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Hearing Aids

September 16, 2011

When billing for a hearing aid, participating providers must submit the claim to Blue Cross and Blue Shield of Texas (BCBSTX). The BCBSTX allowable amount is 80% of the billed charge for PPO and HMO Blue© Texas. BCBSTX payment and member responsibility will be based on this allowable amount. BCBSTX payment will be limited per benefit limits in the member’s benefit plan. Note – the member may not be balance billed for amounts in excess of the BCBSTX allowable amount. The explanation of benefits (EOB) will reflect the accurate amount of the patient’s liability, taking into account the hearing aid benefit that the patient may have through the employer group. In the past, the hearing aid benefit limit was not always applied when the claim was processed. A system enhancement will go into effect on September 16, 2011 that will enable the hearing aid benefit limit to be consistently applied. As a reminder, providers should always call Customer Service to check member benefits.