Although a tempting comparison, I don’t think it’s fair. I think it’s a matter of scale. One source I saw estimated 1.5 BILLION smart phones sales annually. I couldn’t find a comparable number for hearing aids, but it looked like about 1 million a year in US. That is a vast difference in scale.
MDB: Indeed. So imagine the economies of scale if they were cheaper and everyone is selling many more and so they could become cheaper still again. Scale indeed. Profits via volume.
My HAs came with “insurance” that will provide a replacement once for each ear.
If I exhaust that, I’ll be buying online, using an audiogram obtained locally and that I pay for out of pocket.
And in the future, if I want to buy new HAs, I’ll either go to Costco (who, indeed, do have lower prices as a result, I assume, of their scale) and buy “last year’s” model. Apparently they don’t sell the current model.
I also may ask my local audiologist: “If I come to you with brand new HAs that you also sell, what would be the cost per visit for you to fit them?” In my opinion, we should all be asking our audiologists that question now, in an attempt to drive the price the price down.
Perhaps some HA users have complicated needs that would justify an in-person audiologist for fitting and adjustment. I don’t seem to have that need at the current time.
I don’t want to take bread off the table of audiologists, but on the flip side, I don’t want to pay more than what’s “fair.” The US Bureau of Labor Statistics says that audiologists make an average of $76,000 per year. That seems like a reasonable number and I suspect it is in the range that other professionals (say, dental hygienists ) who go through similar training
The graphic posted earlier here shows that the majority of the profit is going to the audiologist. That surprises me, since one would think that after expenses, an audiologist could make far more than the $76 - 113,000 range.
I’d love it if a practicing audiologist jumped in here and explained these numbers. It would definitely help your profession if the consumers here on the forum understood why HA prices seem so high.
Not to demean dental hygienists, but audiologists are required to have a doctoral degree. Dental hygienists are required to have an Associate’s or Bachelor’s degree. I think degree of training might be similar to an optometrist, and I believe optometrists tend to get paid more.
MDB: Didn’t know a doctoral was required to practice. Seems like a bit of overkill for the routine HA fitting.
I often see a Physicians Assistant (working under an MD) for minor medical issues now.
I’d think that a similar arrangement for HA prescriptions would be effective: A PhD audiologist can supervise a less trained assistant.
I think I’ve got this right,but it may vary state by state. A doctorate (Au.D) is currently the requirement for somebody new to call themselves an audiologist. There used to be Master’s programs. One doesn’t have to be an audiologist to fit hearing aids. A Hearing Aid Specialist can do that. An audiologist in a small shop may not have enough business to hire other fitters
I really think it boils down to whether the HA is covered by insurance. Some of the comparisons here to everything being expensive in healthcare is true, but a good portion is covered under medical insurance, while the majority of insurers don’t cover hearing aids. The high price could be justified if insurance is involved. Then insurance usually has a negotiated discount, plus they have a certain amount they will not go over and tell the patient they are not responsible for paying the discounted or overage amount outside of deductibles and co-pays.
What I’m trying to say is when medical insurance is involved, we might say to ourselves, it cost how much, and then thank goodness we have insurance. Then perhaps we wouldn’t be in an uproar about the cost of HA’s. Just a thought.
To follow the analogy up top, audiologists are dentists whereas hearing instrument specialists are dental hygenists. Compared to other comparable professionals audiologists generally get paid less. (As an aside, probably because it is a profession dominated by women, which are generally associated with less compensation.)
Disclaimer: I am not a business owner and, by personal design, do not get commission and have very little exposure to the financial end of audiology. I try to minimize the potential impact (even subconsiously) that knowledge of device-related compensation might have on the choices that I make for patients because I see an ethical dillemma there. I am very lucky to work in a place with no sales targets or pressure and lots of pro bono work.
As for the audiologist’s side of the equation. I have heard that the average hourly cost-of-keeping-the-doors-open for an audiologist in the USA is ~$200 USD. This is probably higher than, say, a physiotherapist because we use a lot of expensive diagnostic equipment. With a new set of hearing aids, the minimum number of hours I would expect to spend with a patient across three years is 6 (4 in the first year, 1 in each of the next). That’s assuming that everything goes perfectly, the patient is very capable, they do not come in for repairs, adjustments, wax removal, etc. Maybe knock off 1.5 hours if it’s an experienced user. Add in some administrative time. This time can go up dramatically if the user is older with comorbid problems (mobility, tactile, visibility, memory, etc.), if they need a lot of counselling and practice, if we want to do extra specialized testing, if they have ears that are just bad for hearing aids resutling in a lot of repairs (and loaners), and so on. Some patients are very, very hands-on while others come in half as often as I’d like them to.
Someone above said that bundling of services poses pricing problems, and it does. If you are a user who is more uncomplicated and needs less time, and you are purchasing bundled services, you are paying for the “free” appointments of other more complicated patients. With the explosion of “free” testing, you are also paying for all the tests for all the patients who do not end up getting hearing aids. Bundling practices, however, tend to be driven by market preference. Service bundles seem to appeal to a lot of people. Audiologists who want to unbundle, at least in my area, have a hard time competing with the ones who bundle because patients want “free” batteries, repairs, cleanings, etc. But independents have a lot of flexibility, so if you ask to pay for their unbundled services they may be able to do that for you.
From the manufacturer pricing side of things? Yes, economies of scale. Speech in noise processing is a difficult problem. Tiny electronics in environments that are very hard on tiny electronics. What the market will bear.
Degree creep is a pet peeve of mine. Physical therapy has the same issue.
Most small, low volume “local guys” pay through the nose for HA’s, which is another reason their prices are so high.
Our cheapest option is probably Costco for face to face services.
I do prefer a good audiologist to a good HIS. There is value in the degree - but perhaps a big group who employ both could be cheaper.
My ex-husband(an IT manager) once told me he did not value a university degree until he graduated himself. Then he told me that he always knew he should do things a certain way but until he went to university he really didn’t understand why he should do it that way.
Certainly there are fields where a degree is superior and medical is an obvious one. I have used both AuD and HIS. Under normal conditions there isn’t a difference. Abnormal conditions must be recognized and the AuD should have the advantage. The HIS should recognize the problem but possibly to a lesser degree. As your husband stated, he saw the problem/need but didn’t fully understand the why.
Assuming both recognize the problem, the outcome is the same. They refer them to a doctor – preferably an ENT. Neither can treat or prescribe.
Hearing aid prices are only one argument for insurance coverage and a single payer system. It seems when you add “medical” to anything, the price goes up. Typical hearing aids and programming are not rocket science. This is proved by folks being able to program their own aids when the software is made available to them. It’s just a trial and error process. One probably needs a hearing test and some help figuring out how to program, but if I can figure it out without special, extended training, so can a lot of people. So I don’t know that restricting the supply of hearing services through licensing audiologists and restricting the supply of hearing aids and programming devices by making them available only through professionals has worked terribly well.
I worked with an audiologist for 19 years and had, in that time, effectively unlimited services. I went in for adjustments about every six months or less. One set of aids from this person did cost about $5K and the next time I needed a set, I couldn’t afford, due to changed life circumstances, another $5K set, so I settled for a used set with one less program (lost my telecoil, which was inconvenient) for $2.5K. After an argument with the audie over a letter I wanted him to provide (he didn’t think hearing loss increased my emotional distress and made a rather insensitive remark about this) I bought a used set of aids from ebay and had them programmed at the local University hearing clinic. It turned out that the prior audie’s theories about amplifying low (the hearing I have) rather than high (where I have less hearing) was skewed, and I heard better after one fitting than after all those fittings with the prior audie. My frequent visits resulted from my intuitive sense that there was more that I wasn’t getting.
Despite my profound hearing loss, it seems fitting my aids, as I finally learned, wasn’t that complicated. The aids from ebay were $600 and the fitting was $235, including a hearing test. The University audie commented that I picked a slightly underpowered aid and could use just a little more amplification. After about three years with the aids, I decided to look for another set with more power. They cost $350. Now, since it is so long since the last test, it’s $235 for another test ($150) plus a programming session. The aids I bought on ebay were a 6 year old model, but they have lasted about three years more and are still good. The “new” aids are also a 6 year old model, but they have Bluetooth capability with a remote worn around the neck and are perfectly adequate. I head one additional fitting session with the last set of aids because I did not realize that the filters on these water resistant hearing aids had clogged and needed to be replaced. So that set cost $600+$235+$85=$920. This is a far more realistic number for most people. I got lucky on the new aids and I expect the cost to get them up and running will be $350+$235=$585 plus maybe one more programming session ($85).
I have sets of filters for the old aid which cost $20 for about ten sets (replace every three to six months). I have tubing for my (custom) ear molds from Hal-hen which cost maybe $10 for about ten sets and I change those myself every few months. It’s a shame that more people can’t have aids because of the cost (my sister, on a fixed income, is one of these). I’ve gained about 60 lbs or more since my ear molds were fitted, but they still work.
At present, until things get better, buy on line, buy used, buy an older model and find an audi who will program your aids on a fee for service basis. I think, in the present system, your audie is unlikely to educate you, you’ll have to educate yourself and make your best deal considering your situation.
I am not that concerned with people self-programming. I feel like I would probably do it for myself if I were living another life (I mean, I’d obviously do it for myself in THIS life), but I don’t know whether that is a true assessment given that it comes from the biased position of already having the expertise. But I think I probably have similar personality traits to the people who do it themselves.
However, improperly fitted hearing aids can lead to increased hearing damage over time. It’s much less likely with modern devices. Particularly if you only have moderate loss.
After two very expensive HA purchases from audiologists, I was a happy guy when I discovered Costco, just b4 buying my third pair.
IMHO, they’re definitely over-priced. I think of the millions of hearing-deficient people who can’t afford the ridiculously high cost. Pretty sad…
Yes, an idiot could cause hearing damage by improperly fitting hearing aids/HAs, especially power HAs. But the idiot population is not limited to self programmers. We should also include professional idiots.
Certainly. They are everywhere. Just not in equal measure.
As I’m from the UK if you are found to have hearing loss then you can get them free on the NHS usually but you can still choose to go private. My parents chose to go private to get my hearing aids as it was too much of a mess about waiting around for the NHS to sort it so we went to Specsavers to buy my hearing aids. We chose the cheapest ones and they were still £495 for the pair.