If you’re a patient or a provider trying to navigate the evolving world of Medicaid, you benefit from staying informed about key updates that affect your hearing health. 

You can rest assured that with clear, step-by-step information, you’ll be better prepared to face the challenges arising from recent changes. 

In today’s episode of The Flex Audiology Show, you’ll have the know-how to navigate your Humana Pathways program: who qualifies, what benefits are available, and how you can access hearing evaluations, treatment, and hearing aids with help from your plan. 

A Look Back: The Old Medicaid Process 

Previously, providers like us had a direct connection with the Indiana Medicaid program, making the pathway for your care smooth.  

When you arrived for testing, the procedure was simple: the provider would test your hearing and send the results to your primary care physician or specialist, and once clearance was received, the claim would be submitted to Medicaid for approval.  

This process typically took only one to two weeks for approval and around 30 days for payment, making the experience predictable, streamlined, and reassuring for everyone involved. 

Now, however, it’s changed – and gotten significantly more complicated! 

The Transition: Indiana Pathways for Aging 

The changes began with the Indiana Pathways for Aging initiative that came into effect in 2024, and you might be wondering what this means for your hearing care.  

With this initiative, medical assistance patients were reallocated to different plans: Humana, Anthem, and United Healthcare. This change was intended to improve the management of Medicaid services.  

However, for you, the transition meant that the once straightforward process became more complex. Providers were suddenly unsure if they would automatically continue to support you under Humana Medicaid or if adjustments were necessary.  

Confusion reigned as communications promised automatic inclusion, leaving you (and us at our clinic!) in need of further clarification. 

The New Challenges with Humana Medicaid 

If you are frustrated by discrepancies in your hearing insurance, you are not alone. The updated Humana Medicaid process introduced several issues that affected everyone’s experience: 

Communication Breakdowns: You deserve a clear explanation of your benefits. When you or your provider called Humana’s Pathways department, different instructions were given, resulting in uncertainty regarding which process to follow.  

In some cases, you might have been directed to a third-party vendor called TruHearing, which is a business, not an insurance company. Although TruHearing manages various plans, this arrangement introduced complications into your claims. 

Third-Party Confusion: You can rest assured that you should never have to worry about unexpectedly exorbitant charges. Yet, under the new system, there were instances where True Hearing’s involvement led to miscommunications.  

You might have heard that you would end up paying high amounts for hearing aids designed for Medicaid patients, which was a claim that didn’t make sense. For you, this could be both a financial burden and a confusing situation to resolve. 

Payment Challenges: There are times when you expect the process to work seamlessly, but with the revised system, even straightforward claims started facing challenges.  

Despite having prior approvals in place, some claims were processed with a payout of $0. As someone who depends on Medicaid for affordable care, you deserve a system that reliably honors its commitments, and these delays and denials only add to your frustration.  

For instance, a routine diagnostic claim that I tried to file for a patient ended up taking five months to process, leaving the patient wondering when he would finally receive the support he needed. 

Flex Audiology’s Response: What This Means for You 

Understanding that you rely on dependable health services, our expert team has taken practical steps to ensure that your hearing care is not compromised during this transition.  

Here’s how these measures directly benefit you: 

Secure Diagnostic Testing: To protect you and ensure that every step is validated, we now prioritize payment verification for diagnostic tests before proceeding with further services. This means that you receive care only when the behind-the-scenes processes are confirmed to be in order. 

Proactive Follow-Up: You deserve to be in the loop; we highly recommend keeping all correspondence for your case, whether in fax, email, or letter.  

For instance, if you receive a fax or mailed copy of a payment approval, it serves as a critical piece of evidence that supports your case should any discrepancies arise.  

This proactive approach ensures that you maintain a record of all necessary documentation, putting you in a strong position if issues occur later. 

Clear Communication: You can also expect better communication going forward. We are learning how to navigate these new challenges by directly liaising with Humana and, when needed, manually adjusting prior authorizations.  

This ongoing dialogue is critical because it means you are less likely to experience surprises when you seek your hearing care. 

Questions About Your Insurance? 

Although the transition in Medicaid processing may have introduced new complexities, you can remain confident that our team is working hard to adapt and communicate these changes clearly.  

By staying informed and proactive about your insurance, you are taking control of your hearing health – an invaluable asset that deserves utmost priority. 

If you aren’t sure what’s happening with your insurance policy or would like to get in touch with our team with questions or concerns, don’t hesitate to fill in your policy information on our website. Our dedicated insurance specialists will be ready to help every step of the way. 

Stay informed, ask questions, and ensure that every step of your hearing care journey is as smooth as possible!