Hearing Matters Podcast

Navigating Managed Care in Audiology with Dr. Noël Crosby

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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.

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Blaise M. Delfino, M.S. - HIS :

Thank you to our partners. Sycle - built for the entire hearing care practice. Redux - the best dryer, hands down. CaptionCall by Sorenson. - Life is calling. CareCredit - here today to help more people hear tomorrow. Fader Plugs - the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm founder and host Blaise Delfino and, as a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

Good afternoon. This is Dr Douglas Beck with the Hearing Matters Podcast, and today I'm here with my friend and colleague, . She earned her doctorate in clinical audiology from the University of Florida and she was the smartest person in our class. She and I went to school together. Dr Crosby was on the inaugural board of the Florida Academy of Audiology and she served as president not once in 2000, not twice in 2009, but again in 2025. And I think that's amazing.

Dr. Douglas L. Beck:

Dr Crosby worked at Sarasota's Silverstein Institute for 14 years that was my old pal, dr Herbert Silverstein who ran that and for the last six of those years she was director of audiology. While there, she established the Institute's cochlear implant program as well as Sarasota Memorial Hospital's Infant Hearing Screening Program. Dr Crosby operates independently of any hearing aid manufacturer and that's a wonderful thing for so many reasons, but basically she can provide her patients with unbiased evaluations and fit them with whatever best meets their goals and outcomes. She is a founding member of her local Hearing Loss Association of America, and Dr Crosby is a member of the American Academy of Audiology, the Academy of Doctors of Audiology and the Florida Academy of Audiology. In 2009, she started AudBling, which is a hearing loss awareness company and she has some of the coolest. I don't want to say trinket and minimize it, but you've got very, very clever audiology stuff there, so I would urge people to go to audbling. com. , how are you?

Dr. Noël Crosby:

I'm fine. How are you, Doug?

Dr. Douglas L. Beck:

Well, I'm doing good. I'm doing good and I'm happy to be here. You and I haven't spent any quality time together in 20 years. I'll bet we see each other in hallways and stuff, anyway. So you just did a session at AAA in New Orleans. That was in March of 2025. And that was on managed care and unfortunately I couldn't make it. I had other stuff scheduled at that time. But let me ask you a couple of basics about that, and then let's talk about the ADA positions on managed care as well. So let's start by talking about what is managed care, if you can give me a couple of sentences on that.

Dr. Noël Crosby:

So I would associate managed care in audiology with third party payers, so that would be administrative groups that are owned by various companies that contract with people's insurance companies to provide the hearing aid and really all audiology components of their services. So most of them are companies that really are more like a third party. They're the in-between between the insurance company and the patient and also an in-between between the insurance company, the patient and the audiologist.

Dr. Noël Crosby:

And they negotiate pricing with the insurance companies and then a lot of times the person or the patient has to go and go through. They can only get their audiology services if they go through somebody who participates with that third party.

Dr. Douglas L. Beck:

, the first that I recall really managed care coming into mainstream. When I was at the House Air Institute in Los Angeles back in whatever it was 81, 82, 83, something like that there were some HMOs that were just getting started health maintenance organizations and I think the way that that worked back then and this is almost 50 years ago, but I think the way it worked was that if I were on Medicare, I could elect to go to Kaiser and Kaiser was always one of the very best in my mind HMOs or I could go to others and what would happen then is that the HMO would get the Medicare payment and they would then supply all of my healthcare needs that were available and if they didn't have it, they would contract to other people who did. Is that kind of how that started and when that all started?

Dr. Noël Crosby:

I would say probably, but I think it's really morphed into something completely different now, because most of the time the patient or the recipient doesn't even know that they're part of this third party. They signed up with their insurance and then the insurance contracts with them, without a lot of communication between the recipient and the insurance.

Dr. Douglas L. Beck:

Or transparency, to be fair, I mean, listen now, tell me if I've got this right. I wrote an article about three years ago explaining how Medicare Advantage works and you know more about this than I do. But my understanding from three years ago is this Once you're on Medicare, you are eligible for Medicare and Social Security given X, y and Z. So if you get Medicare you could have traditional Medicare or you could opt in to Medicare Advantage. Now if you opt into any of the programs, then the federal government will pay that program about $1,200 a month to take care of you for the rest of your life. And so what the Medicare Advantage programs do, whether it's United or Blue Cross or whoever they will package that their services. So they'll say hearing services, dental vision, and we all know they're not very good on most of those. But the average recipient on a Medicare Advantage program will get some kind of blingy thing and they'll get some shiny objects that look really, really good. But then if they get super sick or they have a chronic disease, they actually may not get the same quality care that a standard Medicare recipient would get, because the way that those companies make money out of Medicare Advantage is by not paying all those services you know. Or they'll say, gee, that's not covered, or gee, your monthly payment goes up, or gee, you have a copay, or gee, you have, you know, an office fee and all these things. And I've known many people because I've been on Medicare for a couple of years now. I know many people who wish that they had not gotten into a Medicare Advantage program.

Dr. Douglas L. Beck:

Now Medicare Advantage is about 50% of all Medicare recipients. Because they look at silver sneakers. They look at, oh, you have dental coverage, well, your dental coverage might be half a filling. Oh, we have hearing aids, but never the hearing aids you want. And it's so important to be transparent on these things because the patient, the consumer, thinks, oh, I have Medicare Advantage, I'm going to go get my vision and my hearing and my teeth and my podiatry and all that stuff checked. Yeah, you could do that. But it's not going to be as simple and easy as you think. When you sign up, the marketing's quite a bit different often from the reality.

Dr. Noël Crosby:

Yes, and you can't always see the provider of your choice because, like many of us, aren't participating with the third parties or that with the companies that these insurance companies decide to work with. So the patient? They don't tell the patient that. So the patient thinks oh yeah, now I can go see Dr Crosby and I can use my benefit or my discount Most of it is a discount and they can't. So I think there has to be a lot more transparency about that.

Dr. Douglas L. Beck:

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 know I did do the Medicare Advantage route because I thought it would be good. But then we had this incident that was so interesting and I I I hate to tell the story, but I love to tell the story. So my insurance and my wife's insurance are both through Medicare and we had Medicare Advantage at the time and one of us needed an MRI of our shoulder and neck. So I got that done and it cost me about $400 with Medicare and I thought, well, that sucks.

Dr. Douglas L. Beck:

And then my wife, six months later, wound up having the same thing done an MRI shoulder and neck and hers through her insurance was like $700. And I said you know what? If you just call them, tell them we're going to pay cash. And so she called the MRI place and said, hey, if we pay cash, how much would that be? And they said, oh, 450 bucks. It costs less money to pay cash than it did to use our Medicare Advantage program and that is not a one-off. We are not the only ones that happen to.

Dr. Noël Crosby:

One thing that people don't realize is if they go onto Medicare Advantage and then let's say they get really sick and they have the existing condition and they want to switch back over to regular Medicare. Well, they may not be able to. They may not be able to get back on it.

Dr. Douglas L. Beck:

Yeah, Do you? Do you have a feeling for it is? When we talk about the percentage of audiologists and hearing instrument specialists that accept Medicare Advantage, third-party pay, all manner of insurance I thought I saw a trend about four or five years ago where more and more people were going into concierge audiology. So it's pay-as-you-go sort of thing, and now I'm not seeing that so much. Tell me your reflections on that.

Dr. Noël Crosby:

I feel like more and more people are dropping the Medicare Advantage companies, the third party companies, because I am a small private practice but I don't want to work harder for less money. So I think a lot of us are finding ways that we can still see and still service these patients that have Medicare Advantage. But recently a lot of the companies have been willing to work with us in ways that help us to still provide lower cost alternatives to these patients. But then they get to see us and they don't have to go through their insurance, because there's a lot of companies.

Dr. Noël Crosby:

It just depends on the area that you're in, but in some areas there's no audiologists there might be companies that just do Medicare Advantage plans or third-party payer plans, and some of them have to cut corners, and I don't blame them, because they can't provide all the services that a private patient would get, because they don't get enough to keep their doors open, and that the same thing that's happening is a lot of people are ending up closing their doors because they can't afford to continue.

Dr. Douglas L. Beck:

Stay in business? Sure, well, what about best practices and third party pay, best practices and managed care? Tell me about that.

Dr. Noël Crosby:

So if you were at my panel and you will also be able to I'm going to do some recordings of some of the people which I know. You and I are going to talk about that more later. There's a lot of audiologists who are in areas where there are a lot of I would say, heavier influx of people who have third party payers. They have found creative ways to still provide best practices but also be able to see those patients. But there's a lot of transparency up front. Then you're going to get this hearing aid. It's going to cost you this much, you're going to buy that or purchase that through the third party, but then all these other best practice services are extra. They are not included in that payment that we get from the third-party payer.

Dr. Douglas L. Beck:

And the funny thing is what is a typical payment for a 92557, which is a comprehensive audio-metric evaluation.

Dr. Noël Crosby:

So what I would charge a patient would be $95, and that might be less than other people, might be more than others, but for Medicare it's about $35.

Dr. Douglas L. Beck:

Yeah, and I don't think people realize this. This came to light with me personally, gosh, I don't know 20 years ago when I had my private practices and my dad was on Medicare at the time and he came to see me and of course I wasn't going to charge my father but but he said, oh no, I have Medicare, you should absolutely charge. I mean, I'm not going to pay it and I earned it. So I said OK. So I said but here's the thing, Dad, If I bill 92557 to Medicare, I'm going to have to wait 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 you billed. And back then I billed about 150 bucks for that service and I got a fifth of it or something like that.

Dr. Douglas L. Beck:

And I don't think any Medicare recipients, unless they happen to also be healthcare providers, are aware that when we accept Medicare it's because, yes, we want to take care of patients, yes, we want to do everything we can to help them out, but by the same token, you don't get rich off of this. This is a very, very small payment. And then you're not allowed to back bill the patient for the missing money. In other words, if Medicare pays me, let's say, 35 bucks, 40 bucks, to see a patient and my bill is typically 250, 300, I can't bill the patient for the balance. I have to accept Medicare payment as payment in full. Am I correct?

Dr. Noël Crosby:

on that. Well, also, the supplemental insurance will pay the 20% that Medicare doesn't pay. But you cannot charge your usual and customary. You can only charge the I guess it's called the Medicare allowable amount.

Dr. Douglas L. Beck:

If you're a participating Medicare provider.

Dr. Noël Crosby:

But Advantage plans don't even pay for hearing tests. A lot of times they will not even pay for the 92557. They include it into their because they assume that everybody that's coming in to see us is going to get a hearing aid. So they just say, oh, you have to do the free test in order to see our patient. And that was probably one of the biggest reasons why. I decided I wasn't going to be participating.

Dr. Douglas L. Beck:

Well, that assumption has no bearing in reality. I think the tested not sold, if we can use that category name is upper. It's above 50%. Probably. My guess 30 to 40% of people who are tested actually wind up buying product from that professional. Does that make sense in your history?

Dr. Noël Crosby:

I mean in your own office. You want it to be greater than 50% and I guess it would just, you know, depend on how you set things up, but maybe in the average office it is. I would say, about 50% is what we would say.

Dr. Douglas L. Beck:

There was a stat that went around a few years ago. I want to say in 2020, that the average patient who came in to see you has already been to two other places, and that's why I think it's probably a little bit less than 50 to 50, because if they've been to two other places already, that's two places where they were tested, not sold, tested, not sold, and then in your office, right then they bought it. So that's 100% for you, but for the profession, I think it may be a little bit less. I don't know, and these are always soft numbers because nobody really reports this. This isn't a generally reportable fact that's easy to access. It's kind of like trying to figure out the exact return for credit rate, which I think in our profession runs somewhere around 15% On average. There are certainly people who have 3% and 5%, but there are some people who have 40%, and so these things all matter, but if the basic presumption is that everybody who's going to come in is going to buy hearing aids, that's not even half right.

Dr. Noël Crosby:

No, it's not. Also, I'm going to see a lot of patients who maybe aren't ready for hearing aids or they need medical intervention and they need other things, and so why would I want to see patients for free just to do diagnostic hearing evaluations on patients that need other things? And the way that these third parties function is they don't even acknowledge that there's a whole subset of patients that aren't hearing aid patients.

Dr. Douglas L. Beck:

Yeah, and that's significant because I did know. I did a paper in 2019 with Jeff Danhauer and we showed that in the USA, which now is about 335 million people in the USA, there's 26 million people have perfectly normal hearing thresholds, but they will have hearing difficulty, they will have speech and noise problems. So what does that mean? That means we should be following best practices on all of those patients. We should be doing speech and noise, we should be doing listening and communication assessments, we should be doing extended high frequencies. When we do that, then we start to find these other situations that brought them in.

Dr. Douglas L. Beck:

Now, some of them may or may not be hearing aid candidates, with or without tinnitus, with or without hearing loss. Because what we know also is that you know human hearing 20 hertz to 20,000 hertz. Most audiologists don't test above 8,000 hertz, but until 8,000 hertz is impacted, most EMTs, most audiologists, most hearing care professionals will say 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 just measure 250 to 8,000. Now the problem with that is I'll tell you as a musician is that the lowest note we test on an audiogram when we're doing these very simple, pure tone assessments. The lowest note we test is middle C. The entire left side of a piano is not tested in a normal audiogram, which is why best practices say you have to do so much more. You have to do Ipsy reflexes, contra reflexes, tympanograms, otoacoustic, then we get a good look at what's actually going on with you. But air, bone and speech, that's not any better than a Snellen eye chart for an optometrist.

Dr. Noël Crosby:

Yes, and that is not none of that is typically something that they would cover, you know. They would just say, okay, you have to do this free hearing test, and so why would anyone be motivated to do any more? Because the patient was told that they were going to have a free hearing evaluation. And when you say, oh well, that's only a piece of it, you know we need to do these other things and they're not covered by your insurance, then patients are reluctant because they were just under the assumption that that was free and it was all that needed to be done.

Dr. Douglas L. Beck:

Yeah, because they're paying their monthly fee to their insurance companies 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, you should always walk away. And I say that knowingly that many of our colleagues say free hearing test. I've never liked that at all, and here's why.

Dr. Douglas L. Beck:

Number one even if you're doing a screening, a screening doesn't give you enough information to make a decision. A patient could totally pass a free screening, yet their speech and noise score, their SNR 50, could be nine. That would never show up on a free screening. They could have all sorts of ADD, adhd, dyslexia, specific language disorders None of that would show up on a screening. They could have the worst ability to localize sound None of that would show up in a screening. But if we were to do best practices, every one of those patients we would pick something up on, and so I've never been a fan of free screenings at all. I don't think we should do them as professionals, you know.

Dr. Douglas L. Beck:

Let me ask you a question. I mean, does your neurologist do a free screening? Does your optometrist do a free screening? Does your OBGYN? Does your gastroenterologist? Nobody does free screenings. Why and that's such a major issue to me? I think if you want to bring in a lot of patients with something that that'll attract them, I might say something like this Do you have difficulty understanding speech and noise?

Dr. Douglas L. Beck:

That's our area of expertise. Do you have tinnitus ringing in the ears? Please come and see us. We'll be happy to address that with you. But but you know it, it and we all know that when somebody mentions tinnitus in the marketing piece, you get patients that you can't even handle. There's so many speech and noise problems, single most common reason that people come in to see an audiologist or a hearing aid dispenser. So let me ask you a question. So the Academy of Doctors of Audiology has a recent statement. It was actually in a hearing review. The ADA urges reform in hearing healthcare coverage to improve patient outcomes, and I know you're involved with that as well. Can you tell me? I'll read the summary and then you talk about the takeaways. So the summary is the ADA is advocating for major reforms in hearing healthcare coverage, emphasizing the need for stronger regulations to ensure patients receive essential audiologic services rather than being subjected to profit-driven hearing aid sales. What can you tell me about all that?

Dr. Noël Crosby:

Yeah. So again, what I was saying before is that a lot of these third-party payers, so the person let's say there's 50% people, people have advantage plans, so the person has a tinnitus or the person has something like fullness in their ear, so they need a full audiologic evaluation. But the third party is like, oh, that's just hearing aid, so they'll, they'll send them to somebody who may not be the appropriate provider. It may be somebody who's not set up to do a diagnostic test. They may just do a test for the purpose of a hearing aid and the person really never gets that in-depth evaluation that they need to get because that third party is only focused on the sale of the hearing aid and they're not focused on the other people that need full audiologic care that need full audiologic care.

Dr. Douglas L. Beck:

Yeah, and so ADA. I think they call for hearing benefit plans to be classified as health benefit plans to ensure proper regulation and oversight. How does that work?

Dr. Noël Crosby:

What I want to focus on with this really is just that ADA and all the members of ADA, which are a lot of private practice audiologists who are best practice providers, they know that there needs to be reform because we are not just hearing aid testers.

Dr. Douglas L. Beck:

Salespeople. So, dr Crosby, you know there was a recent March 25th 2025, so a few weeks ago in the hearing review, there was a nice statement from the Academy of Doctors of Audiology and the summary is the ADA is advocating for major reforms in hearing healthcare coverage, emphasizing the need for stronger regulations to ensure patients receive essential audiologic services rather than being subjected to protocols, perhaps from profit-driven hearing aid sales, and I think that's the essence of what you and I were just talking about. Is that everybody driven hearing aid sales and I think that's that's the essence of what you and I were just talking about is that everybody with hearing and listening problems is not a hearing aid candidate, nor do they want or need hearing aids.

Dr. Noël Crosby:

Right, yeah, there's so many people that just need help, advice, medical treatment, and they and the audiologist needs to get paid for their time. I mean, I spend. I spend probably an hour, an hour and a half with a new patient, whether they get a hearing aid from me or not. I can't be doing free testing for an hour and a half and have the patient. Well, if I was doing the free testing, I would have to try to cut my time down and then I would never feel like I was doing the best job for the patient. So there's many of us that know that there are so many people out there that are not just hearing aid candidates.

Dr. Noël Crosby:

They are people that need medical advice and treatment and they need maybe to see an ear, nose and throat doctor, or they need further testing and these third parties don't ever consider that.

Dr. Douglas L. Beck:

They think everyone's just the hearing aid candidate consider that they think everyone's just the hearing aid candidate. Yeah, I think it's wrong to presume that hearing and auditory complaints are going to wind up with hearing aid sales, and I think that's the essence of why third-party payers and administrative models for hearing healthcare often fall short, because many of these patients just need to be seen, counseled, advised. Very few patients with hearing loss actually have any ear disease. You know it's probably fewer than 5% to 7%. 95% of all patients have hearing loss associated with aging. They have hearing loss due to ototoxic drugs, they have hearing loss due to noise-induced hearing loss. They have hearing loss that there is no medical or surgical 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 were all in the same category is ludicrous, yeah.

Dr. Noël Crosby:

And they also need more advice than just a quick hearing test. They're like, even though you say that about, they don't need, you know, surgery or they don't need medical intervention. They need other things. You know the area where I have a lot of patients that would come and they have tinnitus and they think having the hearing test is going to be all they need and there's so much more that we need to do for those patients. But if they have a third party payer, that's not going to happen.

Dr. Douglas L. Beck:

Yeah, that's a bit obscene in many respects. You know, for the people listening who are not aware, tinnitus is typically referred to as ringing in the ears. It sounds that you can perceive that actually have no objective or physical orientation. They are sounds that might be considered phantom sounds. The thing about tinnitus that is so important to understand is tinnitus can be a sign or a symptom of a very, very, very dangerous situation. Most of the time it's not, but you need to see a professional, like an audiologist or an ENT, to make that call. And to make that call yourself can be short-sighted. You should definitely see a professional get worked up, particularly if you have unilateral tinnitus tinnitus on just one side. There could be a reason for that. That would be benign and there could be a reason for that. That could be very dangerous. So tinnitus should always be evaluated. But I think the point is that you're making is that once we've done that evaluation on a patient, then we can guide them to the next step. But if the insurance doesn't allow us to do a thorough evaluation, we can't see the forest for the trees. We don't know which patient is eligible for X, y or Z and which patient is not.

Dr. Douglas L. Beck:

And further with tinnitus patients and I always like to make sure that we all understand this. People will say, well, is there a cure for tinnitus? And the answer is no, there's no cure for tinnitus. There's no cure for diabetes. There's no cure for tinnitus. There's no cure for diabetes. There's no cure for migraines, there's no cure for lower back pain. These are things we manage and 90% of people with tinnitus 90% 9-0, can be managed effectively through things like progressive tinnitus management, trt and some newer protocols that have come up, and these aren't folly. I mean this comes from Oregon Health Sciences and it's very well known in audiology. 90% of tinnitus can be well managed, just like many other difficult challenges that we all face. So I think tinnitus is a great example. Do you do extensive tinnitus workups like pitch matching and loudness matching and try different background sounds and things?

Dr. Noël Crosby:

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 different treatment, if what I do with them isn't enough, then I would refer them to my colleagues who specialize in maybe a linear product or other treatments. Some of my colleagues see severe tinnitus patients and that's what they do, and they can really make a difference in their lives.

Dr. Noël Crosby:

So I don't want anyone to ever think that if you ever go somewhere and they say there's nothing I can do for your tinnitus, please do not take that as the truth. There are many providers out there that are doing an excellent job in assisting these patients.

Dr. Douglas L. Beck:

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 a doctor, says that's normal for your age, no, it is not. It's common for your age, it's not normal.

Dr. Douglas L. Beck:

And all hearing loss that is associated with aging is neurodegenerative. It doesn't get better, it almost 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 our at-risk opportunity for cognitive decline, psychological well-being, withdrawal from social situations None of those are good. Why are we allowing patients to be told that, oh, it's normal for your aging, you have to get used to it. That's nonsense, anyway.

Dr. Douglas L. Beck:

So, dr Crosby, it is a joy to speak to you. Noel, it's been too long. I certainly do remember back in the day when we were working on our doctorates at University of Florida, and it was always great because you were a breath of fresh air. You know, you would cut through all the jibber jabber and your notes were great, my notes were great and I think that in our groups we were able to share note-taking not test-taking and we were able to get even more out of the classes because we had so many smart people in our class and you were certainly the star among all of us, so I'm so glad that we've had these years together.

Dr. Noël Crosby:

Thanks, doug, I appreciate that it was a great experience.

Dr. Douglas L. Beck:

Absolutely All right, dr Crosby. Thank you so much for your time, thanks for your thoughts on managed care and I will look forward to hopefully seeing you at the Florida Academy of Audiology. Wonderful, thank you.

Dr. Noël Crosby:

Thanks for having me.

People on this episode

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Blaise M. Delfino, M.S. - HIS

Host
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Dr. Douglas Beck

Co-host