Excluded Hearing Aid Expenses Mistakenly Covered
Audit Issue
The plan document clearly described coverage for hearing aids for children up to age 19. Hearing aid expenses for adults was excluded.
Audit Finding
Using AUDiT iQ, we identified claims paid for adult hearing aids. For the 3 samples chosen for onsite examination, we confirmed that benefits were paid in error for patients who were 45, 52, and 58 years old.
TPA Response
The claims administrator acknowledged that their system had not been properly configured to exclude adult hearing aids. Corrections were immediately implemented.
Financial Error
The administrator agreed to financial errors amounting to about $13,500.00 for the 3 samples we reviewed. They also agreed to thoroughly investigate past claims history to assess the total financial impact of similar errors.