Medical Clearance for GM BC/BS

Jeffrey Sirianni audioman at HCTC.NET
Fri Oct 31 02:10:03 EST 1997


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


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* Jeff Sirianni, M.A., CCC-A                      *
* Sound Advice / R.G. Delaney, M.D.               *
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* audioman at hctc.net                               *
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