Medical Clearance for GM BC/BS

Frank M Butts fbutts at hsc.vcu.edu
Sat Nov 1 12:51:07 EST 1997


On Fri, 31 Oct 1997, Jeffrey Sirianni wrote:

> Thanks one and all for responding to my inquiry on defining a "standard
> hearing aid" as provided as a benefit for some GM retirees with BC/BS.
> 
> My next question/story stems for a situation that arose last week in the
> office and I would like to share my experience with everyone and gather
> responses and comments.
> 
> I have a couple in my practice (one ENT, one audiologist) who are retired
> GM employees with BC/BS.  The husband is Medicare (disabled) plus BC/BS,
> while the wife is BC/BS only.  They have received several hearing aids a
> piece through their years as an employee/retiree of GM from a Miracle Ear
> dealer.
> 
> When this couple called to set up their appointments to see about getting
> new hearing aids, it was my understanding that a medical clearance was
> required by BC/BS as a prerequisite to hearing aid acquisition.  This was
> verified by a call to the BC/BS office.  I saw both patients one morning
> and each was given a medical clearance by the ENT.  The man's office visit
> for ENT services was covered under his Medicare plan, while the woman's was
> not covered by her BC/BS plan.  (We had a gentleman about a year ago who
> knew that his GM policy would pay for the hearing aid, but not the ENT
> office visit for hearing aid clearance).
> 
> Here's where the story gets interesting.  The woman called back the next
> day mad that we charged her for an ENT office visit for medical clearance
> saying that the Miracle Ear dealer in Indiana never charged her a cent for
> getting a hearing aid.  She did say that the dealer "made arrangements"
> with a local physician for medical clearance to which she went to see
> him/her, but was not charged for his/her ENT medical services.  The woman
> also gave us the name of the Miracle Ear dealer in Indiana.  When we called
> that dealer asking how someone could receive medical clearance without
> paying for the office visit, the dealer got irrate with us and hung up the
> phone.
> 
> It is my understanding that BC/BS does not pay for the office visit in
> order to curb "needless" acquisition of hearing aids.  I would guess that a
> person having such a plan would not pay the ENT office visit fee if a
> hearing aid is not really needed.  From what I'm getting from this story,
> the hearing aid dealer in Indiana, who by the way calls every three years
> when it is time to get a new hearing aid, pays the physician his/her office
> fee for his client's medical clearance as a way of getting people to get
> hearing aids without paying anything at all, which breaks the measures set
> up by BC/BS to curb needless hearing aid acquisitions.
> 
> Is this practice of the dealer paying for medical clearance accepted /
> legal / ethical / a conflict of interest?  I'm guessing that the dealer
> pays the physician fees as I know no physician who see patients for nothing.
> 
> Jeff
> 
> 
> ***************************************************
> * Jeff Sirianni, M.A., CCC-A                      *
> * Sound Advice / R.G. Delaney, M.D.               *
> * 710 Water Street / Suite 404                    *
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> * (830) 896-1433                                  *
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> *                                                 *
> * Discussion Leader of bionet.audiology Newsgroup *
> ***************************************************
> 

It is my understanding that paying for a referral violates federal and
state laws.  I'm sure the an attorny would be the best source for this
improtant question.

fbutts at gems.vcu.edu
> 




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