TLDR: Do not go here if you have TRICARE. You will pay out-of-pocket for any hearing aides here. Call TRICARE and get a referral anywhere else. This provider is taking advantage of service members and their families through a non-transparent billing scheme for TRICARE beneficiaries.
Details:
For reference, my wife has worn hearing aides for 7-years. She has profound hearing loss which qualifies her for TRICARE coverage of hearing aids. She's had two sets of top-of-the-line hearing aides in that time with no out of pocket expense.
Ear Specialists of Omaha is an in-network TRICARE provider. In their contract with Health Net Federal services, Ear Specialist agrees to a 30% discount for durable medical equipment (i.e. hearing aids). In return, Ear Specialist recieved the benefits that come with being in-network (i.e. advertising and referrals).
However, upon intake, buried in the fine print of a provider contract, TRICARE beneficiaries agree to pay Ear Specialists the difference between what TRICARE pays and what Ear Specialist claims to TRICARE. By that measure, no matter the cost of the hearing aides, out-of-pocket cost for hearing aids will always be at least 30%.
$6000 hearing aids - pay $1800. $1800 hearing aids - pay $540. Going to an out-of-network will allow you to claim the full cost of hearing aids up to about ~$5500. You can't do that with Ear Specialists because they are in-network.
In most cases what Ear Specialist does is called "balance billing," which is illegal by federal law. However, because beneficiaries sign a contract, Ear Specialists are within the bounds of the law.
So to summarize: Ear Specialists negotiates a cut rate with TRICARE to get the benefits of being an in-network provider. They then pass the cost of that agreement along to patients, which in every circumstance requires patients to pay out of pocket for hearing aids.
I spoke to two claims specialists at TRICARE. Both were floored that Ear Specialists have this scheme. Neither had ever heard of any other in-network providers using similar contract schemes to recover the discounts they agree to provide TRICARE beneficiaries.
Our providers in Texas and Kansas were able to provide top-of-the-line hearing aides at no out-of-pocket expense. Someone in Omaha surely has figured out how to do so. When I find them, I'll update this post so you can find them too. read more