As an audiologist, I work with patients with hearing loss on a daily basis. Hearing loss is among the most common health problems worldwide, affecting millions.
It's no secret that healthcare can be expensive, including hearing aids and hearing tests. But, did you know that your health insurance might cover them?
Most of the time, if your doctor's office is in the network and takes your insurance, they'll process the insurance claim for you. However, depending on your circumstances and insurance type, you may need to self-submit a claim to receive a reimbursement.
The only catch is, depending on your insurance, you may need to jump through a few hoops to receive a reimbursement.
Curious to learn more about submitting to insurance? Keep on reading and get the intel.
Where to start?
Insurance coverage differs from plan to plan. To verify your plan's benefits, you will have to be a bit of a detective.
First, check out the back of your health insurance card, where you'll find the number to call.
Ask the representative about your plan benefits. Specifically, you'll want to ask if you have hearing loss and hearing healthcare coverage, including hearing tests and hearing aids.
If there is anything you need help understanding, be sure to ask and clarify your questions. For example:
- Does your policy include coverage for hearing aids at any audiologist's office?
- Or, do you need to go with a specific brand?
- Do you require prior authorization for a test or procedure?
What can I do if my claim is denied?
Unfortunately, insurance claims can sometimes be denied even when you've done everything right.
Knowing your insurance policy and understanding claim rejections is vital. If you're unsure, contact the provider and clarify your options.
Understanding your insurance policy and why your claim has been rejected is crucial. If you're unsure or disapprove of the decision, ask your insurance provider about your options for the next steps.
Sometimes, a few clarifications from your hearing provider may be enough to approve the claim. With some effort from your end, your hearing provider can help get your claim approved.
Common Reasons Claims are Denied
Insurance troubles? Denied claims? Don't fret!
Knowing your insurance policy and understanding claim rejections is critical. If you're unsure, just contact the provider and clarify your options.
But with some effort and persistence, your hearing provider can help get your claim approved.
It can be frustrating when your claim is denied. ASHA offers this helpful resource for those dealing with claim denial.
Consider these common reasons for the denial to help you prepare and prevent a denial.
Common Reasons Claims Are Denied:
- Information is incomplete, missing, or incorrect.
- Treatment or service is not deemed medically necessary.
- Treatment or service is not a covered benefit in your plan.
- Prior authorization was not sought (when required by insurance).
Can I self-submit a claim for an OTC hearing aid?
Every health insurance plan is different.
While most plans do not cover OTC devices, two brands are more likely to work with your health insurance: Eargo and MDHearing.
If you have supplemental hearing benefits through NationsBenefits, Eargo hearing aids will likely work with your hearing benefit. Similarly, MDHearing has partnered with MedLine and is working on expanding hearing healthcare, including OTC hearing devices like MDHearing, as of 2024.
Final Thoughts
Self-submitting a claim for your hearing aids or hearing test may seem daunting, but it's essential for reducing costs and getting the reimbursement you deserve.
Points to remember:
- Submission requirements can vary by the insurance provider.
- Making sure the claim is legible, accurate, and including supporting documents is critical.
If you find the process overwhelming, feel free to seek help from your hearing care provider or insurance provider. With a bit of patience, you'll be on your way to getting the coverage that you need for hearing healthcare.
