Hearing Aid Insurance Verification Form

(For Patients)

We’re so happy to be part of your hearing care journey! To help you feel prepared and avoid anysurprises at your appointment, we recommend verifying your hearing aid benefits before your visit. Ouroffice will also verify your benefits as a courtesy. However, we encourage you to call your insurance company as well so you can hear the details directly and ask any questions about your specific plan.If you need assistance at any time, please don’t hesitate to contact us—we’re happy to help!

Step 1: Call Your Insurance Company

Call the Member Services number on the back of your insurance card. When you reach a representative, say: “I’m calling to verify my hearing aid benefits.”

Please call our office before contacting your insurance company so we can provide thecorrect NPI (National Provider Identifier) number if needed.

Treating Provider:

Step 2: Benefit Information

Do I have coverage for hearing aids?

  • Yes

  • NO

Is there a dollar maximum?

$________________________

Is this maximum:

Per ear
Per ear

Is the benefit subject to:

DeductibleAmount: $________________

CoinsurancePercentage:%

Do I need to see an in-network provider?

  • Yes

  • No

Are out-of-network benefits available?

  • Yes

  • No

Do I need to use a specific vendor?

  • Yes

  • No

If yes, which vendor? __________________________

How often can I use the benefit?

  • Every 3 years

  • Every 5 years

  • Other: __________________________

Is a referral required?

  • Yes

  • No

Is prior authorization required?

  • Yes

  • No

Step 3: Call Documentation

Please write down the following before ending your call:

Representative’s Name: __________________________

Reference Number for Call: __________________________

Date of Call: __________________________

Time of Call: __________________________

Our Purpose

Doctors of Hearing, Inc. is dedicated to improving the quality of life of the hearing-impaired community. Doctors of Hearing, Inc. is your trusted source for the information needed to make informed decisions on hearing aid purchases. Doctors of Hearing, Inc., provides expert testing and proper fitting of hearing aids at a reasonable price.

Company Details

Doctors of Hearing, Inc. is a family-owned audiology practice serving patients through its offices in Pasadena, Rancho Cucamonga, and San Dimas, California. Dr. Norma Camacho, Au.D., CCC-A, ABA, is a licensed dispensing audiologist who is board certified by the American Board of Audiology and holds the ASHA Certificate of Clinical Competence, a nationally recognized credential. She is also a member of the Academy of Doctors of Audiology.

Phone numbers: 

626 639-3182  Pasadena Office
909 481-2834 Rancho Cucamonga Office
626 250-6642 San Dimas