April 8, 2025 • 30 mins
When you hear "managed care" in audiology, what comes to mind? In this eye-opening conversation between Dr. Douglas Beck and Dr. Noël Crosby, the troubling reality of third-party payment systems in hearing healthcare takes center stage.
Dr. Crosby, a three-time president of the Florida Academy of Audiology with decades of clinical experience, pulls back the curtain on how managed care administrators position themselves between patients, insurance companies, and audiologists – often to the detriment of comprehensive patient care. The discussion reveals how Medicare Advantage plans, now covering roughly half of all Medicare recipients, frequently fail to deliver on their marketed hearing benefits.
The most concerning revelation? Many third-party payers operate under the false assumption that everyone with hearing difficulties simply needs hearing aids. This fundamentally misunderstands audiology's scope of practice. As Dr. Beck points out, approximately 26 million Americans have perfectly normal hearing thresholds but struggle with speech comprehension in noisy environments – issues that require specialized testing beyond basic screenings.
Both experts share compelling insights about the limitations of "free hearing tests," the inadequacy of quick screenings, and the ethical problems with viewing every patient as a potential device sale rather than someone deserving comprehensive care. The conversation turns particularly insightful when discussing tinnitus management, highlighting how third-party payment systems often prevent patients from accessing treatments that could significantly improve their quality of life.
For anyone navigating hearing healthcare, whether as a patient, provider, or caregiver, this episode provides crucial perspective on a system that often prioritizes profit over patient outcomes. The Academy of Doctors of Audiology's recent call for major reforms in hearing healthcare coverage underscores the urgency of rethinking how we value and deliver audiological services.
Listen now to understand why the future of hearing healthcare depends on recognizing audiologists as healthcare providers first – not simply as hearing aid dispensers. Your hearing deserves more than a quick screening and a sales pitch.
Connect with the Hearing Matters Podcast Team
Email: hearingmatterspodcast@gmail.com
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Blaise M. Delfino, M.S. - (00:19):
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(00:41):
Welcome back to another episodeof the Hearing Matters Podcast.
I'm founder and host BlaiseDelfino and, as a friendly
reminder, this podcast isseparate from my work at Starkey
.
Dr. Douglas L. Beck (00:56):
Good afternoon.
This is Dr Douglas Beck withthe Hearing Matters Podcast, and
today I'm here with my friendand colleague, .
She earned her doctorate inclinical audiology from the
University of Florida and shewas the smartest person in our
class.
She and I went to schooltogether.
Dr Crosby was on the inauguralboard of the Florida Academy of
Audiology and she served aspresident not once in 2000, not
(01:19):
twice in 2009, but again in 2025.
And I think that's amazing.
Dr Crosby worked at Sarasota'sSilverstein Institute for 14
years that was my old pal, drHerbert Silverstein who ran that
and for the last six of thoseyears she was director of
audiology.
While there, she establishedthe Institute's cochlear implant
(01:41):
program as well as SarasotaMemorial Hospital's Infant
Hearing Screening Program.
Dr Crosby operatesindependently of any hearing aid
manufacturer and that's awonderful thing for so many
reasons, but basically she canprovide her patients with
unbiased evaluations and fitthem with whatever best meets
their goals and outcomes.
She is a founding member of herlocal Hearing Loss Association
(02:03):
of America, and Dr Crosby is amember of the American Academy
of Audiology, the Academy ofDoctors of Audiology and the
Florida Academy of Audiology.
In 2009, she started AudBling,which is a hearing loss
awareness company and she hassome of the coolest.
I don't want to say trinket andminimize it, but you've got
very, very clever audiologystuff there, so I would urge
(02:25):
people to go to audbling.
com.
, how are you?
Dr. Noël Crosby (02:29):
I'm fine.
How are you, Doug?
Dr. Douglas L. Beck (02:32):
Well, I'm doing good.
I'm doing good and I'm happy tobe here.
You and I haven't spent anyquality time together in 20
years.
I'll bet we see each other inhallways and stuff, anyway.
So you just did a session atAAA in New Orleans.
That was in March of 2025.
And that was on managed careand unfortunately I couldn't
make it.
I had other stuff scheduled atthat time.
But let me ask you a couple ofbasics about that, and then
(02:54):
let's talk about the ADApositions on managed care as
well.
So let's start by talking aboutwhat is managed care, if you
can give me a couple ofsentences on that.
Dr. Noël Crosby (03:03):
So I would associate managed care in
audiology with third partypayers, so that would be
administrative groups that areowned by various companies that
contract with people's insurancecompanies to provide the
hearing aid and really allaudiology components of their
(03:25):
services.
So most of them are companiesthat really are more like a
third party.
They're the in-between betweenthe insurance company and the
patient and also an in-betweenbetween the insurance company,
the patient and the audiologist.
And they negotiate pricing withthe insurance companies and then
(03:48):
a lot of times the person orthe patient has to go and go
through.
They can only get theiraudiology services if they go
through somebody whoparticipates with that third
party.
Dr. Douglas L. Beck (04:02):
, the first that I recall really managed
care coming into mainstream.
When I was at the House AirInstitute in Los Angeles back in
whatever it was 81, 82, 83,something like that there were
some HMOs that were just gettingstarted health maintenance
organizations and I think theway that that worked back then
and this is almost 50 years ago,but I think the way it worked
(04:22):
was that if I were on Medicare,I could elect to go to Kaiser
and Kaiser was always one of thevery best in my mind HMOs or I
could go to others and whatwould happen then is that the
HMO would get the Medicarepayment and they would then
(04:43):
supply all of my healthcareneeds that were available and if
they didn't have it, they wouldcontract to other people who
did.
Is that kind of how thatstarted and when that all
started?
Dr. Noël Crosby (04:51):
I would say probably, but I think it's
really morphed into somethingcompletely different now,
because most of the time thepatient or the recipient doesn't
even know that they're part ofthis third party.
They signed up with theirinsurance and then the insurance
contracts with them, without alot of communication between the
recipient and the insurance.
Dr. Douglas L. Beck (05:13):
Or transparency, to be fair, I mean
, listen now, tell me if I'vegot this right.
I wrote an article about threeyears ago explaining how
Medicare Advantage works and youknow more about this than I do.
But my understanding from threeyears ago is this Once you're
on Medicare, you are eligiblefor Medicare and Social Security
given X, y and Z.
So if you get Medicare youcould have traditional Medicare
(05:35):
or you could opt in to MedicareAdvantage.
Now if you opt into any of theprograms, then the federal
government will pay that programabout $1,200 a month to take
care of you for the rest of yourlife.
And so what the MedicareAdvantage programs do, whether
it's United or Blue Cross orwhoever they will package that
their services.
(05:55):
So they'll say hearing services, dental vision, and we all know
they're not very good on mostof those.
But the average recipient on aMedicare Advantage program will
get some kind of blingy thingand they'll get some shiny
objects that look really, reallygood.
But then if they get super sickor they have a chronic disease,
they actually may not get thesame quality care that a
(06:16):
standard Medicare recipientwould get, because the way that
those companies make money outof Medicare Advantage is by not
paying all those services youknow.
Or they'll say, gee, that's notcovered, or gee, your monthly
payment goes up, or gee, youhave a copay, or gee, you have,
you know, an office fee and allthese things.
And I've known many peoplebecause I've been on Medicare
(06:37):
for a couple of years now.
I know many people who wishthat they had not gotten into a
Medicare Advantage program.
Now Medicare Advantage is about50% of all Medicare recipients.
Because they look at silversneakers.
They look at, oh, you havedental coverage, well, your
dental coverage might be half afilling.
Oh, we have hearing aids, butnever the hearing aids you want.
And it's so important to betransparent on these things
(06:58):
because the patient, theconsumer, thinks, oh, I have
Medicare Advantage, I'm going togo get my vision and my hearing
and my teeth and my podiatryand all that stuff checked.
Yeah, you could do that.
But it's not going to be assimple and easy as you think.
When you sign up, themarketing's quite a bit
different often from the reality.
Dr. Noël Crosby (07:17):
Yes, and you can't always see the provider of
your choice because, like manyof us, aren't participating with
the third parties or that withthe companies that these
insurance companies decide towork with.
So the patient?
They don't tell the patientthat.
So the patient thinks oh yeah,now I can go see Dr Crosby and I
can use my benefit or mydiscount Most of it is a
(07:38):
discount and they can't.
So I think there has to be alot more transparency about that
.
Dr. Douglas L. Beck (07:44):
But you have the general yeah Okay.
And, and you know I'll tell you, when I first went on Medicare
a couple of years back, you knowI did do the Medicare Advantage
route because I thought itwould be good.
But then we had this incidentthat was so interesting and I I
I hate to tell the story, but Ilove to tell the story.
So my insurance and my wife'sinsurance are both through
Medicare and we had MedicareAdvantage at the time and one of
(08:08):
us needed an MRI of ourshoulder and neck.
So I got that done and it costme about $400 with Medicare and
I thought, well, that sucks.
And then my wife, six monthslater, wound up having the same
thing done an MRI shoulder andneck and hers through her
insurance was like $700.
And I said you know what?
(08:30):
If you just call them, tellthem we're going to pay cash.
And so she called the MRI placeand said, hey, if we pay cash,
how much would that be?
And they said, oh, 450 bucks.
It costs less money to pay cashthan it did to use our Medicare
Advantage program and that isnot a one-off.
We are not the only ones thathappen to.
Dr. Noël Crosby (08:48):
One thing that people don't realize is if they
go onto Medicare Advantage andthen let's say they get really
sick and they have the existingcondition and they want to
switch back over to regularMedicare.
Well, they may not be able to.
They may not be able to getback on it.
Dr. Douglas L. Beck (09:04):
Yeah, Do you?
Do you have a feeling for it is?
When we talk about thepercentage of audiologists and
hearing instrument specialiststhat accept Medicare Advantage,
third-party pay, all manner ofinsurance I thought I saw a
trend about four or five yearsago where more and more people
were going into conciergeaudiology.
(09:26):
So it's pay-as-you-go sort ofthing, and now I'm not seeing
that so much.
Tell me your reflections onthat.
Dr. Noël Crosby (09:32):
I feel like more and more people are
dropping the Medicare Advantagecompanies, the third party
companies, because I am a smallprivate practice but I don't
want to work harder for lessmoney.
So I think a lot of us arefinding ways that we can still
see and still service thesepatients that have Medicare
(09:54):
Advantage.
But recently a lot of thecompanies have been willing to
work with us in ways that helpus to still provide lower cost
alternatives to these patients.
But then they get to see us andthey don't have to go through
their insurance, because there'sa lot of companies.
It just depends on the area thatyou're in, but in some areas
(10:15):
there's no audiologists theremight be companies that just do
Medicare Advantage plans orthird-party payer plans, and
some of them have to cut corners, and I don't blame them,
because they can't provide allthe services that a private
patient would get, because theydon't get enough to keep their
(10:36):
doors open, and that the samething that's happening is a lot
of people are ending up closingtheir doors because they can't
afford to continue.
Dr. Douglas L. Beck (10:43):
Stay in business?
Sure, well, what about bestpractices and third party pay,
best practices and managed care?
Tell me about that.
Dr. Noël Crosby (10:50):
So if you were at my panel and you will also be
able to I'm going to do somerecordings of some of the people
which I know.
You and I are going to talkabout that more later.
There's a lot of audiologistswho are in areas where there are
a lot of I would say, heavierinflux of people who have third
party payers.
They have found creative waysto still provide best practices
(11:14):
but also be able to see thosepatients.
But there's a lot oftransparency up front.
Then you're going to get thishearing aid.
It's going to cost you thismuch, you're going to buy that
or purchase that through thethird party, but then all these
other best practice services areextra.
They are not included in thatpayment that we get from the
(11:37):
third-party payer.
Dr. Douglas L. Beck (11:39):
And the funny thing is what is a typical
payment for a 92557, which is acomprehensive audio-metric
evaluation.
Dr. Noël Crosby (11:46):
So what I would charge a patient would be $95,
and that might be less thanother people, might be more than
others, but for Medicare it'sabout $35.
Dr. Douglas L. Beck (11:56):
Yeah, and I don't think people realize this
.
This came to light with mepersonally, gosh, I don't know
20 years ago when I had myprivate practices and my dad was
on Medicare at the time and hecame to see me and of course I
wasn't going to charge my fatherbut but he said, oh no, I have
Medicare, you should absolutelycharge.
I mean, I'm not going to pay itand I earned it.
So I said OK.
(12:16):
So I said but here's the thing,Dad, If I bill 92557 to
Medicare, I'm going to have towait 90 to 180 days to get paid
and I'm going to get like $28.
And he said what?
And I said, yeah.
And he said, but I thought youbilled.
(12:40):
And back then I billed about150 bucks for that service and I
got a fifth of it or somethinglike that.
And I don't think any Medicarerecipients, unless they happen
to also be healthcare providers,are aware that when we accept
Medicare it's because, yes, wewant to take care of patients,
yes, we want to do everything wecan to help them out, but by
the same token, you don't getrich off of this.
This is a very, very smallpayment.
And then you're not allowed toback bill the patient for the
missing money.
In other words, if Medicarepays me, let's say, 35 bucks, 40
(13:02):
bucks, to see a patient and mybill is typically 250, 300, I
can't bill the patient for thebalance.
I have to accept Medicarepayment as payment in full.
Am I correct?
Dr. Noël Crosby (13:13):
on that.
Well, also, the supplementalinsurance will pay the 20% that
Medicare doesn't pay.
But you cannot charge yourusual and customary.
You can only charge the I guessit's called the Medicare
allowable amount.
Dr. Douglas L. Beck (13:25):
If you're a participating Medicare provider
.
Dr. Noël Crosby (13:28):
But Advantage plans don't even pay for hearing
tests.
A lot of times they will noteven pay for the 92557.
They include it into theirbecause they assume that
everybody that's coming in tosee us is going to get a hearing
aid.
So they just say, oh, you haveto do the free test in order to
see our patient.
And that was probably one ofthe biggest reasons why.
(13:50):
I decided I wasn't going to beparticipating.
Dr. Douglas L. Beck (13:53):
Well, that assumption has no bearing in
reality.
I think the tested not sold, ifwe can use that category name
is upper.
It's above 50%.
Probably.
My guess 30 to 40% of peoplewho are tested actually wind up
buying product from thatprofessional.
Does that make sense in yourhistory?
Dr. Noël Crosby (14:11):
I mean in your own office.
You want it to be greater than50% and I guess it would just,
you know, depend on how you setthings up, but maybe in the
average office it is.
I would say, about 50% is whatwe would say.
Dr. Douglas L. Beck (14:24):
There was a stat that went around a few
years ago.
I want to say in 2020, that theaverage patient who came in to
see you has already been to twoother places, and that's why I
think it's probably a little bitless than 50 to 50, because if
they've been to two other placesalready, that's two places
where they were tested, not sold, tested, not sold, and then in
your office, right then theybought it.
(14:46):
So that's 100% for you, but forthe profession, I think it may
be a little bit less.
I don't know, and these arealways soft numbers because
nobody really reports this.
This isn't a generallyreportable fact that's easy to
access.
It's kind of like trying tofigure out the exact return for
credit rate, which I think inour profession runs somewhere
(15:07):
around 15% On average.
There are certainly people whohave 3% and 5%, but there are
some people who have 40%, and sothese things all matter, but if
the basic presumption is thateverybody who's going to come in
is going to buy hearing aids,that's not even half right.
Dr. Noël Crosby (15:22):
No, it's not.
Also, I'm going to see a lot ofpatients who maybe aren't ready
for hearing aids or they needmedical intervention and they
need other things, and so whywould I want to see patients for
free just to do diagnostichearing evaluations on patients
that need other things?
And the way that these thirdparties function is they don't
(15:46):
even acknowledge that there's awhole subset of patients that
aren't hearing aid patients.
Dr. Douglas L. Beck (15:50):
Yeah, and that's significant because I did
know.
I did a paper in 2019 with JeffDanhauer and we showed that in
the USA, which now is about 335million people in the USA,
there's 26 million people haveperfectly normal hearing
thresholds, but they will havehearing difficulty, they will
have speech and noise problems.
So what does that mean?
That means we should befollowing best practices on all
(16:12):
of those patients.
We should be doing speech andnoise, we should be doing
listening and communicationassessments, we should be doing
extended high frequencies.
When we do that, then we startto find these other situations
that brought them in.
Now, some of them may or may notbe hearing aid candidates, with
or without tinnitus, with orwithout hearing loss.
Because what we know also isthat you know human hearing 20
hertz to 20,000 hertz.
(16:33):
Most audiologists don't testabove 8,000 hertz, but until
8,000 hertz is impacted, mostEMTs, most audiologists, most
hearing care professionals willsay your hearing thresholds are
normal, but they didn't test 20,18, 16, 15, 14, 13, 12, 11, 10,
9,000 hertz.
That we ignore and we justmeasure 250 to 8,000.
(16:55):
Now the problem with that isI'll tell you as a musician is
that the lowest note we test onan audiogram when we're doing
these very simple, pure toneassessments.
The lowest note we test ismiddle C.
The entire left side of a pianois not tested in a normal
audiogram, which is why bestpractices say you have to do so
much more.
You have to do Ipsy reflexes,contra reflexes, tympanograms,
(17:16):
otoacoustic, then we get a goodlook at what's actually going on
with you.
But air, bone and speech,that's not any better than a
Snellen eye chart for anoptometrist.
Dr. Noël Crosby (17:25):
Yes, and that is not none of that is typically
something that they would cover, you know.
They would just say, okay, youhave to do this free hearing
test, and so why would anyone bemotivated to do any more?
Because the patient was toldthat they were going to have a
free hearing evaluation.
And when you say, oh well,that's only a piece of it, you
(17:48):
know we need to do these otherthings and they're not covered
by your insurance, then patientsare reluctant because they were
just under the assumption thatthat was free and it was all
that needed to be done.
Dr. Douglas L. Beck (17:59):
Yeah, because they're paying their
monthly fee to their insurancecompanies and they're told it's
free.
So they expect something.
But you know, here's the thing,and you know, maybe one day
we'll all wise up.
There ain't nothing free.
And when somebody tells you oh,I have a service that's
available for free for you, youshould always walk away.
And I say that knowingly thatmany of our colleagues say free
hearing test.
I've never liked that at all,and here's why.
(18:22):
Number one even if you're doinga screening, a screening doesn't
give you enough information tomake a decision.
A patient could totally pass afree screening, yet their speech
and noise score, their SNR 50,could be nine.
That would never show up on afree screening.
They could have all sorts ofADD, adhd, dyslexia, specific
language disorders None of thatwould show up on a screening.
(18:43):
They could have the worstability to localize sound None
of that would show up in ascreening.
But if we were to do bestpractices, every one of those
patients we would pick somethingup on, and so I've never been a
fan of free screenings at all.
I don't think we should do themas professionals, you know.
Let me ask you a question.
I mean, does your neurologistdo a free screening?
Does your optometrist do a freescreening?
Does your OBGYN?
(19:03):
Does your gastroenterologist?
Nobody does free screenings.
Why and that's such a majorissue to me?
I think if you want to bring ina lot of patients with
something that that'll attractthem, I might say something like
this Do you have difficultyunderstanding speech and noise?
That's our area of expertise.
Do you have tinnitus ringing inthe ears?
Please come and see us.
We'll be happy to address thatwith you.
(19:24):
But but you know it, it and weall know that when somebody
mentions tinnitus in themarketing piece, you get
patients that you can't evenhandle.
There's so many speech andnoise problems, single most
common reason that people comein to see an audiologist or a
hearing aid dispenser.
So let me ask you a question.
So the Academy of Doctors ofAudiology has a recent statement
.
It was actually in a hearingreview.
(19:45):
The ADA urges reform in hearinghealthcare coverage to improve
patient outcomes, and I knowyou're involved with that as
well.
Can you tell me?
I'll read the summary and thenyou talk about the takeaways.
So the summary is the ADA isadvocating for major reforms in
hearing healthcare coverage,emphasizing the need for
stronger regulations to ensurepatients receive essential
(20:07):
audiologic services rather thanbeing subjected to profit-driven
hearing aid sales.
What can you tell me about allthat?
Dr. Noël Crosby (20:14):
Yeah.
So again, what I was sayingbefore is that a lot of these
third-party payers, so theperson let's say there's 50%
people, people have advantageplans, so the person has a
tinnitus or the person hassomething like fullness in their
ear, so they need a fullaudiologic evaluation.
But the third party is like, oh, that's just hearing aid, so
(20:38):
they'll, they'll send them tosomebody who may not be the
appropriate provider.
It may be somebody who's notset up to do a diagnostic test.
They may just do a test for thepurpose of a hearing aid and
the person really never getsthat in-depth evaluation that
they need to get because thatthird party is only focused on
the sale of the hearing aid andthey're not focused on the other
(21:00):
people that need fullaudiologic care that need full
audiologic care.
Dr. Douglas L. Beck (21:07):
Yeah, and so ADA.
I think they call for hearingbenefit plans to be classified
as health benefit plans toensure proper regulation and
oversight.
How does that work?
Dr. Noël Crosby (21:16):
What I want to focus on with this really is
just that ADA and all themembers of ADA, which are a lot
of private practice audiologistswho are best practice providers
, they know that there needs tobe reform because we are not
just hearing aid testers.
Dr. Douglas L. Beck (21:34):
Salespeople .
So, dr Crosby, you know therewas a recent March 25th 2025, so
a few weeks ago in the hearingreview, there was a nice
statement from the Academy ofDoctors of Audiology and the
summary is the ADA is advocatingfor major reforms in hearing
(21:55):
healthcare coverage, emphasizingthe need for stronger
regulations to ensure patientsreceive essential audiologic
services rather than beingsubjected to protocols, perhaps
from profit-driven hearing aidsales, and I think that's the
essence of what you and I werejust talking about.
Is that everybody drivenhearing aid sales and I think
that's that's the essence ofwhat you and I were just talking
about is that everybody withhearing and listening problems
is not a hearing aid candidate,nor do they want or need hearing
aids.
Dr. Noël Crosby (22:14):
Right, yeah, there's so many people that just
need help, advice, medicaltreatment, and they and the
audiologist needs to get paidfor their time.
I mean, I spend.
I spend probably an hour, anhour and a half with a new
patient, whether they get ahearing aid from me or not.
I can't be doing free testingfor an hour and a half and have
(22:36):
the patient.
Well, if I was doing the freetesting, I would have to try to
cut my time down and then Iwould never feel like I was
doing the best job for thepatient.
So there's many of us that knowthat there are so many people
out there that are not justhearing aid candidates.
They are people that needmedical advice and treatment and
they need maybe to see an ear,nose and throat doctor, or they
(22:58):
need further testing and thesethird parties don't ever
consider that.
Dr. Douglas L. Beck (23:02):
They think everyone's just the hearing aid
candidate consider that theythink everyone's just the
hearing aid candidate.
Yeah, I think it's wrong topresume that hearing and
auditory complaints are going towind up with hearing aid sales,
and I think that's the essenceof why third-party payers and
administrative models forhearing healthcare often fall
short, because many of thesepatients just need to be seen,
(23:23):
counseled, advised.
Very few patients with hearingloss actually have any ear
disease.
You know it's probably fewerthan 5% to 7%.
95% of all patients havehearing loss associated with
aging.
They have hearing loss due toototoxic drugs, they have
hearing loss due tonoise-induced hearing loss.
They have hearing loss thatthere is no medical or surgical
(23:43):
cure for, and most of them could, at the right time and place,
be hearing aid candidates,whether it's over-the-counter or
prescription hearing aids.
But to presume that they wereall in the same category is
ludicrous, yeah.
Dr. Noël Crosby (23:56):
And they also need more advice than just a
quick hearing test.
They're like, even though yousay that about, they don't need,
you know, surgery or they don'tneed medical intervention.
They need other things.
You know the area where I havea lot of patients that would
come and they have tinnitus andthey think having the hearing
test is going to be all theyneed and there's so much more
(24:19):
that we need to do for thosepatients.
But if they have a third partypayer, that's not going to
happen.
Dr. Douglas L. Beck (24:25):
Yeah, that's a bit obscene in many
respects.
You know, for the peoplelistening who are not aware,
tinnitus is typically referredto as ringing in the ears.
It sounds that you can perceivethat actually have no objective
or physical orientation.
They are sounds that might beconsidered phantom sounds.
The thing about tinnitus thatis so important to understand is
(24:46):
tinnitus can be a sign or asymptom of a very, very, very
dangerous situation.
Most of the time it's not, butyou need to see a professional,
like an audiologist or an ENT,to make that call.
And to make that call yourselfcan be short-sighted.
You should definitely see aprofessional get worked up,
particularly if you haveunilateral tinnitus tinnitus on
just one side.
(25:06):
There could be a reason forthat.
That would be benign and therecould be a reason for that.
That could be very dangerous.
So tinnitus should always beevaluated.
But I think the point is thatyou're making is that once we've
done that evaluation on apatient, then we can guide them
to the next step.
But if the insurance doesn'tallow us to do a thorough
evaluation, we can't see theforest for the trees.
(25:27):
We don't know which patient iseligible for X, y or Z and which
patient is not.
And further with tinnituspatients and I always like to
make sure that we all understandthis.
People will say, well, is therea cure for tinnitus?
And the answer is no, there'sno cure for tinnitus.
There's no cure for diabetes.
There's no cure for tinnitus.
There's no cure for diabetes.
(25:48):
There's no cure for migraines,there's no cure for lower back
pain.
These are things we manage and90% of people with tinnitus 90%
9-0, can be managed effectivelythrough things like progressive
tinnitus management, trt andsome newer protocols that have
come up, and these aren't folly.
I mean this comes from OregonHealth Sciences and it's very
well known in audiology.
90% of tinnitus can be wellmanaged, just like many other
(26:12):
difficult challenges that we allface.
So I think tinnitus is a greatexample.
Do you do extensive tinnitusworkups like pitch matching and
loudness matching and trydifferent background sounds and
things?
Dr. Noël Crosby (26:25):
No, I would call myself a tinnitus expert.
I have my point where I go okay, I'm not skilled to do that and
then I have colleagues.
So if they need differenttreatment, if what I do with
them isn't enough, then I wouldrefer them to my colleagues who
specialize in maybe a linearproduct or other treatments.
Some of my colleagues seesevere tinnitus patients and
(26:48):
that's what they do, and theycan really make a difference in
their lives.
So I don't want anyone to everthink that if you ever go
somewhere and they say there'snothing I can do for your
tinnitus, please do not takethat as the truth.
There are many providers outthere that are doing an
excellent job in assisting thesepatients.
Dr. Douglas L. Beck (27:08):
Oh, absolutely, and it's the same
thing that you hear.
With hearing, you know, is that, oh, we all have hearing loss,
that's normal for your age,which is absolutely ludicrous.
There's no normal hearing loss,there's no normal visual loss,
there's no normal diabetes.
And when a doctor, let alone adoctor, says that's normal for
your age, no, it is not.
It's common for your age, it'snot normal.
(27:30):
And all hearing loss that isassociated with aging is
neurodegenerative.
It doesn't get better, italmost always gets worse or it
might stay the same.
But it's important to manage it, because if you don't manage it
now, we have social isolation,we have anxiety, we have
depression, we increase ourat-risk opportunity for
cognitive decline, psychologicalwell-being, withdrawal from
(27:52):
social situations None of thoseare good.
Why are we allowing patients tobe told that, oh, it's normal
for your aging, you have to getused to it.
That's nonsense, anyway.
So, dr Crosby, it is a joy tospeak to you.
Noel, it's been too long.
I certainly do remember back inthe day when we were working on
our doctorates at University ofFlorida, and it was always
(28:12):
great because you were a breathof fresh air.
You know, you would cut throughall the jibber jabber and your
notes were great, my notes weregreat and I think that in our
groups we were able to sharenote-taking not test-taking and
we were able to get even moreout of the classes because we
had so many smart people in ourclass and you were certainly the
(28:34):
star among all of us, so I'm soglad that we've had these years
together.
Dr. Noël Crosby (28:38):
Thanks, doug, I appreciate that it was a great
experience.
Dr. Douglas L. Beck (28:42):
Absolutely All right, dr Crosby.
Thank you so much for your time, thanks for your thoughts on
managed care and I will lookforward to hopefully seeing you
at the Florida Academy ofAudiology.
Wonderful, thank you.
Dr. Noël Crosby (28:52):
Thanks for having me.
Thank you to our partners.
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(00:41):
Welcome back to another episodeof the Hearing Matters Podcast.
I'm founder and host BlaiseDelfino and, as a friendly
reminder, this podcast isseparate from my work at Starkey
.
Dr. Douglas L. Beck (00:56):
Good afternoon.
This is Dr Douglas Beck withthe Hearing Matters Podcast, and
today I'm here with my friendand colleague, .
She earned her doctorate inclinical audiology from the
University of Florida and shewas the smartest person in our
class.
She and I went to schooltogether.
Dr Crosby was on the inauguralboard of the Florida Academy of
Audiology and she served aspresident not once in 2000, not
(01:19):
twice in 2009, but again in 2025.
And I think that's amazing.
Dr Crosby worked at Sarasota'sSilverstein Institute for 14
years that was my old pal, drHerbert Silverstein who ran that
and for the last six of thoseyears she was director of
audiology.
While there, she establishedthe Institute's cochlear implant
(01:41):
program as well as SarasotaMemorial Hospital's Infant
Hearing Screening Program.
Dr Crosby operatesindependently of any hearing aid
manufacturer and that's awonderful thing for so many
reasons, but basically she canprovide her patients with
unbiased evaluations and fitthem with whatever best meets
their goals and outcomes.
She is a founding member of herlocal Hearing Loss Association
(02:03):
of America, and Dr Crosby is amember of the American Academy
of Audiology, the Academy ofDoctors of Audiology and the
Florida Academy of Audiology.
In 2009, she started AudBling,which is a hearing loss
awareness company and she hassome of the coolest.
I don't want to say trinket andminimize it, but you've got
very, very clever audiologystuff there, so I would urge
(02:25):
people to go to audbling.
com.
, how are you?
Dr. Noël Crosby (02:29):
I'm fine.
How are you, Doug?
Dr. Douglas L. Beck (02:32):
Well, I'm doing good.
I'm doing good and I'm happy tobe here.
You and I haven't spent anyquality time together in 20
years.
I'll bet we see each other inhallways and stuff, anyway.
So you just did a session atAAA in New Orleans.
That was in March of 2025.
And that was on managed careand unfortunately I couldn't
make it.
I had other stuff scheduled atthat time.
But let me ask you a couple ofbasics about that, and then
(02:54):
let's talk about the ADApositions on managed care as
well.
So let's start by talking aboutwhat is managed care, if you
can give me a couple ofsentences on that.
Dr. Noël Crosby (03:03):
So I would associate managed care in
audiology with third partypayers, so that would be
administrative groups that areowned by various companies that
contract with people's insurancecompanies to provide the
hearing aid and really allaudiology components of their
(03:25):
services.
So most of them are companiesthat really are more like a
third party.
They're the in-between betweenthe insurance company and the
patient and also an in-betweenbetween the insurance company,
the patient and the audiologist.
And they negotiate pricing withthe insurance companies and then
(03:48):
a lot of times the person orthe patient has to go and go
through.
They can only get theiraudiology services if they go
through somebody whoparticipates with that third
party.
Dr. Douglas L. Beck (04:02):
, the first that I recall really managed
care coming into mainstream.
When I was at the House AirInstitute in Los Angeles back in
whatever it was 81, 82, 83,something like that there were
some HMOs that were just gettingstarted health maintenance
organizations and I think theway that that worked back then
and this is almost 50 years ago,but I think the way it worked
(04:22):
was that if I were on Medicare,I could elect to go to Kaiser
and Kaiser was always one of thevery best in my mind HMOs or I
could go to others and whatwould happen then is that the
HMO would get the Medicarepayment and they would then
(04:43):
supply all of my healthcareneeds that were available and if
they didn't have it, they wouldcontract to other people who
did.
Is that kind of how thatstarted and when that all
started?
Dr. Noël Crosby (04:51):
I would say probably, but I think it's
really morphed into somethingcompletely different now,
because most of the time thepatient or the recipient doesn't
even know that they're part ofthis third party.
They signed up with theirinsurance and then the insurance
contracts with them, without alot of communication between the
recipient and the insurance.
Dr. Douglas L. Beck (05:13):
Or transparency, to be fair, I mean
, listen now, tell me if I'vegot this right.
I wrote an article about threeyears ago explaining how
Medicare Advantage works and youknow more about this than I do.
But my understanding from threeyears ago is this Once you're
on Medicare, you are eligiblefor Medicare and Social Security
given X, y and Z.
So if you get Medicare youcould have traditional Medicare
(05:35):
or you could opt in to MedicareAdvantage.
Now if you opt into any of theprograms, then the federal
government will pay that programabout $1,200 a month to take
care of you for the rest of yourlife.
And so what the MedicareAdvantage programs do, whether
it's United or Blue Cross orwhoever they will package that
their services.
(05:55):
So they'll say hearing services, dental vision, and we all know
they're not very good on mostof those.
But the average recipient on aMedicare Advantage program will
get some kind of blingy thingand they'll get some shiny
objects that look really, reallygood.
But then if they get super sickor they have a chronic disease,
they actually may not get thesame quality care that a
(06:16):
standard Medicare recipientwould get, because the way that
those companies make money outof Medicare Advantage is by not
paying all those services youknow.
Or they'll say, gee, that's notcovered, or gee, your monthly
payment goes up, or gee, youhave a copay, or gee, you have,
you know, an office fee and allthese things.
And I've known many peoplebecause I've been on Medicare
(06:37):
for a couple of years now.
I know many people who wishthat they had not gotten into a
Medicare Advantage program.
Now Medicare Advantage is about50% of all Medicare recipients.
Because they look at silversneakers.
They look at, oh, you havedental coverage, well, your
dental coverage might be half afilling.
Oh, we have hearing aids, butnever the hearing aids you want.
And it's so important to betransparent on these things
(06:58):
because the patient, theconsumer, thinks, oh, I have
Medicare Advantage, I'm going togo get my vision and my hearing
and my teeth and my podiatryand all that stuff checked.
Yeah, you could do that.
But it's not going to be assimple and easy as you think.
When you sign up, themarketing's quite a bit
different often from the reality.
Dr. Noël Crosby (07:17):
Yes, and you can't always see the provider of
your choice because, like manyof us, aren't participating with
the third parties or that withthe companies that these
insurance companies decide towork with.
So the patient?
They don't tell the patientthat.
So the patient thinks oh yeah,now I can go see Dr Crosby and I
can use my benefit or mydiscount Most of it is a
(07:38):
discount and they can't.
So I think there has to be alot more transparency about that
.
Dr. Douglas L. Beck (07:44):
But you have the general yeah Okay.
And, and you know I'll tell you, when I first went on Medicare
a couple of years back, you knowI did do the Medicare Advantage
route because I thought itwould be good.
But then we had this incidentthat was so interesting and I I
I hate to tell the story, but Ilove to tell the story.
So my insurance and my wife'sinsurance are both through
Medicare and we had MedicareAdvantage at the time and one of
(08:08):
us needed an MRI of ourshoulder and neck.
So I got that done and it costme about $400 with Medicare and
I thought, well, that sucks.
And then my wife, six monthslater, wound up having the same
thing done an MRI shoulder andneck and hers through her
insurance was like $700.
And I said you know what?
(08:30):
If you just call them, tellthem we're going to pay cash.
And so she called the MRI placeand said, hey, if we pay cash,
how much would that be?
And they said, oh, 450 bucks.
It costs less money to pay cashthan it did to use our Medicare
Advantage program and that isnot a one-off.
We are not the only ones thathappen to.
Dr. Noël Crosby (08:48):
One thing that people don't realize is if they
go onto Medicare Advantage andthen let's say they get really
sick and they have the existingcondition and they want to
switch back over to regularMedicare.
Well, they may not be able to.
They may not be able to getback on it.
Dr. Douglas L. Beck (09:04):
Yeah, Do you?
Do you have a feeling for it is?
When we talk about thepercentage of audiologists and
hearing instrument specialiststhat accept Medicare Advantage,
third-party pay, all manner ofinsurance I thought I saw a
trend about four or five yearsago where more and more people
were going into conciergeaudiology.
(09:26):
So it's pay-as-you-go sort ofthing, and now I'm not seeing
that so much.
Tell me your reflections onthat.
Dr. Noël Crosby (09:32):
I feel like more and more people are
dropping the Medicare Advantagecompanies, the third party
companies, because I am a smallprivate practice but I don't
want to work harder for lessmoney.
So I think a lot of us arefinding ways that we can still
see and still service thesepatients that have Medicare
(09:54):
Advantage.
But recently a lot of thecompanies have been willing to
work with us in ways that helpus to still provide lower cost
alternatives to these patients.
But then they get to see us andthey don't have to go through
their insurance, because there'sa lot of companies.
It just depends on the area thatyou're in, but in some areas
(10:15):
there's no audiologists theremight be companies that just do
Medicare Advantage plans orthird-party payer plans, and
some of them have to cut corners, and I don't blame them,
because they can't provide allthe services that a private
patient would get, because theydon't get enough to keep their
(10:36):
doors open, and that the samething that's happening is a lot
of people are ending up closingtheir doors because they can't
afford to continue.
Dr. Douglas L. Beck (10:43):
Stay in business?
Sure, well, what about bestpractices and third party pay,
best practices and managed care?
Tell me about that.
Dr. Noël Crosby (10:50):
So if you were at my panel and you will also be
able to I'm going to do somerecordings of some of the people
which I know.
You and I are going to talkabout that more later.
There's a lot of audiologistswho are in areas where there are
a lot of I would say, heavierinflux of people who have third
party payers.
They have found creative waysto still provide best practices
(11:14):
but also be able to see thosepatients.
But there's a lot oftransparency up front.
Then you're going to get thishearing aid.
It's going to cost you thismuch, you're going to buy that
or purchase that through thethird party, but then all these
other best practice services areextra.
They are not included in thatpayment that we get from the
(11:37):
third-party payer.
Dr. Douglas L. Beck (11:39):
And the funny thing is what is a typical
payment for a 92557, which is acomprehensive audio-metric
evaluation.
Dr. Noël Crosby (11:46):
So what I would charge a patient would be $95,
and that might be less thanother people, might be more than
others, but for Medicare it'sabout $35.
Dr. Douglas L. Beck (11:56):
Yeah, and I don't think people realize this
.
This came to light with mepersonally, gosh, I don't know
20 years ago when I had myprivate practices and my dad was
on Medicare at the time and hecame to see me and of course I
wasn't going to charge my fatherbut but he said, oh no, I have
Medicare, you should absolutelycharge.
I mean, I'm not going to pay itand I earned it.
So I said OK.
(12:16):
So I said but here's the thing,Dad, If I bill 92557 to
Medicare, I'm going to have towait 90 to 180 days to get paid
and I'm going to get like $28.
And he said what?
And I said, yeah.
And he said, but I thought youbilled.
(12:40):
And back then I billed about150 bucks for that service and I
got a fifth of it or somethinglike that.
And I don't think any Medicarerecipients, unless they happen
to also be healthcare providers,are aware that when we accept
Medicare it's because, yes, wewant to take care of patients,
yes, we want to do everything wecan to help them out, but by
the same token, you don't getrich off of this.
This is a very, very smallpayment.
And then you're not allowed toback bill the patient for the
missing money.
In other words, if Medicarepays me, let's say, 35 bucks, 40
(13:02):
bucks, to see a patient and mybill is typically 250, 300, I
can't bill the patient for thebalance.
I have to accept Medicarepayment as payment in full.
Am I correct?
Dr. Noël Crosby (13:13):
on that.
Well, also, the supplementalinsurance will pay the 20% that
Medicare doesn't pay.
But you cannot charge yourusual and customary.
You can only charge the I guessit's called the Medicare
allowable amount.
Dr. Douglas L. Beck (13:25):
If you're a participating Medicare provider
.
Dr. Noël Crosby (13:28):
But Advantage plans don't even pay for hearing
tests.
A lot of times they will noteven pay for the 92557.
They include it into theirbecause they assume that
everybody that's coming in tosee us is going to get a hearing
aid.
So they just say, oh, you haveto do the free test in order to
see our patient.
And that was probably one ofthe biggest reasons why.
(13:50):
I decided I wasn't going to beparticipating.
Dr. Douglas L. Beck (13:53):
Well, that assumption has no bearing in
reality.
I think the tested not sold, ifwe can use that category name
is upper.
It's above 50%.
Probably.
My guess 30 to 40% of peoplewho are tested actually wind up
buying product from thatprofessional.
Does that make sense in yourhistory?
Dr. Noël Crosby (14:11):
I mean in your own office.
You want it to be greater than50% and I guess it would just,
you know, depend on how you setthings up, but maybe in the
average office it is.
I would say, about 50% is whatwe would say.
Dr. Douglas L. Beck (14:24):
There was a stat that went around a few
years ago.
I want to say in 2020, that theaverage patient who came in to
see you has already been to twoother places, and that's why I
think it's probably a little bitless than 50 to 50, because if
they've been to two other placesalready, that's two places
where they were tested, not sold, tested, not sold, and then in
your office, right then theybought it.
(14:46):
So that's 100% for you, but forthe profession, I think it may
be a little bit less.
I don't know, and these arealways soft numbers because
nobody really reports this.
This isn't a generallyreportable fact that's easy to
access.
It's kind of like trying tofigure out the exact return for
credit rate, which I think inour profession runs somewhere
(15:07):
around 15% On average.
There are certainly people whohave 3% and 5%, but there are
some people who have 40%, and sothese things all matter, but if
the basic presumption is thateverybody who's going to come in
is going to buy hearing aids,that's not even half right.
Dr. Noël Crosby (15:22):
No, it's not.
Also, I'm going to see a lot ofpatients who maybe aren't ready
for hearing aids or they needmedical intervention and they
need other things, and so whywould I want to see patients for
free just to do diagnostichearing evaluations on patients
that need other things?
And the way that these thirdparties function is they don't
(15:46):
even acknowledge that there's awhole subset of patients that
aren't hearing aid patients.
Dr. Douglas L. Beck (15:50):
Yeah, and that's significant because I did
know.
I did a paper in 2019 with JeffDanhauer and we showed that in
the USA, which now is about 335million people in the USA,
there's 26 million people haveperfectly normal hearing
thresholds, but they will havehearing difficulty, they will
have speech and noise problems.
So what does that mean?
That means we should befollowing best practices on all
(16:12):
of those patients.
We should be doing speech andnoise, we should be doing
listening and communicationassessments, we should be doing
extended high frequencies.
When we do that, then we startto find these other situations
that brought them in.
Now, some of them may or may notbe hearing aid candidates, with
or without tinnitus, with orwithout hearing loss.
Because what we know also isthat you know human hearing 20
hertz to 20,000 hertz.
(16:33):
Most audiologists don't testabove 8,000 hertz, but until
8,000 hertz is impacted, mostEMTs, most audiologists, most
hearing care professionals willsay your hearing thresholds are
normal, but they didn't test 20,18, 16, 15, 14, 13, 12, 11, 10,
9,000 hertz.
That we ignore and we justmeasure 250 to 8,000.
(16:55):
Now the problem with that isI'll tell you as a musician is
that the lowest note we test onan audiogram when we're doing
these very simple, pure toneassessments.
The lowest note we test ismiddle C.
The entire left side of a pianois not tested in a normal
audiogram, which is why bestpractices say you have to do so
much more.
You have to do Ipsy reflexes,contra reflexes, tympanograms,
(17:16):
otoacoustic, then we get a goodlook at what's actually going on
with you.
But air, bone and speech,that's not any better than a
Snellen eye chart for anoptometrist.
Dr. Noël Crosby (17:25):
Yes, and that is not none of that is typically
something that they would cover, you know.
They would just say, okay, youhave to do this free hearing
test, and so why would anyone bemotivated to do any more?
Because the patient was toldthat they were going to have a
free hearing evaluation.
And when you say, oh well,that's only a piece of it, you
(17:48):
know we need to do these otherthings and they're not covered
by your insurance, then patientsare reluctant because they were
just under the assumption thatthat was free and it was all
that needed to be done.
Dr. Douglas L. Beck (17:59):
Yeah, because they're paying their
monthly fee to their insurancecompanies and they're told it's
free.
So they expect something.
But you know, here's the thing,and you know, maybe one day
we'll all wise up.
There ain't nothing free.
And when somebody tells you oh,I have a service that's
available for free for you, youshould always walk away.
And I say that knowingly thatmany of our colleagues say free
hearing test.
I've never liked that at all,and here's why.
(18:22):
Number one even if you're doinga screening, a screening doesn't
give you enough information tomake a decision.
A patient could totally pass afree screening, yet their speech
and noise score, their SNR 50,could be nine.
That would never show up on afree screening.
They could have all sorts ofADD, adhd, dyslexia, specific
language disorders None of thatwould show up on a screening.
(18:43):
They could have the worstability to localize sound None
of that would show up in ascreening.
But if we were to do bestpractices, every one of those
patients we would pick somethingup on, and so I've never been a
fan of free screenings at all.
I don't think we should do themas professionals, you know.
Let me ask you a question.
I mean, does your neurologistdo a free screening?
Does your optometrist do a freescreening?
Does your OBGYN?
(19:03):
Does your gastroenterologist?
Nobody does free screenings.
Why and that's such a majorissue to me?
I think if you want to bring ina lot of patients with
something that that'll attractthem, I might say something like
this Do you have difficultyunderstanding speech and noise?
That's our area of expertise.
Do you have tinnitus ringing inthe ears?
Please come and see us.
We'll be happy to address thatwith you.
(19:24):
But but you know it, it and weall know that when somebody
mentions tinnitus in themarketing piece, you get
patients that you can't evenhandle.
There's so many speech andnoise problems, single most
common reason that people comein to see an audiologist or a
hearing aid dispenser.
So let me ask you a question.
So the Academy of Doctors ofAudiology has a recent statement
.
It was actually in a hearingreview.
(19:45):
The ADA urges reform in hearinghealthcare coverage to improve
patient outcomes, and I knowyou're involved with that as
well.
Can you tell me?
I'll read the summary and thenyou talk about the takeaways.
So the summary is the ADA isadvocating for major reforms in
hearing healthcare coverage,emphasizing the need for
stronger regulations to ensurepatients receive essential
(20:07):
audiologic services rather thanbeing subjected to profit-driven
hearing aid sales.
What can you tell me about allthat?
Dr. Noël Crosby (20:14):
Yeah.
So again, what I was sayingbefore is that a lot of these
third-party payers, so theperson let's say there's 50%
people, people have advantageplans, so the person has a
tinnitus or the person hassomething like fullness in their
ear, so they need a fullaudiologic evaluation.
But the third party is like, oh, that's just hearing aid, so
(20:38):
they'll, they'll send them tosomebody who may not be the
appropriate provider.
It may be somebody who's notset up to do a diagnostic test.
They may just do a test for thepurpose of a hearing aid and
the person really never getsthat in-depth evaluation that
they need to get because thatthird party is only focused on
the sale of the hearing aid andthey're not focused on the other
(21:00):
people that need fullaudiologic care that need full
audiologic care.
Dr. Douglas L. Beck (21:07):
Yeah, and so ADA.
I think they call for hearingbenefit plans to be classified
as health benefit plans toensure proper regulation and
oversight.
How does that work?
Dr. Noël Crosby (21:16):
What I want to focus on with this really is
just that ADA and all themembers of ADA, which are a lot
of private practice audiologistswho are best practice providers
, they know that there needs tobe reform because we are not
just hearing aid testers.
Dr. Douglas L. Beck (21:34):
Salespeople .
So, dr Crosby, you know therewas a recent March 25th 2025, so
a few weeks ago in the hearingreview, there was a nice
statement from the Academy ofDoctors of Audiology and the
summary is the ADA is advocatingfor major reforms in hearing
(21:55):
healthcare coverage, emphasizingthe need for stronger
regulations to ensure patientsreceive essential audiologic
services rather than beingsubjected to protocols, perhaps
from profit-driven hearing aidsales, and I think that's the
essence of what you and I werejust talking about.
Is that everybody drivenhearing aid sales and I think
that's that's the essence ofwhat you and I were just talking
about is that everybody withhearing and listening problems
is not a hearing aid candidate,nor do they want or need hearing
aids.
Dr. Noël Crosby (22:14):
Right, yeah, there's so many people that just
need help, advice, medicaltreatment, and they and the
audiologist needs to get paidfor their time.
I mean, I spend.
I spend probably an hour, anhour and a half with a new
patient, whether they get ahearing aid from me or not.
I can't be doing free testingfor an hour and a half and have
(22:36):
the patient.
Well, if I was doing the freetesting, I would have to try to
cut my time down and then Iwould never feel like I was
doing the best job for thepatient.
So there's many of us that knowthat there are so many people
out there that are not justhearing aid candidates.
They are people that needmedical advice and treatment and
they need maybe to see an ear,nose and throat doctor, or they
(22:58):
need further testing and thesethird parties don't ever
consider that.
Dr. Douglas L. Beck (23:02):
They think everyone's just the hearing aid
candidate consider that theythink everyone's just the
hearing aid candidate.
Yeah, I think it's wrong topresume that hearing and
auditory complaints are going towind up with hearing aid sales,
and I think that's the essenceof why third-party payers and
administrative models forhearing healthcare often fall
short, because many of thesepatients just need to be seen,
(23:23):
counseled, advised.
Very few patients with hearingloss actually have any ear
disease.
You know it's probably fewerthan 5% to 7%.
95% of all patients havehearing loss associated with
aging.
They have hearing loss due toototoxic drugs, they have
hearing loss due tonoise-induced hearing loss.
They have hearing loss thatthere is no medical or surgical
(23:43):
cure for, and most of them could, at the right time and place,
be hearing aid candidates,whether it's over-the-counter or
prescription hearing aids.
But to presume that they wereall in the same category is
ludicrous, yeah.
Dr. Noël Crosby (23:56):
And they also need more advice than just a
quick hearing test.
They're like, even though yousay that about, they don't need,
you know, surgery or they don'tneed medical intervention.
They need other things.
You know the area where I havea lot of patients that would
come and they have tinnitus andthey think having the hearing
test is going to be all theyneed and there's so much more
(24:19):
that we need to do for thosepatients.
But if they have a third partypayer, that's not going to
happen.
Dr. Douglas L. Beck (24:25):
Yeah, that's a bit obscene in many
respects.
You know, for the peoplelistening who are not aware,
tinnitus is typically referredto as ringing in the ears.
It sounds that you can perceivethat actually have no objective
or physical orientation.
They are sounds that might beconsidered phantom sounds.
The thing about tinnitus thatis so important to understand is
(24:46):
tinnitus can be a sign or asymptom of a very, very, very
dangerous situation.
Most of the time it's not, butyou need to see a professional,
like an audiologist or an ENT,to make that call.
And to make that call yourselfcan be short-sighted.
You should definitely see aprofessional get worked up,
particularly if you haveunilateral tinnitus tinnitus on
just one side.
(25:06):
There could be a reason forthat.
That would be benign and therecould be a reason for that.
That could be very dangerous.
So tinnitus should always beevaluated.
But I think the point is thatyou're making is that once we've
done that evaluation on apatient, then we can guide them
to the next step.
But if the insurance doesn'tallow us to do a thorough
evaluation, we can't see theforest for the trees.
(25:27):
We don't know which patient iseligible for X, y or Z and which
patient is not.
And further with tinnituspatients and I always like to
make sure that we all understandthis.
People will say, well, is therea cure for tinnitus?
And the answer is no, there'sno cure for tinnitus.
There's no cure for diabetes.
There's no cure for tinnitus.
There's no cure for diabetes.
(25:48):
There's no cure for migraines,there's no cure for lower back
pain.
These are things we manage and90% of people with tinnitus 90%
9-0, can be managed effectivelythrough things like progressive
tinnitus management, trt andsome newer protocols that have
come up, and these aren't folly.
I mean this comes from OregonHealth Sciences and it's very
well known in audiology.
90% of tinnitus can be wellmanaged, just like many other
(26:12):
difficult challenges that we allface.
So I think tinnitus is a greatexample.
Do you do extensive tinnitusworkups like pitch matching and
loudness matching and trydifferent background sounds and
things?
Dr. Noël Crosby (26:25):
No, I would call myself a tinnitus expert.
I have my point where I go okay, I'm not skilled to do that and
then I have colleagues.
So if they need differenttreatment, if what I do with
them isn't enough, then I wouldrefer them to my colleagues who
specialize in maybe a linearproduct or other treatments.
Some of my colleagues seesevere tinnitus patients and
(26:48):
that's what they do, and theycan really make a difference in
their lives.
So I don't want anyone to everthink that if you ever go
somewhere and they say there'snothing I can do for your
tinnitus, please do not takethat as the truth.
There are many providers outthere that are doing an
excellent job in assisting thesepatients.
Dr. Douglas L. Beck (27:08):
Oh, absolutely, and it's the same
thing that you hear.
With hearing, you know, is that, oh, we all have hearing loss,
that's normal for your age,which is absolutely ludicrous.
There's no normal hearing loss,there's no normal visual loss,
there's no normal diabetes.
And when a doctor, let alone adoctor, says that's normal for
your age, no, it is not.
It's common for your age, it'snot normal.
(27:30):
And all hearing loss that isassociated with aging is
neurodegenerative.
It doesn't get better, italmost always gets worse or it
might stay the same.
But it's important to manage it, because if you don't manage it
now, we have social isolation,we have anxiety, we have
depression, we increase ourat-risk opportunity for
cognitive decline, psychologicalwell-being, withdrawal from
(27:52):
social situations None of thoseare good.
Why are we allowing patients tobe told that, oh, it's normal
for your aging, you have to getused to it.
That's nonsense, anyway.
So, dr Crosby, it is a joy tospeak to you.
Noel, it's been too long.
I certainly do remember back inthe day when we were working on
our doctorates at University ofFlorida, and it was always
(28:12):
great because you were a breathof fresh air.
You know, you would cut throughall the jibber jabber and your
notes were great, my notes weregreat and I think that in our
groups we were able to sharenote-taking not test-taking and
we were able to get even moreout of the classes because we
had so many smart people in ourclass and you were certainly the
(28:34):
star among all of us, so I'm soglad that we've had these years
together.
Dr. Noël Crosby (28:38):
Thanks, doug, I appreciate that it was a great
experience.
Dr. Douglas L. Beck (28:42):
Absolutely All right, dr Crosby.
Thank you so much for your time, thanks for your thoughts on
managed care and I will lookforward to hopefully seeing you
at the Florida Academy ofAudiology.
Wonderful, thank you.
Dr. Noël Crosby (28:52):
Thanks for having me.
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