What a "refer" result actually means
Every baby born in Louisiana gets a hearing screen before they leave the hospital. That is because of Louisiana Act 43, passed in 1992. The screen is quick and safe. It happens while the baby is sleeping in the newborn nursery.
Two things can happen on the screen. Your baby can "pass," which means normal hearing was confirmed in both ears. Or your baby can "refer," which means the screen could not confirm normal hearing and one more test is needed. A refer is not a diagnosis. About 2 to 3 of every 100 babies get a refer result. Only about 1 to 3 of every 1,000 babies have permanent hearing loss.
Common reasons for a refer that are not hearing loss: fluid in the middle ear from birth, the baby moving during the test, or background noise in the nursery. That is exactly why the follow-up test exists. It sorts real hearing loss from these other causes.
The 1-3-6 timeline you should follow
The national medical standard is called the JCIH 1-3-6 timeline. It comes from the Joint Committee on Infant Hearing. Here is what it means for your family:
- By 1 month of age: hearing screening is complete. If you already got a refer result, this step is done.
- By 3 months of age: diagnostic testing is complete. This is the test we do at ACI. It is called a diagnostic ABR.
- By 6 months of age: if hearing loss is confirmed, early intervention has started. This means hearing aids, family support, and enrollment in Louisiana EarlySteps if needed.
Babies who get diagnosed and start intervention by 6 months develop language on the same track as babies with normal hearing. That window matters. Call our office at (337) 223-9448 to get your baby in on this timeline.
What the diagnostic ABR test looks like
ABR stands for auditory brainstem response. It measures how your baby's hearing nerve responds to sound. It is the gold-standard test for infants under 6 months old because it does not require the baby to answer or react. The baby just sleeps.
Here is what happens at the appointment:
- Feed your baby right before you arrive. A full baby is a sleepy baby.
- We settle you into a quiet exam room. You can hold the baby the whole time.
- We place three small sensor stickers: one on the forehead and one behind each ear. They do not hurt.
- We tuck tiny soft earphones into your baby's ear canals. They play gentle clicks and tones at different volumes.
- A computer records how the hearing nerve responds to each sound.
- We look at the results and talk you through them the same day.
Plan on 60 to 90 minutes. Bring a bottle, pacifier, and blanket. Do not put lotion or oils on your baby the morning of the test because the sensor stickers stick better on clean skin.
Insurance and Louisiana Medicaid coverage
Louisiana Medicaid covers the diagnostic ABR test in full for babies under 21 through the EPSDT benefit. There is no cost to the family. That covers the test, any follow-up appointments, and hearing aids if they are needed. See our Louisiana Medicaid hearing aid coverage guide for the full breakdown.
Most private insurance plans in Louisiana also cover the test as a diagnostic follow-up to a failed newborn screen. Call our front desk at (337) 223-9448 before your appointment and we will verify your specific benefits.
If hearing loss is confirmed
You are not alone. Louisiana has a strong program called EHDI, which stands for Early Hearing Detection and Intervention. It is run by the Louisiana Department of Health. We coordinate with EHDI, your pediatrician, and Louisiana EarlySteps to make sure your baby gets fitted with hearing aids and enrolled in early intervention on time.
If your baby needs hearing aids, see our hearing aids for kids in Lafayette guide for what to expect. Louisiana Medicaid pays for the hearing aids in full for children under 21. Louisiana state law also requires private insurance to cover up to $1,400 per hearing aid per ear every 36 months for children under 18.
The four Doctors of Audiology at ACI Hearing Center have been serving Acadiana families since 1984. All four of us see babies. Meet the team on our team page.
Book your baby's follow-up test
Call (337) 223-9448 or use our online request form. Tell us your baby's date of birth and which hospital did the newborn screen so we can request the screening results ahead of your visit. We are located at 103 Saint Thomas Street, Lafayette, LA 70506.
Frequently Asked Questions
My baby did not pass the newborn hearing screen. Does that mean my baby is deaf?
No. A refer result is not a diagnosis. It means the screening test could not confirm normal hearing and further testing is needed. About 2 to 3 of every 100 babies get a refer result, but only about 1 to 3 of every 1,000 babies have permanent hearing loss. Common non-hearing reasons for a refer include fluid in the ear from birth, movement during the test, or a noisy room. The diagnostic ABR test at our office gives you the real answer.
How soon should we get the follow-up test after a refer result?
The national guideline is to complete the diagnostic evaluation by 3 months of age. This is called the JCIH 1-3-6 timeline: screen by 1 month, diagnose by 3 months, and start any needed intervention by 6 months. Call our office at (337) 223-9448 and we will get your baby in on that timeline.
Does Louisiana Medicaid cover the newborn hearing follow-up test?
Yes. Louisiana Medicaid covers the diagnostic ABR test for infants under the EPSDT benefit. There is no cost to the family for the test or for any hearing aids the child may need before age 21. We handle the prior authorization paperwork.
What does the diagnostic ABR test feel like for my baby?
The test is not painful. Your baby sleeps in a quiet room. We place three small sensor stickers on the head, tuck tiny soft earphones in the ears, and play gentle clicks and tones. A computer records how the hearing nerve responds. Most babies sleep the whole time. Bring a bottle, pacifier, and blanket.
How long does the appointment take?
Plan on 60 to 90 minutes. Feeding the baby right before the appointment helps them sleep through the whole test.
What if my baby is diagnosed with hearing loss?
We walk you through everything. If hearing aids are needed, Louisiana Medicaid covers them for children under 21 at no cost. Louisiana state insurance also requires coverage of up to $1,400 per ear every 36 months for children under 18. We coordinate with your pediatrician and the Louisiana EHDI early intervention program so nothing falls through the cracks.