Health Benefits for Federal Employees Promoting Direct Access for Audiologists Bottom Line
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Bottom Line  |   December 01, 2002
Health Benefits for Federal Employees
Author Notes
  • Maureen Thompson, is ASHA’s director of private health plans advocacy.
    Maureen Thompson, is ASHA’s director of private health plans advocacy.×
Article Information
Hearing Disorders / Practice Management / Professional Issues & Training / Regulatory, Legislative & Advocacy / Telepractice & Computer-Based Approaches / ASHA News & Member Stories / Bottom Line
Bottom Line   |   December 01, 2002
Health Benefits for Federal Employees
The ASHA Leader, December 2002, Vol. 7, 3-13. doi:10.1044/leader.BML.07122002.3
The ASHA Leader, December 2002, Vol. 7, 3-13. doi:10.1044/leader.BML.07122002.3
The Federal Employees Health Benefits Program (FEHBP)—the world’s largest employer-sponsored insurer—provides health insurance for nearly 9 million federal employees and annuitants, as well as current and former spouses and employees. FEHBP licenses health plans to compete for federal employee premium dollars. Currently, more than 350 health plan options are offered nationally, with up to 15 only available in local areas.
As you’ll note in the following set of questions and answers, a recent law permits—but does not require—direct payment to audiologists by FEHBP plans. Audiologists need to advocate for their inclusion as direct-care providers with FEHBP plans. Read on for more information, Web sites, and grassroots strategies to build support for the expanded autonomy of audiologists treating the nation’s large population of federal workers.
Who are considered “covered providers” with FEHBP plans?
A. The list of FEHBP-covered providers includes physicians, clinical psychologists, qualified clinical social workers, optometrists, nurse midwives, and nurse practitioners. Audiologists are not specifically listed in the “covered provider” section of most health plans participating in the FEHBP. In 2002, three of the seven nationwide fee-for-service (FFS) plans available to enrollees reimburse audiologists directly. Those plans and their Web sites are:
Of the six FFS plans that are open only to specific groups (e.g., Secret Service), two reimburse audiologists directly:
How does the Federal Employees Health Protection Act of 1998 affect audiologists?
A. Before enactment of the Federal Employees Health Protection Act (P.L. 105–266), the only covered professional services for hearing care under FEHBP were those rendered by physicians. With the passage of P.L. 105-266, FEHBP plans are permitted to provide direct access, direct payment, or reimbursement to health care providers such as audiologists. The law does not specify, however, that particular health services be covered or excluded. Thus, the law does not mandate direct reimbursement to audiologists.
As a result, four of the nationwide FFS plans participating in the FEHBP still require that audiology services be billed through a physician and deny reimbursement claims submitted directly by independently practicing audiologists. Such actions prevent FEHBP-covered consumers from having direct access to audiologists.
Audiologists need to become direct-access providers under FEHBP. How can we achieve that goal?
A. Audiologists must advocate for their inclusion as direct-care providers with FEHBP plans. To achieve this goal, it is critical that audiologists contact the U.S. Office of Personnel Management (OPM) and FEHBP plans about the quality and cost-effectiveness of direct audiologic care.
Adding audiologists to the list of covered providers is congruent with the basic thrust of the FEHBP—having reasonable minimum standards for health benefits plans and ensuring direct access to specific health professionals.
How can we advocate for direct access with individual FEHBP plans?
A. Until the FEHBP mandates audiology services, audiologists must advocate for direct reimbursement of their services with individual FEHBP plans.
To help you lobby effectively, ASHA has prepared a new technical information packet, FEHB Plans: Expanding Direct Access for Audiologists. This free product offers an overview of the FEHBP and ASHA’s legislative efforts to date. It also offers sound advice on which FEHBP plans to target, what FEHBP plan administrators want to know about audiologists and the people they serve, issues to address when advocating with FEHBP plans, suggested strategies and timelines, and suggested monthly “To Do” lists.
How can I learn more about the FEHBP program?
A. For an overview, visit the OPM’s Web site.
For a copy of the free ASHA materials, call the Action Center at 800-498-2071 or fax your request to 301-897-7358. Request item #0804265.
For more information on FEHBP, contact Maureen Thompson through the Action Center at ext. 4431, by fax at 301-897-7356, or by e-mail at mthompson@asha.org.
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December 2002
Volume 7, Issue 12