Hearing loss, hearing aids and case for medical necessity

By Monica Wiser

Just about every day, I have to break the news to my patients that their insurance company does not cover hearing aids.

They are deemed “medically unnecessary” by Medicare and many other insurers.

It is a slap in the face to the 48 million Americans who suffer from hearing loss.

According to the American Speech-Language Hearing Association, 90 percent of those cases cannot be treated with medication or simple surgery.

Insurance companies may believe that they are saving money by exempting hearing aids from coverage, but the cost of not treating hearing loss is far greater.

Untreated hearing loss has been linked to several health conditions that insurance companies do end up covering. The following medical conditions have been linked to untreated hearing loss.

Increased risk of dementia

John Hopkins University recently published a longitudinal study that revealed that people with hearing loss are up to five times as likely to develop dementia if the loss goes untreated.

Several other such studies have confirmed this finding (Brandeis University, University of Pennsylvania and Washington University in St. Louis).

There are several theories as to why this occurs: increased cognitive load,  social isolation and atrophy of the region of the brain that not only processes speech, but processes memory.

The cost to society to treat dementia is estimated to be up to $215 billion annually when the cost of home health care and assisted living are taken into account.

It is more costly to the nation than treating heart disease or cancer (RAND study).  The cost to the patient and their family members is far greater.

Increased risk of fall

People with untreated hearing loss are three times as likely to suffer from injury-causing falls. The average hospital cost for a fall injury is $35,000.  According to the CDC, falls are the leading cause of injury death for Americans 65 years and older. Non-fatal falls are estimated to cost $34 billion in direct medical costs.

Increased hospitalizations 

Hospitalizations increase by 32 percent. These hospitalizations are not only due to falls, but to lack of awareness of surroundings, leading to car accidents, workplace accidents and pedestrian accidents.

The cost of these hospitalizations cannot be accounted for due to the various conditions that may be diagnosed during hospitalization.

Depression, anxiety, stress

The economic burden of depression, including workplace costs, direct costs and suicide-related costs, was estimated to be $210.5 billion in 2010.

Anxiety disorders cost the U.S. more than $42 billion a year, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA.

Additionally, it is estimated that treating work-related stress alone costs $300 billion.  (University of Massachusetts Lowell.) Stress outside of the workplace was not calculated in this figure.

These health conditions are costing the nation well over $800 billion annually.

While hearing loss does not contribute to every case of dementia, falls, hospitalizations, depression, anxiety and stress, a significant portion of that figure can be reduced by treating hearing loss.

The real cost of not treating hearing loss, however, cannot be measured in cold, hard figures.

The cost to society of the unrealized potential of people with hearing loss is immeasurable.  It is time for the healthcare industry to reexamine the medical necessity for treating hearing loss with hearing aids.

Monica Wiser, M.A. CCC-A is an audiologist in private practice at Beaufort Audiology & Hearing Care on Lady’s Island. She has over 20 years of experience in the field and has worn hearing aids since childhood.

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