Ear Community is proud to launch Pax’s Ear Fund
Pax’s Ear Fund is a hearing health reimbursement program offered through Ear Community that allows audiologists to be reimbursed for fitting/programming services when patients are denied coverage for this service by their insurance provider leaving them unable to pay the fee or high deductible at the time of the fitting/programming. This reimbursement program only covers patients born with microtia and/or aural atresia who wear Bone Anchored Hearing Devices/Bone Conduction Hearing Implant Systems. As a nonprofit organization that serves the microtia and aural atresia community, we ask that patients must have microtia and/or aural atresia to qualify as we have limited funds to work with for our community.
Details of this program:
While insurance providers may have a code for cochlear implant programming and the cleaning and programming of hearing aids, there may not be an equivalent billing code for the fitting/programming of bone conduction hearing devices. This can leave the patient having to pay out-of-pocket for this service when they often cannot afford to do so. When fitting and programming bone conduction hearing devices, audiologists may try to bill under the unlisted CPT code 92700 but may still be denied by the patient’s insurer. Ear Community can help! Pax’s Ear Fund would allow audiologists to seek direct reimbursement for these appointments. Reimbursement would be allowed for (1) fitting/programming fee per patient only and not to be used multiple times on the same patient. The reimbursement would go directly to the audiologist from Ear Community for this service, not the patient.
Ear Community would need to be set up as a vendor in the audiologist’s clinic system so that a billing invoice can be generated to Ear Community for the reimbursement request. Requests for reimbursement must be approved by Ear Community first before billing our organization directly. This can be done via email along with verifying the cost of the (1) fitting/programming fee for the patient and simply having both parties agree to the reimbursement amount with date of service. A copy of the denial letter from the insurer can be submitted to Ear Community by the audiologist. Clinics may simply choose to send Ear Community a copy of the financial agreement form that informs the patient of the out-of-pocket cost in advance of the fitting/programming as proof for reimbursement request. Ear Community would mail a check to the audiology clinic for that audiologist to be reimbursed.
It is Ear Community’s goal to help as many children and adults to hear their best as much as possible. The reimbursement for audiologists for the patient fitting/programming will be on a first come first serve basis. Ear Community will respond with the acceptance of the reimbursement or let the audiology office know if our organization’s funds for the year have already been exhausted upon the audiology clinic reaching out before both parties enter agreement for reimbursement. Pax’s Ear Fund is made possible by a sweet little boy named Pax who was born with microtia and atresia. Pax and his family know how important it is to help provide the gift of hearing to those in need. Ear Community is grateful for Pax’s Ear Fund! Pax’s fund gives Ear Community the opportunity to help give back to the Deaf and Hard of Hearing Community when helping members of the microtia and atresia community thrive.
Qualification requirements:
– Patient must have microtia and/or aural atresia
– Fitting/programming fee is for patients who wear a BAHS (implanted or on the soft band headband), not traditional hearing aids.
– Patient must have been denied coverage for the fitting/programming service for the Baha/BAHS by their insurer or cannot afford the fitting/programming fee due to having a high deductible that cannot be met financially at the time of the appointment. Proof of denial can be submitted by the audiologist showing denial of coverage for the service of a fitting/programming under the unlisted code of 92700.
– The dollar amount for the fitting/programming must be noted on Ear Community’s application form for reimbursement along with date of service (see attached application for reimbursement).
Additional stipulations:
* Audiologists must reach out to Ear Community first when seeking approval for reimbursement for the fitting/programming service fee before submitting for direct reimbursement to our organization. When doing so, please confirm what the audiology fitting/programming fee dollar amount will be along with the date of service. This program will only cover (1) fitting/programming fee per patient and not multiple fitting/programming fees for the same patient.
* Patients must be in the United States and appointments must take place in the United States.
* A HIPAA waiver from your office may be signed by the audiologist/patient in order to communicate with Ear Community, if needed.
* The patient is not allowed to file for reimbursement for the (1) fitting/programming with their insurer when Ear Community reimburses the audiologist for this service.
Ear Community Programming Reimbursement Form
It is Ear Community’s goal to help as many children and adults with microtia and aural atresia to hear their best as much as possible!
Thank you,
Ear Community
www.EarCommunity.org
