New Guidance on Insurance Replacement of Hearing Aids (Sept. 2023)
BSHAA supports the position that the relationship between the audiologist and the client plays a significant role in achieving successful outcomes in terms of hearing improvement. As a result, a hearing instrument which has been professionally fitted must not be treated as a commodity item by the insurance industry but as an important medical device, prescribed by a highly trained, regulated clinician who has formed a trust-based relationship with the client.
However, BSHAA also accepts that in some cases that important relationship will not be as good as it should be at any given point.
The client can choose – but must be aware of that choice.
Specified items at an amount agreed
It is recognised that insurance companies will want to ensure their liabilities are kept in control, especially where the claim is as an unspecified item.
An exception to this would be where hearing aids have been specified and insured for ‘X’ amount. It seems reasonable in this case, that up to ‘X’ payment is reasonable and should in no way be questioned or challenged.
Offering a Choice
Insurance companies should not overtly or covertly interfere in the important relationship between a clinician and their client. If it is made clear there is a choice of providers, that is fair and appropriate.
BSHAA recommends that all members ensure the relationship they have with each client is as good as it can be:
- Prior to any loss* perhaps on the first fitting: brief the client of their rights in the event of a loss. For example, advise your clients that they do not have to accept the insurance company’s ‘preferred supplier’ for the replacement instrument. There is no risk to their claim in their choice of provider.
- Make your clients fully aware of the likely process upon them contacting the insurer: that is, in almost all cases – they will be passed onto another hearing aid company on the first call, or that the proposed new supplier will call the client back very soon after the first call. An assumption is made from the start (in most cases).
- Brief the client that the insurer will imply or at least assume that their method of replacement is the ONLY method available. This is not the case. There is no obligation to accept the insurer’s method. The client can state which supplier they would prefer to deal with.
- Brief the client on your own warranty length, and on the quality and quantity of your after care. That is to help your client realise that if they get a replacement from a new supplier, this warranty and service might be compromised or altered.
*(or irreparable damage requiring a replacement)
The company providing the replacement should
- In the interests of transparency, make it clear in their first contact with the client that, although the insurer has instructed them to facilitate a replacement, the client still has the right to use their own preferred supplier if they so choose.
- Match the existing length of warranty at least.
- Avoid follow-up phone calls to secure the new sale (securing the supply of the new hearing aids) prior to the claimant receiving their funds. There should be no implication of a necessity to order, to secure the pay-out.
- It should not be implied that the claimant can only deal with the proposed supplier. Terms such as ‘validating the claim’ by using this supplier should be avoided. This could imply that this is the claimant’s only choice.
- Avoid describing your nominated hearing aid supplier as ‘our specialist team’, or ‘my colleague’. They should be described in a third-party way – as ‘our preferred supplier’ or ‘our partner’ or similar. Anything else would be a breach of GDPR as it would mean disclosing personal information, the client’s name etc., to a third party (potentially) without their consent.
By BSHAA Board (Lead: Rob Donnan)