Aetna coverage

My insurance states that I have HA coverage up to a fairly high $$ level. BUT the providers state they only get reimbursed for about 25% of the cost and I am out of pocket for the rest. Has anyone had success with Aetna paying what their policy claims they would pay?
Thanks for the help, I am new to this forum and would be a first time user.

I had Aetna when I got my aids last year. Group coverage through my company.
Aetna paid $3950.00. My out of pocket was $2150.00.
My HIS got a pre-qualification from Aetna so I knew up front what they would pay.
My HIS was out of network. I was told by Aetna that they would pay 80% of a max $5500.00 benefit to an in network dispenser, however, the closest in network for me was 250 miles away.
Aetna paid my HIS directly.

Bogey,

Yes, I’ve had success with Aetna. My insurance stated they covered 100% and nearly every provider I went to was extremely hesitant to respond in a positive way when I told them that. Based on their experience, most insurance companies never pay what they say they will pay.

However, what I did was choose an Audi that used HearPO. It required me to pay up front out of my own pocket, but the discounts in doing so were quite amazing…the aid I got was $1,400 cheaper than every Audi I asked. Thus, when it came time to file the claim, Aetna paid it in full, including accessories.

The great thing about HA and the way it works is you can buy them, file the claim immediately, see what Aetna does, then just return them if they screw you over by paying less. Just be sure to find an Audi who offers at LEAST a 45 day trial since claims can take up to 30 days to process.

Thanks. I was thinking of going directly to Starkey and having them fitted there. Does anyone know if they have the same return policy? I’m looking at the IICs, and from all I’ve ready, a key component to having success with them is getting them fitted correctly. Most of the places by me don’t seem enthused or experienced with them.
Thanks again.

Insurance is just a game you have to play… know exactly what they pay and be sure to go to a in network provider. At least where I use to work if there was no in network Doc within a county surrounding my county of employment then they would play an out of network provider as in network. Go to you benefits department and explain what you need they will I’m sure forward you to their contact at Aetna… now get everyone’s name and document who, when, what was said and ask them to send you a letter (or email). Then have an in network provider get you pre-approved and you will know exactly where you stand. Trying to game the insurance and return sometime they have paid for might get a little sticky.

The only way to win with insurance companies is be presistant… (but polite)

Depends upon your policy, I guess. I have Aetna and have zero coverage but they did set me up with HearPO so I saved a bunch anyway.

I think Starkey only works through their professionals. I do not think they will sell directly to the end user.

Actually they will, but unless you live in the twin cities it may not be a very good idea. Google “Starkey Center for Excellence” for additional information. The gist of it is that if you make a donation to the Starkey Hearing Foundation they will give you a free pair of their current high end aids and fit you with them at the Center for Excellence (in Minnesota).
Of course, most people would prefer not to have to travel back to Minnesota each time they need an adjustment. If the concept of the CFE interests you it’s worth nothing that if you buy Starkey aids locally and then were to travel to Minnesota the CFE would service your aids at no charge. From an expertise/service-standpoint the CFE isn’t really any better or worse than most of the other established clinics I’ve seen, but some folks are attracted to the concept and they do serve visitors free lunch in their cafeteria.

As an aside, the CFE has had a surprising effect on the sale of Starkey aids in Minnesota. Being a Minnesota company you’d think they’d be quite popular here! Actually, most clinics within the Twin Cities (with the exception of “All American Hearing”-clinics, which are a subsidiary of Starkey) prefer not to fit the brand because they don’t like that Starkey is directly competing with them in a way that devalues their high-end model.

I had spoken to starkey. What intrigued me was the thought that they would have more expertise in taking the impressions for their own IICs.
What is annoying is how hard it is to get a straight answer from Aetna. I realize any reimbursement is better than nothing, but their claims of how much they cover, ( in my case up to $5k), is very misleading.
Thanks again for all the comments and suggestions.

Do they do this for Micro Tech aids too? I think they use the same address.

Yes, last I checked they would service any of their brands and I recall seeing a patient with Micro Tech aids being serviced. I should also add that as far as servicing patients (who obtained their Starkey aids elsewhere) the normal path was for the provider to contact Starkey’s CFE to setup an appointment for the patient. The idea here was that if a local provider was having trouble satisfying the patient then the CFE would do their best to resolve the problem
Benefits would include (generally) same-day in-warranty repairs and they make shells for custom products on-site so physical fit issues can be corrected before the patient leaves the center (good for patients with hard to fit ears).

Potential drawbacks include:
(Unless you’re one of their “celebrity” clients – Bill Austin and his staff have fit a lot of famous people) You may find yourself waiting at the CFE MUCH longer for service than you would at a traditional clinic, depending on how busy they are that day.
Very high-volume atmosphere so although the staff is friendly they’re not likely to recognize you from visit to visit and recall the specific challenges you’re working through, other than going by patient notes.
Their philosophy on how hearing aids should be programmed and fit is a little more “traditional.” In discussing their approach with them I’m satisfied they have well thought out reasons for doing things the way they do. With that said, their approach differs from mine (and probably from the majority of professionals fitting hearing aids today).

That is one case where (if you’re in Minnesota) I would recommend buying your hearing aids locally and being referred to the CFE for the fitting. DO NOT BUY YOUR HEARING AIDS DIRECTLY FROM THE CFE (VIA DONATION) UNLESS YOU PLAN TO RETURN THERE FOR ALL OF YOUR SERVICE.
IICs require deep impressions, which I’m comfortable with, but many in our profession aren’t used to taking.

With that said, if you came to me I’d probably spend 20 minutes addressing your reasons for wanting IICs and most likely trying to talk you out of getting them! Others may disagree, but I always felt IICs were potentially useful on marketing material (to get people in the door), but not always the optimal choice for most patients.

Thanks for your comments. I live in KC, so not local. I am in a position for the next few years where “visible” aids would be a hindrance in my profession. Thus, the IiCs.
All this being said, the lack of a straight answer about why Aetna’s policy says one thing, but reality seems to be another is frustrating.

I love my Soundlens but the impressions were incredibly painful.

Jeff,
Good to read that someone is having success with them. Do you think the pain is part of the deal to ensure they are fitted correctly or ???
Had your audiologist had much experience in taking that deep of impression?
Thanks