Nassau Audiologist: Use Your Health Benefits Before You Lose Them

As the calendar year comes to a close, one Nassau County hearing aid specialist has some words of wisdom for those who experience hearing loss: examine your benefits closely now, or risk losing out on significant savings.

“Insurance makes it so complicated for patients to understand what their benefits actually are,” said Aviva Tilson, an audiologist and founder of a hearing aid fitting and service practice I Love Hearing. “Every plan is different and carries different benefits.”

According to Tilson, December is an optimal time to check up on health insurance plans because so many of its components are time-sensitive and may reset in the new year. However, the best time to maximize a plan’s benefits can vary, depending on three factors: Health savings accounts (HSAs), Flex Spending Accounts (FSAs), and deductibles.

“One patient may only have a little money left to go through their annual deductible and can pay nothing for hearing aids, while others may maximize their benefits by buying one hearing aid this year and another next year,” Tilson said. “No matter what, don’t walk away from the benefits you’ve earned.”

HSAs and FSAs are bank accounts with tax advantages used to save and pay for out-of-pocket medical costs. When included with the health insurance plan or offered by an employer, enrollees can use the set-aside funds in an HSA or an FSA to pay for items a policy may not cover, such as hearing aids. Generally, HSAs can be rolled over year after year, while FSAs must be spent by the end of the calendar year or the benefits are lost.

“We see many patients who don’t even realize that a few dollars a month is coming out of their paycheck and going into a health savings or flex spending account,” Tilson said.

Deductibles, explained Tilson, refer to the amount of money a policy holder needs to pay out of pocket before insurance coverage kicks in. The threshold, as well as the percentage covered after the deductible is met, can vary wildly, often depending on the age of the patient and the type of policy they hold.

“Older adults generally have lower deductibles because they see more doctors, while a young person could have a deductible as high as $10,000,” Tilson said. “Additionally, some plans will only pay for a small percentage (little as 60% I would take this out as some plans only cover 30% 60% is sort of a good one )of costs after the deductible is met, while others cover much more or even the entirety of the bill.”

Depending on what type of plan a policyholder has, the payout to cover out-of-pocket items such as hearing aids could be more valuable earlier in the year than at the end of the year.

“Once December rolls around, a policy holder has already spent significantly on medical expenses that year,” Tilson said.

Tilson acknowledged that many policyholders have difficulty deciphering what is actually covered or not covered.

“Verifying what belongs in each policy can be really hard for the average person,” Tilson said. “That’s why we have a dedicated billing team thoroughly versed in hearing aid coverage that verifies insurance coverage on the policy holder’s behalf.”

Audiology practices like I Love Hearing offer these verification services to patients, directly reaching out to insurance companies and determining what they are eligible to receive. At I Love Hearing, Tilson said, “the results of that conversation are documented (and supplied to the patient”.remove this, as we don’t like to give it to the patient we go over it with them).

“Our dedicated billing team knows exactly what to ask to get to the bottom of the matter: what is covered and what is not,” Tilson said. “We clearly spell out what is left and what is going to be covered, and importantly, we document that information and explain it to the patient before they move forward. This way, patients can plan properly and won’t receive surprise bills or denials from their insurance company.”

With the clock ticking to December 31^st, time is running out for patients to check up on their benefits and book appointments with their providers while there’s still time.

“If you don’t use the benefits, you can lose them, so I always recommend patients take a second look at their policies and take advantage of what they’re entitled to,” Tilson said.I Love Hearing sells most major hearing aid brands and repairs nearly all makes and models of hearing aids and hearing protection devices. The hearing aid practice operates five locations: four in Nassau County on Long Island and one on the Upper East Side of Manhattan. Each office accepts most insurance plans. For more information and to make an appointment, visit www.iLoveHearing.com.