Shopping around for a pair of hearing aids is harder than you think, starting with the hearing exam. Getting a hearing test resulting in an accurate audiogram is easy enough. The test only takes twenty minutes or so, and when administered by a trained audiologist or licensed hearing aid fitter, the result is usually an accurate map of your hearing profile. It’s the first essential step in getting fitted for hearing aids programmed to precisely match your levels of hearing loss at all frequencies.
But because in nearly all cases hearing exams and other audiologists’ services are bundled with the end sale of a pair of hearing aids, the hearing test very often is the first step in a sales process that applies subtle pressure on the consumer to follow through with the purchase of a pair of expensive hearing aids from the provider administering the initial test. People buying hearing aids don’t try out as many brands as consumers in other markets, lessening competition that would otherwise drive product innovation, price competition, and faster market growth.
The process should be like getting your eyes checked by an ophthalmologist, who you pay for an exam and who then gives you a prescription for eyeglasses that you can use at any retailer stocking a variety of manufacturers’ eyeglasses to choose from. Instead, when you go to an audiologist, the usual process is to get your hearing test for free, then a prescription for the one brand of hearing aids that audiologist sells, with an immediate invitation to try and then buy those hearing aids. The difference is that with eyeglasses, exams and prescriptions are usually unbundled from the sale of the eyeglasses, whereas most audiologists bundle their professional services with the price of the hearing aids they sell.
Bundling services with product sales limits consumer choice because audiologists have a strong incentive to move the consumer quickly to purchase of the manufacturers’ hearing aids they stock. It’s uncomfortable for a consumer who has gotten a “free” hearing exam to stop the process then and there, ask for a copy of the results, and use the audiogram to shop around for the best aids they can find. So many consumers fail to try different brands of hearing aids, and competition in the market is constrained.
Therefore, unbundling of hearing health services from the sale of hearing aid products in the hearing-health supply chain would increase competition, opening the way for more product choice at a broader range of price points. As in other industries where competition increases, growth in the hearing device market would accelerate as more products, including lower priced products, reached a much larger available market of users.
Several forces are at work that may dramatically disrupt this status quo in the hearing aid supply chain. First, the Hearing Loss Association of America (HLAA) came out in favor of unbundling hearing aid sales from professional services as part of its Campaign to Make Hearing Aids Affordable. Meanwhile, there are a growing number of manufacturers offering lower priced hearing aids programmed at the factory to match audiograms sent in by users who got their hearing tested but did not buy their hearing aids from the professional who administered the exam. And third, hi HealthInnovations, a newly formed subsidiary of the huge UnitedHealth Group insurance company, has started selling more affordable hearing aids direct to consumers who take a simple test that’s available on the hi HealthInnovations web site. In the coming year, we may see a new distribution channel grow in the hearing aid industry, offering more a la carte services unbundled from the final sale of hearing aids.
As I embark on my shopping expedition for a new pair of hearing aids, I will be writing about my experiences with bundled and unbundled hearing aid sales. One way or the other, I plan to try out as many manufacturers’ hearing aid models as I can. And I’ll write about my experiences with both approaches to hearing aid sales and service.
Donna says
I absolutely agree with Richard’s comment. Your perspective that most audiologists bundle their test is perhaps due to where you live. In the Midwest, I’ve never known an audiologist NOT to charge for their diagnostic hearing evaluations unless they work for a non-profit/goverenmental organization. I’ve worked in hospitals, ENT physician offices and now my own private practice, and have always billed health insurance for diagnostic testing whenever possible (something hearing aid dispensers can’t do because they are not qualified to be credentialed as insurance providers). There are some non-medical model audiology practices that focus only on hearing aid sales, but not where I live. These tend to be big chains or manufacturer owned practices (becoming more common unfortunately). They figure a free test like the dispensers always shout about will get people in the door, and are afraid of charging because their competitors don’t. My cost-of-goods is also around 35% of the charge for the hearing aid (test not included). The rest is overhead and time–keeping my doors open (which requires at bare minimum $85 per patient contact hour in my low cost of living area) and includes unreimbursed diagnostic time (insurance pays only about one third of what I charge and I have to write the rest off), and all of the time I spend selecting, prepping, fitting, verifying, follow-up adjusting, routine clean/checks, warranty service, etc, etc, etc. The time is considerable! If you are paying for time in advance, make sure you are paying for the time of someone who knows what they are doing!
Erik says
The unbundling idea sounds great. What concerns me is mail-order, factory programmed aids. These absolutely must come with local audiologist fine tuning as necessary or the idea doesn’t work. I’ve not investigated these methods in the past so I don’t know whether such lower cost alternatives give that option.
However, I know from experience that although a hearing aid is programmed based on my audiogram it may not be to my liking. Odds are it won’t be. I tend to be extremely picky about what I hear, can’t hear or want to hear with hearing aids. I’ve gone through 5 pairs and have tried 2 others. Without an audiologist correctly adjusting based on my verbal feedback I’d not have kept most of those five pairs.
That brings up another point. A good audiologist who knows how to use the programming software is worth his/her weight in gold. At one point I demo’d Phonak Savia BTE’s. I couldn’t stand what I perceived as poor quality so returned them and stuck with my slightly inadequate Resound ITE’s for a few more months. Insurance changed, went to a different audiologist who helped me through several types. I reluctantly gave the Savia a second try at his encouragement and within 5 minutes of fine tuning they became the best devices I’d owned to that point.
I now wear Phonak Naida V’s for the “Super Power” capability and “Sound Recover” feature. Those are three years old and I’m debating a new set of something in late 2012. I’m looking forward to your posts are you research the same choices as I. Personally, I wish the Lyric aids were strong enough for my audiogram as I’d love to give them a try. I love BTE’s as long as I have my BTE stereo cables for phone use but I do miss using phones and headsets like an average person!
Steve says
Great to see HLAA getting behind the unbundling of product and service. I’ve been writing about the need for that for ages and would be excellent to see it happen.
What’s your own view on the direct-to-customer sale after an online hearing test? Personally, I’ve always needed some kind of modification to the default settings on new hearing aids so I think direct sales need to have a fair amount of programmable options to be useful to the majority.
More choice and lower prices can’t be a bad thing!
Richard Hogan, MS, CCC-A says
David,
A well written article. As an Audiologist, I could not agree more with your assessment of the industry and the need to unbundle services. A few things for perspective, in nearly every state Hearing Instrument Dispensers are not-allowed by law to charge for hearing assessments because their hearing tests are only allowed to be used to fit hearing instruments, not to provide a diagnostic assessment of a patients hearing healthcare. Many private practice Audiologists have followed this practice because it is difficult for the average person to differentiate the subtleties between the two evaluations.
Secondly, there appears to be a huge move afoot by the Audiological community to unbundle diagnostic, device, and professional fees. Most of what the consumer pays for when they buy an instrument are for professional fees (in my own practice my COGS is about 35%), so consumers should learn to expect (and demand) the highest level of professionalism, expertise, and service.
Liz says
I wear NHS hearing aids, so thankfully when it comes to choice from what I had to make my mind up last year on, it was easy, and I went with trust of audiologist too. That decision was right for me.
But I have looked into buying my own hearing before then, and it was a big decison whether to go ahead or not, as well as choice of hearing aid on top too. So mind boggling. Obviously I stuck with NHS, but where I went to consider private, I experienced care and good, non pressured advice.
I have also seen pressurised sale tatics too, which I was glad I was there when my Mum went for a hearing test, and the advice that followed it. But she did not take the offer.
I hope my Mum one day will consider a hearing aid, but at the moment she won’t. Not even on NHS. But I told her if you consider private, go where I tried, as there there was no pressure to buy, plus she would have got two hearing aids for the price of one where she was pressured before.
Time will tell if one day she has an hearing aid.