BC/BS 38000 in Texas

Jeffrey Sirianni audioman at hctc.net
Wed Jun 17 14:04:32 EST 1998


To Texas Providers of Hearing Aids via BC/BS 38000:

A recent problem arose in our office that has opened a very large can of
worms.  As those of you know, the plan provides a benefit of $500 per ear
every three years (it could be five years, I'm not sure).  An informal
survey of providers I know say that they do the following for binaural
candidates:

1. Select with the patient, the devices desired.

2. Explain to the patient that BC/BS 38000 will cover the first $1000 and
that the patient is responsible for charges over $1000.  For example, if a
binaural fitting runs $2400, BC/BS 38000 will pay $1000 and the patient is
to pay the balance of $1400.

3. Fit and dispense the devices and collect $1400 from the patient.

4. At the end of the trial period (and the devices are kept), bill BC/BS
38000 for $1000.

Well a patient of mine, who has failed to pay her outstanding balance, has
made a big stink with our office and with BC/BS 38000.  Using the example
above, she agreed to pay $1400, but in two payments of $700, $700 on
delivery and $700 at the end of the trial period, which we agreed as she is
an established patient.  Hearing aids were dispensed, patient paid $700,
and we billed and collected $1000 from BC/BS 38000.

The patient has not made her second payment of $700 and this was due 6
months ago.  She was about to be sent to a collection agency when she
called our office to tell us that she looked into the BC/BS 38000 plan and
now interpreted the BC/BS benefits to cover hearing aids (the $1000
benefit) to be payment in full.  In other words, she says the $1000 benefit
is the "allowable" by BC/BS 38000 and that we cannot bill her for anything
above $1000.

Our office manager has been on the phone with the BC/BS field
representative and he has had six people in their legal department look
into this matter.  Well bad news hit today.  The field representative has
said that BC/BS will be establishing new guidelines for billing the 38000
plan, including a 10% markup over invoice cost, plus ancillary billing
codes (ie fitting and dispensing fees).  I'm not sure what the allowable
wil be, but it is a pretty lousy plan, at 10% over invoice.  It sounds to
me like they don't want us to make any money from these patients AND that
they do not put a fair dollar amount on our profesional skills and
services.  I am outraged that they are implementing such a program without
the consultation of audiologists.

PLEASE CALL YOUR LOCAL BC/BS FIELD REPRESENTATIVE AND VOICE YOUR DISMAY
OVER ANY CHANGES IN THE BC/BS 38000 PLAN, INCLUDING ANY IMPLEMENTATION OF
AN ALLOWABLE, ESPECIALLY AT SUCH A CUT RATE.

Comments please from BC/BS 38000 providers....

Jeff


***************************************************
* Jeff Sirianni, M.A., CCC-A                      *
* Sound Advice / R.G. Delaney, M.D.               *
* 710 Water Street / Suite 404                    *
* Kerrville, TX  78028                            *
*                                                 *
* (830) 896-1433                                  *
* (830) 896-1440 FAX                              *
*                                                 *
* audioman at hctc.net                               *
*                                                 *
* Discussion Leader of bionet.audiology Newsgroup *
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