On January 6th 2016, notice was issued by the UAW Retiree Medical Benefits Trust indicating significant changes in the hearing benefit for UAW members utilizing health insurance through BCBS Traditional Care Network, Blue Cross Blue Shield PPO, Humana Traditional Care Network, and Humana (Non-Medicare) PPO. The members impacted are the UAW-GM Retirees and the UAW-Chrysler Retirees. These changes are not effective for HMO and Medicare Advantage plans.
Summary of Changes
Effective March 1, 2016 these members will AUTOMATICALLY be enrolled in the Audionet America hearing program and will no longer have benefits administered directly by Blue Cross Blue Shield. The members are REQUIRED to use the Audionet network providers to receive covered benefits.
Participants may utilize current BCBS or Humana benefits now and in March they will be able to utilize the new Audionet benefit even if they utilized the BCBS or Humana benefit within the last 36 months.
Similar to the current benefit program for UAW-Ford Retirees and UAW-GM Active Employees, the new benefit will provide up to (2) Mid-Level standard digital hearing aids covered in full once every 36 months when using an Audionet provider. Charges for maintenance, fittings, and follow-up visits is covered in the provider fee for the first 6 months and then a $20 co-pay applies for all on-going care visits. Plan co-pays and levels vary by group. The UAW GM-Retirees benefit is notably different than the other plan structures. Please visit the Audionet website for details.
Audionet Amercia is an Audiologist only network. To become an Audionet provider, all independent audiologists must partner through an existing network.
· American Hearing Benefits (AHB): Product selection limited to 3 manufacturers. (Starkey, NuEar, Audibel)
· Beltone: Only open to Beltone Operators.
· HearUSA: Product selection limited to 8 manufacturers. (Siemens, Hansaton, Rexton, Oticon, Unitron, Widex, Phonak, and Resound)
· Miracle Ear: Only Open to Miracle Ear Operators.
· YourHearingNetwork: Product selection limited to four manufacturers. (Oticon, Phonak, Sonic Innovations, and Widex.)
Further Information from the Michigan Audiology Coalition
Choosing to join one of the Audionet network affiliates or decline these patients is an important decision. With the initial introduction of the Ford Retiree plan through AHB, providers were required use product from only one manufacturer regardless of patient need. With the current Audionet program, that requirement is no longer in place. The plan has provided up to 8 different manufacturers you can utilize to meet patient needs depending on which network you choose to work with to obtain products. The remaining on-going concern is the reduced overall reimbursement to the provider. Attached here are some FAQs that may help you.
Choosing not to participate will remove these patients from your practice.
· This change could allow you to focus your practice on private pay patients and/or other insurance groups.
· Some patients may choose to forego the new benefit to remain with a provider they prefer.
Choosing to participate will open or keep open your practice to all UAW members.
· It is likely you will see an increase in patients to audiology practices with reduced per patient revenue.
· It may require that you modify your practice schedule to increase the quantity of patients you see each day/week/month to maintain your planned revenue growth.
· The increased revenue will not be associated with product costs allowing your margin to grow, but requiring higher patient volume.
If you choose to participate or if you already do, please note the following.
Access to Care - The announced changes to the UAW retirees benefit has the potential to significantly impact patients and audiology providers. Be prepared to add patients to your practice and provide support and guidance for patients changing providers.
· The Audiologist Only requirement of the plan will limit the involvement of Hearing Aid Dealers in the participant’s care. This may increase the patient volume of audiology practices.
· Patients may be required to change providers to obtain benefit through the Audionet network.
Reduced per unit reimbursement – Network provider reimbursement usually comes in the way of dispensing fees. This means that individual practices will lose the larger revenue of the hearing aid unit (and its accompanying cost of goods) and begin to see an increase in service fee revenue. This change can be very positive for the practice’s margin.
Open the door to Fee for Service – All of the Audionet plans cover service fees for 6 months from the fitting. After 6 months, you can and should begin charging a $20 co-pay for follow-up and maintenance services. It is important to charge the co-pay to each recipient consistently. Also, you will want to update your warranty statements and/or invoice statements for these patients to indicate the $20 co-pay after the 6 month period. This will alleviate most patient complaints when they start experiencing a fee for service model.