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BC/BS 38000 in Texas

martin martin at minot.com
Wed Jun 17 14:04:36 EST 1998

I just went through a like concern with BC/BS of North Dakota.
They will pay a max of $3000.00 for hearing aids over a three year period.
The cost of digital technology is much more than this. They have informed me
that I was allowed to bill the pt. for the balance.
I do not know if this will be helpful or not.
Larry G. Martin, MA, CCC-A Audiologist
-----Original Message-----
From: Jeffrey Sirianni <audioman at hctc.net>
To: ASHA Listserve <asha-aud-forum at postman.com>; bionet.audiology
<audiolog at net.bio.net>
Date: Tuesday, June 16, 1998 10:39 PM
Subject: BC/BS 38000 in Texas

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