Understanding Managed Care Insurance Programs for Hearing Aids
Dr. Shopovick explains the shift from direct insurance benefits for hearing aids to managed care insurance programs. In the past, direct benefits allowed patients to use both in-network and out-of-network providers with varying coverage percentages (e.g., 70% for in-network, 50% for out-of-network). This system gave clinics flexibility to provide the best hearing aids based on patient needs.
However, by 2024, many insurers now use third-party companies, creating managed care programs that primarily benefit the insurance companies by cutting costs. These programs restrict patients to in-network providers and limit hearing aid options based on contracts, often leading to reduced patient care. For instance, United Healthcare Hearing doesn’t cover the new Oticon Intent hearing aids, limiting patient access to premium technology. Dr. Shopovick advises researching Medicare Advantage plans to see if they involve managed care, as it can affect the quality of care.
How Managed Care Insurance Programs Affect Your Hearing Aid Coverage
“Hey everyone, it’s Dr. Shopovick, and today we are going to be going over managed care insurance programs.
So before we dive into that, back in the day before managed care, most insurance benefits were direct. So this means that you could use this benefit with an in-network provider or an out of network provider. So just as an example, if you were to see an in-network provider, your insurance, your hearing aid benefit, may cover 70% towards a pair of aids and then you would be responsible for that 30%. Or, if you see an out of network provider, they may only cover 50% of the cost of the aids and you would be responsible for the remainder 50%.
Now these direct benefits are a win-win for the patient and the clinic because our hands are not tied to what hearing aids we need to fit, what models we can fit, what level of technology- we have free range with these direct benefits to fit the product that is best for our patients based on their hearing loss and their specific listening needs.
So fast forward to 2024, most insurances have gone away with that direct hearing aid benefit and they now contract with these third party companies and they kind of created this managed care program. And these managed care programs are really only a win for the insurance because they are the ones saving money by doing this and it comes at the cost of best patient care.
So what these managed programs your insurance is basically telling you is if you want to use this managed care benefit you have to see a provider that is only in-network, so not every provider in your area will be in-network with this third party program. So that’s one issue. Another issue is that these managed care programs really tie our hands in giving best patient care because insurance dictates what brand of hearing aids we can sell, the model, the technology level, so it’s not in the best interest of the patient. And just as an example, United Healthcare Hearing is one of the managed care programs, and the new Oticon Intent hearing aids that just came out a few months ago, they are not on that contract, which means if a patient is interested in getting that premium Oticon technology, it is not available for their managed care program which is unfortunate if someone is looking to get that premium best technology device.
So when you are picking your Medicare advantage plan or just going through that, make sure you do your research to see if your benefit is a managed care or third party benefit because it may impact the care that you receive for your hearing. But if you have any other questions, feel free to visit our website at NowHearThisClinic.com and I hope you guys learned a little bit about managed care programs today.”
