I’m getting back in the market for new Oticon More hearing aids. However, I’m unable to find an Audiologist who is in network for hearing aids coverage in the NJ area. My insurance provider Aetna Meritain covers the cost of the hearing aids fully which is an incredible perk that I’ve never had and would like to take advantage of.
However, when looking online and having visited multiple audiologists, these audiologists are in network but only for hearing exams and not for buying hearing aids. The websites for the insurance company do not specify this distinction. How does one find audiologists that are in network? I’ve called numerous audiologists and they all say yes but when we talk numbers in person, I am blindsided. I prefer to work with a professional rather than DIY for lower maintenance but this bait and switch is becoming a hassle.
I’d call the insurance company and ask for names of audiologists that are fully in network. If they can’t give you any or the one give is an unreasonable distance away, (assuming this is employer provided insurance) I’d contact your HR department and explain that the benefit is not as described.
This is the issue with much hearing aid insurance.
While I get my aids from the VA, my wife’s insurance does cover aids. We live in Central Arkansas, in a community of retired people, with audiologist by the numbers but none will deal with the insurance companies that serve Arkansas.
I talking to my VA Audiologist he said he left private practice and went to the VA because he can make more money from a VA salary, and his teaching job at the university than he could in his own private practice because the insurance companies never paid what they calmed they would, and he had to do all Medicare hearing test for almost no pay.
And don’t try to say he as a bad Audiologist because I haven’t had a better one in my 16 years with aids.
I bought my current Oticon hearing aids from an outfit called ZipHearing.com and they had audiologists in my area with whom they worked. They handled the insurance paperwork for me. Turned out to be the audiologist they pointed me toward was one I was going to go to anyway! You might look into that avenue.
Unfortunately this is not uncommon. Often times insurance companies provide a ‘benefit’ but have few providers they choose to work with, or price their reimbursement such that providers choose not to work with them. Ultimately it does indeed boil down to the profit motive.
I too, have a lot more I could say on this subject but will forgo lest I to get myself in trouble with the forum.
@gkumar: Thus far, I haven’t been able to find anything other than terrible reviews for Aetna Meritain. Apparently, Meritain is running interference for Aetna as the outsourced claims adjuster. They do Aetna’s dirty work of denying claims, saving the insurer a lot of money.
A legitimate audiologist is not going to want to risk doing business with them if they believe that they’re going to get stiffed, at the end of the day.
There are tips in some of the negative reviews with how to deal with them, but the prognosis isn’t good
Before giving up, yelling at both the carrier and filing an official complaint with HR can help break up the logjam. No company liked to find out they paid for a policy that doesn’t meet their employees needs, especially if it’s something they flat out claim to offer, and for all you know, your company paid extra for.
You can also complain to your state department of insurance. Almost all states have specific requirements that a plan offering x service to enrollees must demonstrate a sufficient number of providers to make that service available. You can’t just start up a benefit of “we cover your dental needs”but have no participating dentists. And if a provider has a contract with the carrier, the carrier can compel the provider to, we’ll, provide the care.
HAs aren’t cheap. I’d exhaust all avenues before folding and laying out a few thousand dollars you may well not have to spend. Of course if you hate the providers, assuming they are credentialed are licensed, well then it’s your choice to reject the coverage. I’ve certainly done that if I wanted a particular doctor not in their network. But that was my choice. They had the same specialists, I just didn’t want them.
My healthcare provider has a contract with Truhearing. I contacted Truhearing and they set me up with a local HearUSA audiologist. This audiologist sells Signia hearing aids and know nothing about Phonak. Called Truhearing again and they set me up with another local truhearing audiologist. The second audiologist called truhearing and she told me that l can’t opt out of my healthcare provider hearing aid benefit. My healthcare provider hearing aid benefit is the private brand Truhearing hearing aids advanced or premium hearing aids made by Signia. None of the Truhearing hearing aids were powerful enough for my profound hearing loss. I had to pay for my new Phonak Paradise P70 UP aids from an online hearing aid seller.
@gkumar: I suggest that you search for “Aetna Meritain reviews” for yourself and decide which links seem credible to you.
(I use DuckDuckGo as my search engine: may give different results than Google or Bing).
[EDIT: Further “Quacking” (using DuckDuckGo) reveals that Meritain is a wholly-owned subsidiary of Aetna Insurance. Glassdoor and other sites that compile information on Meritain as a place to work describe “a small company stuck inside a big company”, with high staff turnover and a generally stressful work environment.
Once again, I urge you to take a role in your own education about Meritain, because - as is true with any internet search - I or anyone else could select links that paint Meritain as excellent or abominable. I believe that Quacking search results are more objective than would be the case with Googling, but this is also something you should discover for yourself.]
I tried Hearing Life and also a private audiologist. Seems like Aetba Meritain advertises they cover 100% of coverage for hearing aids every two years to patients, but to providers they cap that 100% to some $XK amount like $1K based on some contracted rate that’s not public. This basically forces the provider to decline insurance services although they are in network or pass down the non trivial costs to the patient.
Has anyone convinced the payer to remove this contracted cap for the provider given its been difficult to find an in network Audiologist in the local area of NJ?
The best advice was to call the insurance company I’m curious what they’re answer is. Then ask what exactly does 100 percent mean. Do they cover 100 percent of the aids or is the audiologist required to charge a certain price, well below normal price and they cover all of the reduced price