Best Practices Checklist

Hearing Aid Insurance FRAUD

By: Dr Cliff Olson
October 6, 2018
Video Transcript

As long as there has been insurance, there has been insurance fraud.  This happens in every industry including Hearing Healthcare.  Sometimes, this fraud is occurring right under your nose and you don’t even know it.  So I’m going to share a few stories with you about actual patients of mine who’s insurance companies just about got scammed by some Hearing Aid Dealers who didn’t follow the rules.

A few months ago, I had two patients who came to me for a second opinion on their hearing loss treatment options about a week apart from each other.  One of these patients came from a prominent ENT clinic and the other came from a large retail chain clinic.  their stories were similar.  Neither was impressed with the rushed process they went through from diagnosis to recommendation of hearing aids.  Neither understood their hearing loss, hearing aid options, or what treatment would entail.  

Just like I recommend, they decided to do some research before committing to treatment.  After becoming more informed, they both decided to pursue treatment at my clinic where my team investigated their insurance benefits.  In both cases, the insurance companies were billed for hearing aids.  My first reaction was that it must be some kind of mistake.  My second reaction was that they must have actually purchased hearing aids from these clinics.After discussing the findings of these insurance investigations with the patients, it turns out that they never pursued treatment at these clinics. It turns out, hearing aids should not be billed unless they have been fit to the patient.  Technically, this is insurance fraud.  In both cases, the patients had to open a dispute with their insurance companies.

Fortunately, both of them had their hearing aid benefits reinstated.  The bad news is, they both had to wait months to get these benefits reinstated.The scary thing is, if these patients never came to my clinic, they never would have known that their insurance was billed.  Sure, both of these patients ultimately were able to receive hearing aids from my clinic, however, insurance fraud like this on a large scale can increase insurance premiums.  Once the benefits were reinstated, both were fit with hearing aids at my clinic.  This is where the story gets more interesting.

One of the patients spent $4,000 less at my clinic compared to the original clinic who billed his insurance.  Essentially, the previous clinic was going to bill the patient more than his insurance would cover in a situation called Balanced Billing.  The previous clinic was going to bill his insurance $4,000 and charge him $4,000 for a total of $8,000.  Some insurance contracts allow for Balance Billing, others do not.  To be fair, it is unclear if the large hearing aid retail chain's contract allows for balance billing, however, the patient saved $3,400 at my clinic vs the original clinic.  

The morale of these stories is that you need to take ownership of your insurance benefits. If you get your hearing tested and decide not to pursue treatment, you should call your insurance company after several weeks to see if they were billed for treatment.If you do pursue treatment and you are asked to pay the difference, you should immediately call your insurance company and ask if you are allowed to be balance billed from that provider.  Otherwise, it won’t just be your insurance company that is a victim of fraud, it will also be you.

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