- Participating Physician Groups (PPG)
Diagnostic hearing and balance evaluations are covered to determine whether the member needs medical treatment. For individual and group Medicare Advantage (MA) HMO members, the evaluation can be furnished by the member's primary care physician (PCP) , or a Health Net participating ear specialist or audiologist when referred by the member's PCP. MA PPO members can self-refer for in-network or out-of-network levels of coverage.
Some individual and group MA HMO plans cover routine hearing tests by a Health Net participating audiologist when referred by the member's PCP.
Individual Plan Coverage Hearing Aids
For plans that cover hearing aids, the member must obtain the hearing aids directly through Hearing Care Solutions. Members must call Hearing Care Solutions directly to schedule an appointment. Referrals are not required.
Group Plan Coverage Hearing Aids
Hearing aid coverage is included under some group MA HMO plans as an enhanced benefit. Refer to the member's Schedule of Benefits and EOC for specific information on plan coverage and exclusions.
If and when a plan covers a hearing aid, it must be obtained through a Health Net PCP or PPG (for members affiliated with a PPG). The provider is contractually required to refer the member to a Health Net participating hearing aid provider.
If the member has a personal preference for an alternative model of hearing aid carried by the participating hearing aid provider, the member is liable for any difference in cost from the covered standard model and the preferred alternative model. A member who would like to purchase a model with special features is entitled to be informed of the additional cost before purchasing the hearing aid.