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Thread: First time shopping for a hearing aid? Your reactions?

  1. #41
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    Buying aids through a health plan seems to be a morass. In most health care government guidelines fix actual costs via medicare and medicaid but those prices melt if you don't have health insurance. In hearing aids it is worse. The simple fact is that insurers make claims and true cost opaque. It is just more obvious with aids.

    What is billed/allowed and what is actually paid are vastly different things.

    Good luck!
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  2. #42

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    Kenji didn't you was an insurance expert.. Does this shit come in your dreams!
    ?

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    Quote Originally Posted by Johnohamma View Post
    Wanted to share my first experience buying. First time looking for an aid. My aud suggested an Opn 2 for $2000 but no insurance (Epic) Went to the closest Epic referred provider 45 miles away. Showed them my test results, they put a Starkey Halo i2400 on me (first time I ever tried one). Have to say it was great, severe tinnitus disappeared by 85 %. Quoted me a price of 2745. Had the Wells Fargo form all set to go. Said they don't do Epic, but do a $1000 "discount" from 3900, whatever that means

    Held off, called Epic who said Epic pricing should be 2400 and my United Healthcare insurance would kick in too and and the provider had to abide. Called back the provider and they said they never received the referral (??) and no we don't do that. WTF. Very confusing for a first time buyer. Now on to the next Epic provider....
    Does Epic allow out-of-network providers? I assume that Epic referred providers here means in-network providers only.

    I also bought my OPN1s through my insurance plan (ACN). ACN allow either in-network or out-of-network providers. Except for in-network they'll cover 95% (I pay 5%), and for out-of-network they pay 70% (I pay 30%). I worked with an audi who's not in the ACN network initially. In order to keep me from going to an in-network provider, she said I'd only have to pay her the 5% (as I would with an in-network) and she'll just take the 70% from ACN. Basically she gets 25% less than the 95% an in-network would to keep my business.

    When she submitted the claim to ACN she jacked the price up from $6,200 (quoted to me where my 5% is based on) to $7,200 (quoted to ACN). Of course ACN was having none of that price quote (70% of $7,200 is $5,040) so they began negotiating. Finally she accepted a payment of $3,700 from ACN. That along with my $310 means she got paid $4,010 for the 2 OPN1s.

    What I learned from this is that the reason ACN agrees to pay more (95%) to in-network providers is most likely because they have more control over pricing for in-netowrk and the in-network providers can't charge them anything they want, they must agree to the established in-network pricing guidelines. Since ACN has less control over the pricing for out-of-network, they only pay 70% instead of 95% to mitigate the lack of pricing control for the out-of-network providers. Even then, they won't agree to any price quote. There is a R&C (reasonable & customary) clause for out-of-network price quotes. This gives them leeway to negotiate higher price quotes down to a more reasonable price level before they accept.

    So the reason your second guy with the Starkey Halo would rather give you the $1K discount instead of going through Epic is probably because they can still make more money even with the $1K discount than if they had to be subjected to the Epic pricing as in-network Epic providers. That's why Epic was telling you that the Starkey guy had to abide by the Epic pricing because he's the Epic in-network provider.
    Last edited by Volusiano; 07-01-2017 at 02:05 PM.
    HA wearer since the 1990's > Rexton Insite+ CIC (2011-2016) > Oticon OPN RITE (2016)

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