United offers direct-to-consumer hearing tests and aids

The health plan says the program will save patients thousands of dollars, but physicians question whether it's good medicine.

By — Posted Oct. 24, 2011

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A United HealthGroup subsidiary said it can provide hearing tests and hearing aids at a deep discount for patients by "eliminating intermediaries" that drive up cost.

United and its subsidiary, hi HealthInnovations, said "intermediaries" doesn't refer to physicians, and that the company will encourage patients to see their doctors for certain hearing problems.

But physicians who diagnose and treat hearing loss said that even if it's not the aim, promoting a service that could leave physicians out of the loop is potentially dangerous. They said patients who skip the doctor's office in favor of United's self-administered test risk missing treatable underlying conditions or making the conditions worse.

"Bypassing a physician evaluation and referral can lead to misdiagnoses and inappropriate treatment that could cause lasting and expensive damage to patients," the American Academy of Otolaryngology, Head and Neck Surgery, said in a statement.

Todd Hillman, MD, a Pittsburgh otolaryngologist, called United's plan "a poor idea."

"With the cost of having a 'middleman,' such as myself, if you could skip that step safely, there is no doubt it would lower the cost of a device. However, it cannot be done safely on a consistent basis," he said.

In its Oct. 3 announcement of the new offerings, hi HealthInnovations said it was "completely changing the distribution model and eliminating intermediaries, which can drive up the cost significantly."

Anyone can go to the hi HealthInnovations website and take the company's free hearing test. Once on the site, the user is instructed to plug headphones into a computer or mobile device and be in a quiet location. During the test, the user adjusts the volume on high-pitched and low-pitched sounds directed into each ear. The user also answers self-assessment questions on topics such as whether there is difficulty following conversations or hearing the telephone ring in the next room.

After the test, the user immediately receives an assessment of his or her hearing. If the user is found to be experiencing hearing loss, the website goes to a page that lists recommended hearing aids.

According to the company, comparable devices cost as much as $4,000, but hi HealthInnovations aids will cost from $749 to $949 per ear. For some members of United's Medicare Advantage plans, the hearing aids will be available at no out-of-pocket cost.

Lisa Tseng, MD, chief executive officer of hi HealthInnovations, said the company cuts costs by ordering in high volume and skipping the brand marketing of the hearing aids. She said the company does not want to keep physicians out of the picture. The self-test directs patients to see a physician if results indicate that their hearing loss is on only one side or if it developed rapidly, Dr. Tseng said.

"We're here to supplement what hearing professionals are able to do," she said.

If everyone with hearing loss tried to consult a physician, there wouldn't be enough specialists to see them, Dr. Tseng said. The current physician population has the capacity to serve only about 25% of the 36 million people with hearing loss, she said.

Besides a shortage of physicians who can diagnose and treat hearing loss, there is the problem of a lack of coverage for hearing aids. Medicare usually does not cover them.

Some Medicare Advantage plans, including United's, will pay for a portion of the cost, but hearing aids are out of reach for many patients who need them even with that help, United spokesman Tyler Mason said. After prescription drugs, coverage for hearing devices is the most desired benefit for older members, he said. "Seniors have been demanding this for quite some time."

However, the otolaryngology academy said in its statement that United should have taken another approach to helping patients access hearing aids.

"Any changes in the paradigms by which hearing aids are evaluated and fitted must be shown to have equal or superior outcomes to those currently employed and not be based solely on cost," the statement said.

Besides selling hearing aids directly to consumers, the self-test hi HealthInnovations is offering will replace neither a traditional audiogram nor an exam to determine the cause of hearing loss, Dr. Hillman said. Improper testing in a nonsoundproof room, for example, can result in readings off by as much as 30 decibels, he said.

A physician also needs to identify whether the hearing loss is due to factors such as wax buildup or infections, as well as tumors or other conditions that require treatment, he said.

"I understand it's one area where people want to decrease the cost, but the equivalent would be purchasing eyeglasses online and guessing what you think your prescription might be," Dr. Hillman said. "It's not a step at this point that can be skipped."

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Hearing test from United HealthGroup subsidiary hi HealthInnovations (link))

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