The Patient's Freedom of Choice: Interview with Craig Johnson, AuD
Douglas L. Beck, AuD, speaks with Dr. Johnson about balance-bill and the patient's right to choose.
Academy: Hi, Craig. It's always good to chat with you.
Johnson: Hi, Doug. Thanks, yes, it's been a while since we spoke.
Academy: Right. In fact, back in the day, you and I were in parallel political universes pushing forward on core issues such as cerumen management, doctoral education, and lots of audiology-based political issues. Of course, I've pretty much gotten out of politics, but clearly you've stayed involved! I guess it was about 10 years ago you served as president of the ADA. As I recall, when you were elected president it was still called the Academy of Dispensing Audiologists, and when you finished your presidential term, the ADA was well on the road to becoming the Academy of Doctors of Audiology.
Johnson: Thanks for noting that, Doug. You've got a great memory, and yes, that was one of our initiatives.
Academy: Craig, I'd like to focus our discussion today on the patient's freedom of choice. Of course, you wrote an article on this topic for Audiology Today (AT) in the November/December 2011 issue. So I was hoping you would re-cap some of that information and perhaps update us on the topic, too?
Johnson: Sure. The core issue is building and maintaining state and national recognition for audiologists as the managers of hearing and balance care and the need to be our own advocates. For instance, in 2009, the Federal Employee Health Benefit Plan (FEHBP) offered hearing aid benefits for the first time, and they sought the Academy's and ASHA's guidance and input on these issues. Unfortunately, the local carriers misinterpreted the FEHBP guidelines and their misinterpretation bled through to the local carriers and other, secondary state-based programs.
Academy: It seems so simple in retrospect, but confusion runs rampant with regard to bureaucrats and administrative people when they have to interpret the law with respect to day-to-day situations…but okay, admittedly, we're getting ahead of ourselves. Please tell us what happened?
Johnson: Sure, well, as I mentioned, in 2009 the FEHBP pushed forward a new hearing aid program for their members. However, the local carriers misinterpreted the program and presumed the total payment from the plan was supposed to be the total cost to the patient. That is, the carriers presumed the new provision was supposed to be "payment in full" and their members could not upgrade to better technology if the member was willing to pay the difference. In fact, the local carriers said "no upgrades," meaning the member could not use their insurance benefit as a partial payment for the technology they chose. It's also important to understand that since the beginning of time, audiologists in Maryland were permitted to balance-bill the patient, so this was a major negative change for patient care. Therefore, we marshaled various resources that included our "old" contacts at the Office of Personnel Management (OPM), the national Federal Blue Cross Blue Shield headquarters and a key congressional ally, Congressman Chris Van Hollen (ranking member of the House Budget Committee)
Academy: And I hasten to add….you knew these officials from your prior political life as president of the ADA and as the previous chair of Academy's Government Relations Committee?
Johnson: Yes, and that's why it's so important to get involved and to maintain those e-mail addresses and cell phone numbers!
Academy: And so you contacted the decision makers, explained the situation, and then what happened?
Johnson: Well, the whole story is detailed in Audiology Today, but the bottom line is everything changed. The ruling was clearly stated and announced in 2010, allowing the audiologist to "balance-bill" and thereby reinstating the patient's right to choose beginning January 1, 2011.
Academy: And so the Office of Personnel Management, who has the responsibility to direct federal health insurance programs pretty much said the members could use their insurance payment as a partial payment if they desired, and the member could pay the difference to obtain premium technology?
Johnson: Exactly. And in fact, the chief of health insurance for the Office of Personnel Management (OPM) noted the $1,000 hearing aid benefit was intended to be an "offset" allowing the patient to choose their preferred technology based on their need and desires, and naturally, the audiologist could bill the patient for the difference, if the patient chose more expensive technology. So making a long story short, Congressman Van Hollen was the key "rainmaker" (inside the beltway talk for someone who makes things happen) who contacted OPM and asked them to "clearly state" that patients should (and do) have freedom of choice, with respect to selecting and paying for hearing aid upgrades.
Academy: And then what happened?
Johnson: Well, Congressman Van Hollen's persuasion resulted in OPM realizing the value of patient's freedom of choice with regard to their hearing aid care. A very clear statement was issued by the OPM in July 2010 that went into effect January 1, 2011. So, patient's freedom of choice was restored, and by the way, the benefit was recently increased to $1,400 per ear.
Academy: That's an amazing story, Craig. It seems to me professionals are usually held captive by insurance companies, but this time, it seems clear thinking and rational thought won!
Johnson: I agree, and the impact will be felt on local hearing aid benefits as more states, insurance companies and professional learn about this.
Academy: Thanks, Craig. I appreciate your service to the patients and the professionals and thanks for keeping those e-mail addresses and phone numbers!
Craig Johnson, AuD, is president of Audiology Associates, Inc., in Baltimore, Maryland, and legislative director for the Maryland Academy of Audiology.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.