Medical Clearance for GM BC/BS

Jeffrey Sirianni audioman at HCTC.NET
Sat Nov 15 15:30:05 EST 1997


At 12:44 AM 11/1/97 -0600, you wrote:
>Jeffrey Sirianni asked:
>
>> 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.

Paul aka HearWHAC <hearwhac at netins.net> responds:

>What would be the difference between an audiologist/dealer paying for
>the physician's clearance, and an optician paying for the optometrist's
>examination? I believe this is done frequently.

I agree with you partially, although I am still "uneasy" with the whole
idea.  I guess "uneasy" is a better word than "against" since your argument
is well stated and logical (business-wise).  I guess my problem is that if
insurance companies set a policy that a patient must pay for the medical
clearance in order to keep unnecessary fittings from occuring, the practice
of an audiologist/dispenser paying the medical clearance charge is
bypassing the regulatory process.  BTW, both of the patients (husband and
wife) admit that they do not use their hearing aids obtained from the ME
dispenser, but know that they are "entitled" to a new aid every three
years, so gosh darn it they're going to go and get them.

I do partly disagree with the analogy between the audiologist/dispenser
paying for medical clearance for a hearing aid with that of the optician
paying a optmetrist for an eye exam.  When someone has a small amount of
optical difficulty seeing or reading, a pair of glasses could provide much
more benefit than a hearing aid would to someone with a minimum amount of
hearing loss who is not really motivated to wear a hearing aid faithfully.

Another problem that I have is that persons who have obtained a hearing aid
via the "I don't have to pay anything" method, who does not wear it will
send bad signals to those in the community who actually need hearing aids.
Those people in real need will hear "well I got a hearing aid from my GM
BC/BS plan, but I don't wear it" and will assume that hearing aids are not
beneficial.  It seems to me that the audiologist/dispenser may be making
good money from GM retirees by providing cost-free fittings, but can do
tremendous harm to the industry itself.  The counter argument here is that
if you have lots of non-users out there in your community it can be
self-destructive in that a person will hear "I got a hearing aid through
ABC Hearing Aids, did not have to pay anything, but don't wear it." As a
result, others in the community will get a poor perception in ABC Hearing
Aids.  Sounds self-detructive, but if you're doing lots of GM BC/BS
business, you can make a living off it without really caring about the
image of the industry.

>I can't come up with a reason why this would be illegal. The insurance
>company would not care. (Believe it or not, insurance companies are glad
>to provide a new aid every three years. It makes them look good and
>costs are really not that important to them.) Why would it be unethical?
>Hey, the guy/gal is providing an "extra" service - paying the cost of
>the doctor's visit. And what would be the conflict of interest?  Jeff,
>this is an interesting question. I suspect the answer is, "It is okay to
>do this because there is no rule or law prohibiting it." But I'm sure my
>comments will generate other comments.

The problem is that insurance companies audit their practices and modify
them on a regular basis to stay profittable.  Such insurance companies may
cut the benefits if they become too costly and as a result, the people in
real need of the benfit lose out.

I do agree that it is not illegical, but destructive to the H-I'ed.

>Now, if you asked, "Is this an intelligent business practice?" my answer
>would be, "Absolutely not!" The insurance programs pay so little, I know
>of no reason to a) solicit anybody or b) discount hearing aids (which is
>what paying the doctor's fee is) more than what the insurance companies
>are willing to pay. If somebody is stupid enough to do this, hey, it's a
>free country. (I noticed a check came into our office today for a little
>more than $600 from BC/BS of Michigan - for "Payment in Full" for a
>hearing aid. Needless to say, if we were paid this amount for every
>hearing aid we dispensed in our practice - and if we had to go through
>all the paperwork, agony, sweat, waiting, lousy cash flow, etc. we would
>have to greatly reduce the quality of our work. Insurance hearing aids
>are not too good a deal, believe me. But not everybody gets the
>"privilege" of writing the checks to pay the expenses in a hearing aid
>practice.)

I can only think of one way that a franchise audilogist/dispenser can make
out better than an independent audiologist/dispenser.  We all know about
discounts and invoicing and how they relate to insurance re-imbursement at
"invoice cost".  Perhaps franchise audiologists/dispensers can arrange
"better" invoices than independent audiologists/dispenser, regardless of
how illegical this is.

Jeff


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