Amplification device
A tool that makes sounds louder by boosting the signal received.
Ancillary benefits
Ancillary benefits are additional forms of healthcare coverage or services that supplement an employee's primary major medical insurance plan. This often includes hearing, dental, or vision care and usually includes an additional out of pocket cost for the health plan member. Also called supplemental benefits.
Annual maximum benefit
The highest dollar amount an insurance plan will pay for covered services within a specified period, typically one year. Once this limit is reached, the insured is responsible for all additional costs. This is distinct from the annual out-of-pocket maximum, which represents the maximum amount a member must pay during the same period.
Audiologist
An audiologist is a licensed healthcare professional who diagnoses and treats hearing, tinnitus, and balance disorders. Most audiologists hold a Doctor of Audiology (AuD) degree, while others may have a PhD or ScD in related fields.
Audiology billing codes
Standardized codes used to bill insurance for audiology services, including hearing tests and hearing aid fittings.
Benefit check
A benefit check, also known as benefit verification, is a review of an individual’s current health plan coverage, including deductible, co-pays, and out-of-pocket responsibility for specific services.
Benefit eligibility
Confirms if a member has an active insurance policy and they are entitled to benefits.
Benefit plan
A benefit plan is a specific healthcare coverage package that outlines included services, payment structures, and member responsibilities under the plan. Members should review their benefit plan carefully.
Benefit verification
Benefit verification, also known as a benefit check, is the process of confirming an individual’s insurance coverage, including what services are covered, limitations, and prior authorization requirements.
Certification standards
Requirements hearing providers must meet to be recognized by insurers or accrediting bodies. It is a detailed review and verification of a health care practitioner’s qualifications and experience—license, medical education, history of sanctions, prior malpractice cases and other information—before they join a network.
Claim adjudication
Insurance company’s review process to decide if a submitted claim is approved, denied, or needs additional information.
Claim appeal
Request for insurance company to reconsider a denied or partially paid insurance claim.
Claim dispute
Disagreement between a provider, patient, or insurer regarding how a claim was paid.
Claim status
Current standing of a submitted insurance claim. This could be pending, approved, or denied.
Claim status update
Insurance company’s communication on the progress of a claim.
Claim submission
Sending a completed claim to an insurance company for review and payment.
Coinsurance
Coinsurance is the percentage of healthcare costs that a member is responsible for after meeting the deductible. This coinsurance amount varies depending on the plan.
Coinsurance rate
A coinsurance rate specifies the exact percentage a member must pay under their plan after the deductible is met, such as a 20% coinsurance rate for covered services.
Copay
A copay is a fixed amount that a member pays for a specific medical service, usually at the time the service is received. Copays are part of the member’s overall healthcare costs.
Coverage eligibility
Criteria from insurance company to determine if a person would receive insurance coverage for certina types of health care. Critieria includes age (Medicare), employment status (employer sponsored health plans). This is the first step that determines if the patient has access to the health plans services.
Coverage limit
Maximum amount an insurance company will pay for healthcare services within a given period, often a year.
Coverage summary
Insurance document that includes explanations of costs, benefits, and features including deductibles, copayments and coinsurance.
Coverage tier
How a health plan splits health care costs. In a "Basic" tier, the patient pays the most while the health plan pays the least. In a "Premium" tier, the health plan pays the most while the patient pays the least.
Credentialing standard
A detailed review and verification of a health care practitioner’s qualifications and experience: license, medical education, history of sanctions, prior malpractice cases and other information before they are approved to join a network.
Deductible
A deductible is the amount a member must pay out-of-pocket before the health insurance plan starts covering expenses. Meeting the deductible is necessary for the plan to provide full coverage.
Device coverage
Insurance benefits that apply specifically to medical devices, specifically durable medical equipment. In the case of hearing insurance, it usually means hearing aid coverage.
Diagnostic hearing exam
Diagnostic assessment used to determine hearing loss etiology and then provide the degree, type, and severity of hearing loss, all of which determine treatment options.
Discount plan
Program that offers reduced prices on hearing aids and services. In this case, the health plan member is responsible for the entire cost, which is provided at a discount negotiated by their health plan.
ENT (Ear Nose Throat) doctor
An ENT (Ear, Nose, and Throat doctor), also called an otolaryngologist, is a medical physician who specializes in diagnosing and treating conditions related to the ear, nose, throat, and related structures of the head and neck. They handle everything from hearing loss and sinus issues to balance disorders, throat problems, and certain head and neck surgeries. ENTs often work closely with audiologists when evaluating and treating hearing concerns.
Explanation of benefits (EOB)
An explanation of benefits (EOB) is a documented summary showing how an insurance company processed a claim from a provider. The explanation of benefits (EOB) details amounts billed, what the insurance covers, and what the member is responsible for paying.
Flexible spending account
A flexible spending account (FSA) is a tax-advantaged account that allows employees to set aside pre-tax dollars for medical expenses, childcare and eldercare. Funds in a flexible spending account must generally be used within the plan year or they may be forfeited.
Funded plan
When a health plan pays for a portion of health services, such as hearing aids.
Health plan
A health plan is an insurance package that pays for some, most, or even all of a patient’s medical expenses in exchange for premiums, protecting members from high costs by covering necessary services and preventive care. A health plan can be provided as a benefit through your employer, purchased directly from the insurance marketplace, or, if you qualify, through government programs like Medicaid and Medicare.
Health risk assessments
Process of gathering information, usually via a questionnaire, about an individual's health status including lifestyle and family history to identify and analyze potential health risks.
Health savings accounts
Health savings accounts (HSA) are tax-advantaged savings accounts that allow individuals with high-deductible health plans to set aside pre-tax money for qualified medical expenses. Funds in a health savings account roll over year to year and can be used for copayments, coinsurance, and deductibles.
Hearing aid allowance
The dollar amount a health plan has agreed to allow the member to use for hearing aids.
Hearing aid benefits
Range of services and financial support an insurance plan provides for hearing aids.
Hearing aid coverage
Hearing aid coverage refers to whether and how an insurance plan helps pay for hearing aids, including related exams, fittings, and repairs. Proper hearing aid coverage ensures members have access to essential hearing care.
Hearing aid financing
Hearing aid financing allows members to spread out the cost of hearing aids over time through monthly payment plans. Hearing aid financing helps make hearing solutions more affordable for patients.
Hearing aid fitting
A hearing aid fitting is the process in which a hearing care provider adjusts, fits, and programs hearing aids to meet the patient’s unique hearing needs. Hearing aid fitting is essential because every individual experiences hearing loss differently.
Hearing aid insurance
Hearing aid insurance, also commonly called a hearing aid warranty, covers repairs, services, loss, and damage of hearing aids. Hearing aid insurance ensures members can maintain and replace their devices when necessary.
Hearing aid loss insurance
Hearing aid loss insurance provides coverage specifically for replacing lost hearing aids. Many hearing aids include a manufacturer’s warranty with one-time replacement coverage for loss or damage during the first 1 to 3 years.
Hearing aid repair
Service to fix or restore a hearing aid that is not working properly.
Hearing aid replacement
Hearing aid replacement refers to receiving a new hearing aid when the current one is lost or damaged. Hearing aid replacement is often covered under hearing aid insurance or warranty programs.
Hearing aid warranty
A hearing aid warranty is a manufacturer guarantee covering repairs or replacement for
faulty or
accidentally damaged hearing aids, u
sually lasting 1 to 3 years. Hearing aid warranty is sometimes referred to as hearing aid insurance.
Hearing assessment
Evaluation conducted by a licensed hearing care professional to determine if there is a hearing loss and determine its type and severity.
Hearing benefits
Insurance coverage specifically designed to protect, assess, and address hearing health is called hearing benefits.
Hearing center
A hearing center is a facility where hearing care services, including evaluations and hearing aid fittings, are provided. Hearing centers are also commonly known as hearing clinics.
Hearing clinic
A hearing clinic provides hearing care services, including testing and hearing aid fittings. Hearing clinics are also referred to as hearing centers.
Hearing coverage
Hearing coverage consists of insurance benefits specifically designed to support hearing loss assessment and related services. Proper hearing coverage ensures access to essential hearing healthcare.
Hearing device
A hearing device is any product
designed to improve hearing, such as
hearing aids or
assistive listening devices. Using a hearing device can significantly
enhance communication and
quality of life.
Hearing evaluation
A hearing evaluation is a comprehensive assessment conducted by an audiologist to assess auditory function, diagnose the presence and type of
hearing loss, and develop a treatment plan. This includes gathering
case history, performing
behavioral and
bioacoustic tests, and using calibrated instrumentation.
All data is integrated and analyzed to determine an accurate diagnosis and management plan.
Hearing exam
A hearing exam is a test conducted by a hearing healthcare professional to identify hearing loss. While less comprehensive than a full hearing evaluation, a hearing exam provides important diagnostic information.
Hearing health
Hearing health refers to the overall condition of a person’s hearing and the preventive care practices taken to protect it. Maintaining hearing health is essential for communication and quality of life.
Hearing insurance
Hearing insurance is a type of coverage that helps pay for the cost of
hearing aids, hearing tests, and related care, including fittings and follow-up services.
Hearing insurance provider
An organization that provides insurance to cover the cost of hearing diagnostic services,
hearing aids, accessories, or related services, including fittings, is called a hearing insurance provider.
Hearing loss disability
Hearing loss disability has multiple meanings. Even mild hearing loss impacts the ability to hear and understand sound, especially speech, in everyday environments. If hearing loss is more severe and impacts daily tasks and job performance, it can be a disability. In the U.S., a disability rating formula, based on results from a series of hearing tests, is used to determine a hearing handicap percentage. This disability score provides access to additional services and compensation through government funded programs for people with hearing loss.
Hearing loss prevention
Hearing loss prevention
refers to practices, tools, routines, and education designed to reduce the risk of hearing damage and
hearing loss.
Hearing provider network
A hearing provider network consists of licensed professionals who are credentialed by the health plan or third-party administrator (TPA) to provide hearing health care services to health plan members.
Hearing specialist
Licensed audiologist (Au.D.) or hearing instrument specialist who evaluates and treats hearing issues.
Hearing screening
A hearing screening is a simple check used to indicate pass (normal hearing) or fail (potential hearing loss), signaling the need for further evaluation.
Hearing test
In-depth evaluation of auditory function by a licensed professional that measures the ability to hear and can contribute to the diagnosis of hearing loss cause.
In-network provider
An in-network provider is a healthcare professional contracted with an insurance company, typically offering lower costs for patients than out-of-network providers. In-network providers are usually credentialed by the insurance company, meaning their qualifications and experience have undergone a thorough review and verification.
Insurance claim
Invoice submitted by a health care provider to the health plan for payment of the services provided to the patient/health plan member.
Insurance eob
Stands for Insurance Explanation of Benefits (EOB). Documented statement of how health insurance processed a claim from a provider. It includes the amount requested from the provider, the amount insurance will cover, and how much a member is responsible for paying. This document can be used to find billing errors and as documentation for services received.
Insurance open enrollment
Specific period when members can enroll in, change, or renew their health insurance plan.
Insurance TPA
An organization that manages benefits on behalf of an employer, union, or health insurer is commonly known as an insurance TPA.
Insurance verification
The process of confirming a member's insurance details, including ID number, coverage, and eligibility to ensure the policy is active, is called insurance verification.
Maintenance coverage
Insurance benefits that cover the regular upkeep and servicing of
hearing aids or other devices are referred to as maintenance coverage.
Medicaid hearing aid coverage
Hearing aid benefits provided through state Medicaid programs, which vary by state, are known as Medicaid hearing aid coverage.
Medical necessity
AHHC defines medical necessity as hearing health care services rendered by a provider exercising prudent clinical judgement, which are consistent with the evaluation, diagnosis, prevention, treatment, or alleviation of symptoms of hearing loss.
Medicare advantage
Type of Medicare-approved health insurance coverage for seniors and certain disabled individuals offered by private companies, sometimes including hearing benefits. Also known as Medicare Part C.
Medicare hearing aid coverage
Coverage of diagnostic hearing evaluations performed by an audiologist for the assessment of hearing loss, tinnitus, or balance disorders is referred to as Medicare hearing; Medicare does not cover hearing aids.
Member support
Services provided by insurers or third-party administrators to help members understand and utilize their insurance are known as member support.
Network provider
A licensed provider who is credentialed and contracted with a health plan to provide services to members is called a network provider.
Out-of-network provider
A provider who is neither credentialed nor contracted with a health plan, often resulting in higher out-of-pocket costs, is referred to as an out-of-network provider.
Out-of-pocket
Costs members pay themselves, including deductibles, copays, and coinsurance.
Out-of-pocket maximum
The most a member will pay in a plan year before insurance takes care of 100% of the cost for covered services.
Plan enrollment
The process of signing up for an insurance plan.
Plan exclusions
Services or items not covered under a member's insurance plan.
Plan limits
Maximum amounts or restrictions within an insurance plan. For example, number of covered exams per year.
Plan rules
Guidelines that determine how a member's insurance benefits are applied to services or devices received.
Plan updates
Changes to a member's insurance coverage or plan details.
Plan verification
The confirmation that a member has active coverage and detailed information about co-pays, deductibles, and covered services is referred to as plan verification.
Pre- or Prior authorization
Prior approval required by an insurer, based on medical necessity, before certain services, devices, or medications are covered by a member's plan is called pre-authorization.
Preferred provider
An in-network provider recommended by an insurance company, often offering lower costs or improved quality of care for members, is referred to as a preferred provider.
Preventive coverage
Insurance benefits that cover services aimed at preventing health problems, which may include hearing screenings, are known as preventive coverage.
Provider credentialing
The process that insurers use to verify a provider’s qualifications, authorize them to deliver care, and review licensure or malpractice claims is referred to as provider credentialing.
Provider network
A list of credentialed providers and facilities contracted with an insurance company to offer services at discounted rates is called a provider network.
Provider reimbursement
The amount an insurance company reimburses a provider for services is known as provider reimbursement, and members can see this on their Explanation of Benefits (EOB).
Rechargeable hearing aids
Hearing aids powered by integrated rechargeable battery cells instead of disposable batteries, which are charged nightly, are called rechargeable hearing aids.
Reimbursement rate
Additional insurance that provides benefits not included in a standard plan, such as hearing, dental, or vision services, is known as supplemental coverage.
Reimbursement request
A reimbursement request is when we ask for a health plan to pay for out-of-pocket costs that should be covered, not for tax purposes. The can be for hearing aids and related medical expenses, including batteries, exams, and repairs. All of which can be considered tax deductible.
Service audit
A healthcare service audit is a systematic review of a healthcare organization's processes, policies, and records to ensure compliance, improve efficiency, and enhance clinical outcomes.
Supplemental coverage
Additional insurance that provides benefits not included in a standard plan, such as hearing, dental, or vision services, is called supplemental coverage.
Tax deductible
Hearing aids and related medical expenses, including batteries, exams, and repairs, can qualify as tax deductible expenses.
Upgrade program
In health insurance, a hearing aid upgrade refers to a member choosing a hearing aid with features, functionality, or technology that exceeds the level of a "basic" or "medically necessary" device covered by their plan.
VA benefits
Hearing services, including hearing aids, provided through the U.S. Department of Veterans Affairs, are included as part of VA benefits.
