Just to point out again, Kaiser is not a monolithic entity. Each region has a lot of independence. From experience with NCAL Kaiser, I know space is at a premium and I suspect the same is true of SCAL. For whatever reasons, Kaiser SCAL chose to outsource their hearing aid fitting. I wonder if that’s also true for pediatrics?
Thanks for all the feedback.
I did a search on HearUSA and was NOT happy with the results. Sounds like a disaster with bankruptcy and all kinds of financial shenanigans.
The HearUSA on site Rep said that they can get other brands, but said they do the vast majority of fittings are done with Signia HAs.
It just chaps my hide to pay more out of pocket with my significant Kaiser benefit than Costco charges. It feels like I’m getting old technology as the first of the Nx HAs were introduced in October of 2017. The service better be significantly better than Costco or why bother with the added expense?
I think I am going to try the 7Nx with the Sierra recommended DSL v5 fitting formula for the trial period. If something new comes out, or I don’t like the sound, I may demand a change in device or office.
Costco generally offers pretty good service, certainly as good or better than I’ve gotten from NCAL Kaiser. Do you really have a hearing aid “benefit,” or a negotiated deal with HearUSA. Although I have very good health insurance coverage through Kaiser NCAL, I have no hearing aid coverage. They sell hearing aids at prices very competitive with community prices, but not even close to Costco. Unless there’s something very specific you want that Costco can’t offer, I’d go straight to Costco and skip the anguish.
And regarding “cookie bite” loss. Whoever you see, would be a good idea to ask if they have any experience fitting such losses. It’s my understanding that they can be tricky to fit. If they don’t have experience, seems like a reasonable followup would be what resources they have to help them (often factory reps can get involved)
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Here is what your sound levels delivered to your ear with inputs of 50, 65, and 80 dB would be estimated at with three different formulas using an M receiver:
SmartFit - propitiatory Signia fitting formula
NAL-NL2 - Common standard formula across the industry
DSL v5 - Another less common standard formula
They all are probably going to sound quite different. The SmartFit would be the least aggressive, and the DSL v5 the most aggressive.
One possibility if you have a cooperative and experienced fitter would be to put one fitting in the standard Automatic program #1, then put the other two in copies of the Automatic program but with the different fitting formulas. That would allow you to easily switch between fitting formulas by just making a program change. Not 100% sure it can be done, but I think it can.
Sierra, That’s a lot to digest. A couple of questions:
- What do you mean by aggressive? Under-amplifying the LF signals to allow my natural hearing to come through and over-amplifying the higher frequencies to maintain as much high freq signal strength as possible?
- It looks like the gain curves for the frequencies below 750Hz for Smartfit and NAL2 are similar.
- It looks like the gain curves for frequencies above 6kHz for NAL2 and DSL v5 are similar.
- If you max out the gain at 6kHz through 8kHz, are you more likely to still have gain through 12kHz? (You mentioned that above.)
- Is the compression at the frequencies with the highest gain an expected outcome of hearing Aids in general?
- Are there adjustments by the software for all 20 bands in the 7Nx HA? Any of the bands above 12kHz or below 250Hz?
Thanks for your help! The audiologist is going to just LOVE me.
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First off, I am no expert in HA’s. I use the KS8’s but only have about 10 weeks experience with them. I just downloaded the software so I could understand what they can do better.
- By aggressive, I mean by how much they are adding in gain to the natural sound. Your left ear with an 80 dB input in the 2-4 kHz range is peaking at about 100 dB in your ear. The NAL-NL2 hits just a touch over 100 dB. The DSL v5 is getting up to about 112 dB at 3 kHz. That should sound twice as loud as the SmartFit or NAL-NL2.
- I would not worry too much about the lower frequencies. Your hearing is good there, and there should be no problem hearing the lows, even with a closed fitting.
- Yes, with DSL v5 slightly higher
- Not totally sure what happens at higher frequencies. The formulas seem to just stop at 8 kHz. However the last adjustment handle says it is at 10.6 kHz. I assume after that you get no gain from what is naturally there.
- Compression is not a given in the HA, but it is most often needed by your ear. For example if you have a 70 dB loss and you try to restore that to zero you would need something like 140 dB in the ear. That is not going to be pleasant! So compression of louder sounds is desirable. The other deeper issue is that with hearing loss your hearing typically goes non linear. So while you may have 40 dB loss with quieter sounds, you may have much less with really loud sounds. For that reason compression is a good thing.
- The 20 handles for adjustment go from 63 Hz at the lowest, to 10,625 Hz at the highest. There are actually 48 bands, but you only have handles for 20. The HA’s distinguish down to 48 bands, but you can only adjust 20 groups.
Hope that helps some,
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Sierra: That helps a lot! I’m going to have to plug those numbers into a spreadsheet to see if I can make some more sense of it all!
Thanks!
You can find links to the programming software here. I downloaded the Connexx 8.5 software and use the Rexton Emerald data.
I went to my fitting today at HearUSA.
I met with a young looking (she later said she was 40) Doctor of Audiology, and she said all the right things except the price of $8500 for the pair. That is very expensive, and I said so. I told her the difference between the Signia 7Nx and the Costco KS8 (besides the $7000 difference in price) is the service and her expertise. She agreed and talked about what she can do for me such as real ear measure and multiple readjustments during my new use of HAs especially at the beginning. She even mentioned her school (in Ontario Canada) pioneering some of the algorithms such as DSL v5.
They wanted $8500 for the Signia 7Nx with 312 battery. I expressed my reservations about 1.5 year old tech and she disagreed. I asked if she only fits Signia, and she explained that she also fits Oticon. I decided to go with the Oticon OPN 1s with 312 battery. It is the same price and with my $4000 insurance coverage it will cost me about $4500. They have to order it and I’ll have it fitted next week. I am starting to get a little excited, but those numbers would have scared me off for another 5 or 10 years if I were not so motivated by my 4 year plan to retire.
I was disappointed to not be able to get the Phonaks which are easier with Android Phones, but I will make it all work even if I need an add on device. I’m trying to focus on the hearing functionality, and not get bogged down by the specific features.
I’ll post another update after next weeks fitting.
I wonder if Kaiser pays HearUSA for the “benefit,” or if HearUSA pays Kaiser for the marketing advantage? I’m kind of guessing the later. They get a bunch of appropriate referrals that already have an audiogram. Personally I think Kaiser should strike up a deal with Costco.
Yeah. Something smells in the business agreement. I’m guessing they overcharge the captive audience, and split the benefit. I don’t see a $4000 value for the $4000 benefit.
I can’t get the HA for $4500 with good service and support, so I still come out ahead versus paying it all out of pocket (unless the service turns out to not be all that good). I would much rather NOT have the exclusive agreement, and just take the $4000 benefit to the provider of my choosing.
Keep in mind that you could get a pair of aids from Costco that is very similar to the Signias for $1599 with generally good service.
You’re being charged way, way beyond the max for “state of the art” hearing aids. What good is a Kaiser Permanente discount, or $1000 off each HA, when someone jacks up the “standard price” 50% to 80%?
I’m curious where you are getting the $4000 in insurance coverage for the Oticon since Kaiser Permanente seems to only offer $1000 off for each hearing aid ordered over a three year period. So my understanding is if you buy HA’s through KP you get a total of $2000 off if two HA’s are bought.
In any case I’d call around and get other quotes or visit some private Audi’s and then when you go in and test your new Oticon - you could mention what the going rate for the HA’s are on open market versus the “jacked” up quote you received.
The Kaiser Benefit level varies by the group/company that purchases the coverage. My company is rather generous with the $2000/ear coverage. The on-site consultant was surprised at that.
I can definitely see myself going the self program path in three/four years when I replace them. Since I am a new wearer, I can actually benefit from the expertise of the Audiologist even at that obscene cost.
This industry is badly in need of overhauling!
I have Kaiser in oakland/Walnut Creek. My Kaiser plan gives $0.00 towards hearing aids. Nada. I got my first hearing aid at Kaiser and it was fine. Oh, Kaiser itself has an audiologist give my hearing test; very good. But the hearing aid people are completely separate from Kaiser.
I bought the aids I use now from a very local independent dealer and they’re top notch. They offer terrific cleaning and other services for free–and I can just walk in for a cleaning. Much better fine tuning of my aids, including installing a music program, than the Kaiser affiliate offered.
I’m glad I passed on Costco just for the ease of service.Also, the aids I tried at Costco didn’t work as well for me as the ones I now have.
Interesting! I thought Kaiser NCAL would at least be consistent throughout the region, but I guess not. Fresno Kaiser has a hearing aid center staffed by Kaiser audiologists. The testing aspect is considered a different department than the hearing aid department, but the staff is all Kaiser.
I got my HAs. I got the Oticon Opn S1 with the connect clip. Open fitting. They are the first Opn S1 she had fit. She mostly does Signia Pure 7NX and Opn 1 HAs.
Dr. D’Cunha ran the REM test just like on Dr Cliff’s Youtube videos. She used the NAL-NL2 fitting formula. It was a little different in that they also did a word test as part of it. The words were a mixture of 6 languages and were unintelligible.
The HAs are really subtle in that it was hard to tell they were there unless certain sounds were made. I can actually differentiate between Ch and J sounds. I went on a two hour hike when I got back home, and didn’t realize how many background sounds/noises I was missing. I have only said “What?” once so far!
Their appearance is also really subtle. I had told several co-workers I was getting them and none noticed them even after I pointed them out. They are really small and the wire is fine. I am getting a haircut tonight, so tomorrow should be interesting.
The only disappointment so far (besides the price) is the streaming. I got a ConnectClip ($100) and use it to connect to my Note8 phone. I don’t think it is worth it even at that price.
The streaming is really tinny, but I think it is because the ConnectClip/HA are only producing the frequencies that the HAs are programmed to boost. I’ll have to work with the doctor to boost all the frequencies to some extent, or I may just have to use over the ear headphones.
I go back in two weeks to re-adjust the programming, since I’m a brand new HA user.
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I mentioned your experience with Kaiser Oakland to a Kaiser audiologist and he was surprised. He said Kaiser Oakland definitely has a hearing aid center. He did say that pediatrics is their specialty. Oakland is one of two facilities (as well as Sacramento) in NCAL that does cochlear implants. In general I do know that Kaiser will refer to outside facilities when the demand is high or at patient request.
I bought my first hearing aid from Kaiser in Walnut Creek. They are affiliated with Kaiser but my understanding is that they are a separate entity. They can do hearing tests, but currently I see a Kaiser audiologist for my hearing tests. That audiologist has no relationship with the hearing aid center, which is an independent contractor. I may be wrong! In any case Kaiser insurance gives nothing towards hearing aids.
In Fresno, hearing aids and audiology are separate departments, but they’re both run by Kaiser. Perhaps similar to how there’s an Opthalmology/Optometry department and optical sales. I’d guess Oakland would be similar but clearly don’t know.