Victory for Audiologists: Wal-Mart Sets the Record Straight with Four Blues Plans

Wal-Mart has notified Blue Cross Blue Shield plans in four states - Alabama, Arkansas, California, and Illinois - that reimbursement claims submitted on behalf of their employees by independently practicing audiologists are not to be routinely denied. In addition, claims that were denied previously will now be reconsidered.

In November, ASHA alerted Wal-Mart that reimbursement claims submitted by independently practicing audiologists were being denied, while the very same services provided and billed through a physician provider were reimbursed. These denials occurred despite the fact that, in both physician and audiology practices, it was the audiologist who performed and interpreted the diagnostic audiological testing, not the physician.

This physician-only requirement eliminated this important benefit for many Wal-Mart employees because of regions within every state served only by audiologists in independent practice. The physician-only requirement also significantly increased Wal-Mart's cost to provide a diagnostic audiological benefit to its employees. According to actuarial data prepared for ASHA by Milliman USA, the per-member-per month (PMPM) cost for audiological services is $0.10 PMPM when provided and billed by an audiologist. This figure increases to $1.75 (PMPM) when the same services are provided and billed by a physician. For more information on ASHA's efforts with Wal-Mart, please contact Maureen Thompson, ASHA's Director of Private Health Plans Advocacy, via e-mail at mthompson@asha.org or by phone at 800-498-2071, ext. 4431.