Wiki Proper billing/collection for hearing aids

[leeannatk]

This is a new area for me - one of our pediatric ENT groups has in-house audiology and is providing hearing aids and associated care. Up until this point the policy has been that we bill only medicaid directly and with all third party payers require the patient to pay up front and then they may submit to their carrier for remibursement. The one exception is patients that are enrolled in early steps and we do bill their third party carrier and then submit the denial or minimal reimbursement and Early steps pays the cost.
We recently had a patient who paid for thier HA then submitted the claim to Aetna (we are contracted with them). Aetna now wants us to accept the allowable and reimburse the patient the balance.

I'm a bit lost on this one. Thoughts?

Lee Ann, CPC

 

[kvangoor]

It depends on your contract with them. Most third party payers do not include hearing aids in their contracted fees so you are able to balance bill. The EOB may list a write off but you are not obligated to take that unless your contract mentions hearing aids. I would check with your Aetna rep. or your contracting dept.