It’s bad enough that U.S. healthcare prices are the highest in the world. That the healthcare industry routinely treats us as marks and suckers makes it infinitely worse.
San Juan Capistrano resident Dennis Ettlin, 70, was shopping in the most recent Medicare open enrollment for a new Medicare Advantage plan that would cover his hearing aids. A state-of-the-art pair, he knew, could run thousands of dollars.
Ettlin came across an attractive offer: an Anthem Blue Cross plan that covered “up to $3,000 for hearing aids and supplies every year.” The only catch was that the hearing aids had to be purchased from Colorado-based Hearing Care Solutions, or HCS, which contracts with insurance companies for such benefits.
Like any smart consumer, Ettlin did his homework. Before signing with Anthem, he said, he stopped by an HCS branch in San Clemente and asked about the cost of the hearing aids he desired. He was told a pair would run him about $3,800 — a good price.
“I asked if that meant the $3,000 benefit would be applied to the $3,800, and if my net cost would be $800,” he recalled. “The salesman said yes.”
So Ettlin signed with Anthem, waited until his new Medicare Advantage plan took effect, returned to the store and said: “Hook me up.”
That’s when he learned that the actual cost of the two hearing aids was $10,000. But with the $3,000 in coverage from Anthem and some additional sweetening from HCS, Ettlin was told, he’d only be responsible for about $1,800 per unit, or $3,600 for the pair.
“I was flabbergasted,” he said. “It seems like a bait and switch.”
It does indeed. Ettlin has lodged a complaint with Medicare and is now awaiting word from the federal agency.
There are a few things to unpack here. First, how an anticipated $800 out-of-pocket cost skyrocketed to $3,600.
Second, the challenge all consumers face in finding out the actual cost of healthcare.
Finally, this is a growing problem. Hearing aids are fast becoming a concern for millions of Americans as our aging society places new strains on healthcare.
Roughly 48 million Americans say they have difficulty with their hearing, according to the Hearing Loss Assn. of America. A third of all people age 65 or older are, to some degree, hard of hearing.
“Hearing loss is a major public health issue that is the third most common physical condition after arthritis and heart disease,” the organization says.
The National Institute on Deafness and Other Communication Disorders says that among hearing-impaired adults age 70 and older who could benefit from hearing aids, fewer than 30% use them. Only 16% of adults ages 20 to 69 who could benefit from hearing aids have ever tried them.
One reason is the cost — they’re expensive, and most private insurance plans don’t cover them. The industry, bless its greedy little heart, generally views hearing aids as elective, not medically necessary. Like a face-lift.
Because as we all know, going deaf is a personal choice.
You almost get the feeling that insurance companies are doing everything they can to avoid having to cover a legitimate (but pricey) medical expense.
The President’s Council of Advisors on Science and Technology said in a 2015 report that a single hearing aid costs an average of $2,300. Most people need two. Nowadays, top-of-the-line models can easily run as much as $4,000 — per ear.
Medicare doesn’t cover hearing aids either. Only some Medicare Advantage plans, such as the one Ettlin chose, include the devices as a benefit.
However, finding out actual costs can be a challenge. HCS, like nearly all providers of medical devices, apparently uses inflated prices when dealing with insurers to boost the amount the company actually receives.
So even though Ettlin’s eyes went wide when he first saw that $10,000 figure, the reality is that no one pays that much. This raises an important issue, though.
Why can’t the U.S. healthcare system have transparent pricing? Why do we routinely complicate and confuse things by starting with Fantasyland prices that every player in the healthcare equation admits in no way reflect actual costs or how much people are really charged?
I’ve spoken with insurers, hospitals, drugmakers, medical device manufacturers — not one could make a rational argument for this deliberately deceptive approach to pricing. I’ve been told again and again this is just how we do it.
That’s insane. President Trump says he wants to do something about the country’s ridiculously high drug prices. How about he broaden his horizons and require honest pricing for all healthcare products and services, with providers posting actual prices online for all to see?
Just trying to nail down Ettlin’s situation demonstrated how hard it can be to get healthcare companies to come clean.
I reached out to both Anthem and HCS, laying out for each details of the problem and giving them plenty of time to look into the matter.
I noted from the get-go that there were medical privacy considerations, and asked the companies to email privacy waivers to Ettlin, which he was more than happy to sign, so they could talk to me.
Ettlin said neither Anthem nor HCS sent him a waiver.
Yet both companies didn’t hesitate to use this as a dodge to avoid answering my questions.
“We cannot comment on the specifics of this case due to patient privacy,” said Leslie Porras, an Anthem spokeswoman.
“HCS cannot comment on specifics due to privacy laws,” said Nicole Bloch, an HCS spokeswoman.
Like I hadn’t anticipated that days earlier.
In a lengthy email, Bloch laid out all the ways HCS strives “to make hearing care more affordable and transparent,” all evidence to the contrary notwithstanding.
She suggested it may forever be a mystery as to how Ettlin came to believe he’d be charged only $800 for hearing aids.
“We simply do not know what transpired, what specific aids were referenced, what if any discounts or services were not included with the pricing, or even if the appropriate insurance carrier benefits or documentation were ever utilized,” Bloch said.
Yeah. We simply do not know.
Or maybe Ettlin had it right. Bait and switch.
Would it help if I shouted?
BAIT AND SWITCH!
I feel better already.