Audiology Services, Hearing Aids, and Health Insurance

It has been said, “When you have your health, you have everything. When you don’t have your health, nothing else matters at all.” No truer words have been spoken.

Every one of us has either been confronted with a health issue or known someone who has. With approximately 304 million Americans (over 92%), insurance coverage is mostly the same, but the monthly premium may vary along with the out-of-pocket costs for everyone.

Typically, most, but not all, insurance carriers cover audiology services. When you have trouble with your ears, hearing, and balance, a board certified & licensed audiologist in private practice is the professional you need to see.

Audiologists are the primary medical professionals who evaluate, diagnose, treat, and manage hearing loss and balance disorders in individuals. They may work in a variety of settings including private practice, hospitals, schools, military, clinics, universities, and veterans’ administration. This professional holds a Doctorate in Audiology (Au.D.), Ph.D. or Sc.D. In addition, board certification and continuing education is required. Audiologists are licensed by the Pennsylvania Department of State Bureau of Professional and Occupational Affairs.

For the board certified & licensed audiologist in private practice, these people operate a business just like your family doctor, other medical specialists, or hospital. Services rendered by an audiologist are neither free nor associated in dispensing hearing aids. Services are billed to your insurance carrier for processing, approval, and payment. Any amount approved and applied to your annual deductible, coinsurance, and copay are the responsibility of the policyholder – YOU.

Usually, services provided and billed by a private practice audiologist include, but are not limited to these CPT codes and descriptions:

  • 99215 – Comprehensive Office Visit
  • 92557 – Complete Audiogram (pure tone and speech)
  • 92563 – Tone Decay
  • 92550 – Impedance Testing (tympanometry and reflex testing)
  • 92588 – Distortion Product Otoacoustic Emissions
  • 92625 – Tinnitus Evaluation (if applicable)

These codes and services are recognized and approved by most all insurance companies.

Recently, I encountered an individual who was under the mistaken impression that audiology services are free when purchasing hearing aids. Their stance was hearing aids cost money and nothing needed to be paid for audiology. This is far from the truth and an embarrassing and lingering fallacy propagated by hearing aid dealers long ago. Hearing aid sales and services are separate from and not associated with audiology services.

Hearing aid dealers and those who dispense and fit devices are required to have a Hearing Aid Dealers Registration with the Pennsylvania Department of Health.

Even though hearing aids may be available from a private practice audiologist, there are others who may supply them. These devices are available from store front retailers, big box stores, mail order, etc. The issue with the latter group is that these individuals do not have a Doctorate in Audiology, not Board Certified, not Licensed in Audiology, are not required to have a formal education in the area for evaluating, diagnosing, treating, and managing hearing loss. The two critical components a patient must have is a complete audiological evaluation and, when fitted with amplification, continuing follow up services for adjustments, counseling, and aural rehabilitation. That latter group performs a screening (not an evaluation), do a first fit to get the devices on your ears, and do not have the education to ensure the proper follow up as an audiologist will do. This group is not permitted to bill insurance for audiology services.

When you decide to acquire hearing health care services, do so with a private practice audiologist. Know that these services are provided by a professional with a doctorate. Inquire with your insurance carrier as to the coverage for the previously listed codes and descriptions. When you are seen by an audiologist, these medical services will be billed to your insurance carrier because they come under audiology services and they must be paid for; they are not free. A copy of your primary insurance card must be provided to the audiologist at the time of your visit. If hearing aids are purchased and fitted, payment for these devices is often out-of-pocket, not covered by insurance, or related to audiology services.

Please avoid embarrassment and confusion. Be aware of the differences with audiology services, hearing aids, and health insurance.