Santa Barbara Audiology

I just learned about this on BlueSky. ProPublica’s Claim File Helper lets you customize a letter requesting the notes and documents your insurer used when deciding to deny you coverage. It was part of their investigation on what insurers were saying behind the scenes when they deny a claim.

This takes me back to 1995, when I lived in San Francisco. I worked part time as an audiologist so that I could pursue a dance career. As a result of having type 1 diabetes, I was uninsurable on the open market (Remember that? Before Obamacare?). My only option for health insurance was to join the California high risk pool. It was funded by a tobacco tax (that’s criminal all by itself). It took months to get approved because there were so many more applicants than funds. It cost $600/month and covered %60 of claims. I spent so much time and shed so many tears on the phone trying to get my claims paid.

I’m sorry that I don’t accept for-profit insurances anymore. (I couldn’t handle the denials and phone calls.) I do still accept MediCal, MediCare, Veteran’s Administration, and the Department of Rehabilitation. There’s paperwork of course, but they really look out for the people they insure, which makes me happy.

I have had an increase in patients who tried Jabra, had limited benefit, and came in to investigate other options. So I finally got a chance to test a Jabra! It’s inexpensive. Why? Frequency response might have something to do with it.

First, on the above audiogram, look at each frequency band and notice how important the high frequencies are for speech intelligibility. The band around 2kHz is the most important at 33%. The band above 3kHz is next in importance at 23%. Below 500 Hz is about 8%.

Now look at the above real ear measurement. This is ideal. Notice how the performance of the hearing aids (green and pink lines) match up with the targets (green and pink markers). (This happens to be an Oticon Intent 1, but any high end hearing aid can match a target all the way out to 8kHz, easily). If you’re not familiar with real ear measurements yet, take a look at the video on the Hearing Aids page.

Now for the Jabra. The left side graph shows that the hearing aid amplification fades above 3kHz. According to the audiogram in the first image, this is a problem because you’re missing 23% of the clarity you could have. (The right side graph shows that the Jabra aid on that side was dead. This can happen to higher end hearing aids too. All it takes is some debris in the microphone. In my experience though, some manufacturers are more reliable than others.)

Here’s another impulsive post on something I think hearing aid wearers should know about. Read about insurers and Medicare in the New York Times. I’m not surprised.

Initially, I tried so hard to accept as many insurances as possible, because when someone pays an insurance premium they should be able to access the benefit. Eventually, the hours on the phone with these Medicare “advantage” plans and the emotional strain of talking to people who don’t care about my patients was too much. All of this recently made it an easy decision to drop these insurers.

I do still accept Department of Rehabilitation, the Veteran’s Administration, MediCal, and MediCare. There’s still paperwork, but at the end of the day I’m happy because they expect a high standard of care, it isn’t about profit, and the people I talk to really care about my patients.

So if you’re considering an Medicare Advantage plan, you now have a little more info to consider in your research. Medicare.gov has resources too.

The single most important thing you can learn to do is to change the wax guard on your hearing aid. When a hearing aid stops working, it’s almost always the wax guard. Even if your ears don’t make wax, it’s usually the wax guard because it will trap moisture and skin flakes as well. Here’s how to change a wax guard.