Fifer Robert C
Department of Pediatrics, Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, Florida.
Semin Hear. 2020 Feb;41(1):55-67. doi: 10.1055/s-0040-1701245. Epub 2020 Feb 10.
Reimbursement for hearing aids in the present time has become as complicated, if not more so, than any other area of health care. For many years, hearing aids were a noncovered item where insurance was concerned. The predominant model of bundling costs into a single dollar amount was copied decades ago from hearing instrument specialists. However, insurance companies and federal agencies are increasingly covering the cost of the diagnostic hearing evaluation and at least some of the costs associated with hearing aid purchases. One operational question is whether the bundled charge model is still appropriate, or should audiologists follow more closely the example of optometry whereby professional services are charged separately from the cost of goods sold? The models that have evolved constitute a broad mixture of bundling, partial bundling (i.e., partial unbundling), and complete unbundling. There exists no uniformity for which charge method is best. But, with greater frequency, insurance requirements are forcing a movement toward partial or complete unbundling of associated costs. Regardless of which charge model is adopted, calculation of the cost of service delivery for each audiology practice is an essential business component to justify charges and make educated decisions regarding participation in various insurance, cooperative, or network plans.
目前，助听器的报销事宜变得与医疗保健的其他任何领域一样复杂，甚至有过之而无不及。多年来，就保险而言，助听器一直属于不承保项目。将成本捆绑为单一金额的主要模式是数十年前从听力仪器专家那里照搬过来的。然而，保险公司和联邦机构越来越多地承担诊断性听力评估的费用，以及至少部分与购买助听器相关的费用。一个实际问题是，捆绑收费模式是否仍然合适，或者听力学家是否应该更紧密地效仿验光配镜行业的做法，即专业服务收费与所售商品成本分开计算？已经演变出的模式包括广泛的捆绑、部分捆绑（即部分拆分）和完全拆分。对于哪种收费方法最佳，不存在统一标准。但是，保险要求越来越频繁地促使相关成本朝着部分或完全拆分的方向发展。无论采用哪种收费模式，计算每个听力学科实践的服务提供成本都是一项至关重要的业务组成部分，以便证明收费合理，并就参与各种保险、合作或网络计划做出明智决策。
