day-to-day routine.
When you consider how dramatically hearing aids can influence a person’s health and happiness, it’s difficult to understand how insurers could say that they’re inessential and not worthy of insurance coverage. Unsurprisingly, the issue extends beyond whether hearing aids are necessary or elective. It’s also about risk vs. reward.
Medicare and Medicaid Coverage for Hearing Aids
We’ve discussed the fact that it’s rare to find hearing aids covered by insurance provided by private lenders, but what about Medicare and Medicaid? In most cases, hearing aids aren’t covered by Medicare, the government health program for individuals ages 65 and up. That’s because Medicare typically covers services, not devices.
There are a few Medicare Advantage plans that include hearing aid coverage; however, traditional Medicare doesn’t include any hearing aid coverage whatsoever. In addition, tinnitus (which can sometimes be treated using hearing aids) is not recognized by Medicare as “medically necessary” to treat. It is also a non-covered diagnosis for devices with major insurance companies.
Medicaid, on the other hand, often covers hearing aids, with different standards for each state. Unfortunately, this coverage typically only includes young people. For example, the Medicaid programs in Colorado and Arizona only cover hearing aids for individuals under the ages of 20 and 21, respectively. Curious about Medicaid and Medicare coverage in your state? You can find more information about coverage by state through the Department of Health and Human Services.
Does My Health Insurance Policy Cover a Trip to the Audiologist?
Once you have decided to schedule an appointment with the audiologist, you’ll still need to make sure that your visit is paid for. Many people wonder if their health insurance will cover all or some of the costs of their visit. As you know with seemingly every medical clinic, the extent that you are covered will strongly depend on the specific details contained within your policy.
Fortunately, a basic visit to a hearing center is much more affordable than many people assume. Even at some of the best audiology centers in the United States, you can expect to pay only about $60 for a standard hearing test and about $80 for a full tinnitus evaluation. Typically, the first visit to one of these clinics will take about 90 minutes. It is also important to note that if you cannot afford the cost of audiology treatment, there may be financing options available.
Is it Worth Investing in a More Extensive Health Insurance Policy?
There are some health insurance policies that will cover the cost of visiting an audiologist, the cost of hearing aids, and several other hearing-related expenses. There are also plenty of policies that will not cover any of these things. As you would probably expect, health insurance policies with more extensive coverage will usually cost more.
Hearing issues affect a very large portion of the population, meaning it may be a good idea to invest in more extensive health insurance coverage. Statistically, you are many times more likely to develop tinnitus than cancer (though treating cancer obviously costs much more).
If you are at risk of developing a hearing disorder—consistent exposure to loud sounds, advanced age, family history, etc.—investing in better coverage will be even more beneficial. Still, the decision that is in your best interest will depend on many health and financial factors that are specific to you.
We are not contracted with the following carriers
Medicaid, TriCare, VA Choice, Kaiser, Colorado Vocational Rehab.
Click here to schedule an appointment or give us a call for more information.
At Sound Relief Hearing Center, we provide hope and help to those living with tinnitus and other hearing health issues. Our patients are at the center of everything we do, and we strive to guide them to overcome their challenges by delivering innovative and compassionate healthcare.
Dr. Julie Prutsman, owner of this family-owned practice, has expanded to 8 locations across Colorado and Arizona. In 2012, she founded Sound Relief in her hometown of Highlands Ranch, Colorado and continues to foster their mission through mentorship of the brightest minds in the field of Audiology.