I do not know about Phillips or Rexton but the Jabra/ReSound AutoREM feature gives a pretty accurate starting point. There is not that much to get wrong. As Dr Cliff knows…
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I don’t think he is a con man but I believe he has gotten in over his head with YouTube. I honestly believe he means well, and wants his patients to have the best hearing possible. But what has happened is that YouTube has conned him into spending more than he wants to to be able to get his message out. You see YouTube suckers people in with a certain number of free videos and time then puts the screws to you with demands for advertisements and then you have to have so many likes and advertisement money to keep your ratings up so your videos even show up under their searchs. It is definitely a con.
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All medical professionals make decisions about which cases they will accept. You may not realize it sometimes because it can be phrased differently, but its always there.
“No, you don’t need surgery” can actually mean,
“Too much risk, I’m not willing to take that risk”
“I think you will probably die of something else”
“I’m not good at fixing that specific thing”
“I can’t make any money on that”
“Your insurance doesn’t pay for that”
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He’s a veteran. I believe he was a Marine. He refers to his service in some videos.
My experience, I had a Doctor who said he was underpaid. He changed how he operated his practice. He changed and had group sessions; he became head of his association.
My challenges when I figured I was heard of hearing:
- What business should I use. (Looked in Bell Yellow Pages)
- Was I hard of hearing? (Family said so)
- Did I need one hearing aid or two? (One; couldn’t afford two)
- How could I pay because they were too expensive? Learned I might qualify for workman’s compensation in the future.)
Dr C has figured out easy ways to get a bigger share of business.
He has learned that many people can’t hear speech in noise. His method increases business for him
I wonder if his early videos were intended to pick up new business from people that were unhappy with their HA’s supplied by Costco. Perhaps that didn’t turn out for him.
Finally, I’ve always thought businesses I chose should make a fair and reasonable profit. But I’m very unhappy if they mess with me or don’t charge fairly. And, for a year and a half I thought my hearing aids were no good. That’s not so; the setup was no good. The challenge is to find an audiologist who really knows how to do setup.
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My VA audiologist is a full professor of audiology and gave up his private practice to work for the VA clinic and in fact the clinic started out at his clinic until the VA clinic was finished. He said he prefers to work with veterans and he also is a professor at the University of Arkansas audiology school. My case is one of the case studies for his students. The VA clinic started out with just him as the only audiologist, but now there is one or maybe 2 more audiologist at the clinic that are graduates of the audiology program at the University.
I would not have known he wore aids if he hadn’t pointed it out. But he wears CIC aids for a cookie bite hearing loss.
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To Neville, um_bongo, and other audiologists here:
If I lived near you, I’d have called your office for an appointment when I last looked for new HAs.
Thanks for all your help.
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So…I have been unhappy with my new Jabra Enhance Pro 20s I got from Costco. I have worn hearing aids for more than 25 years. I have gotten them all from Costco and have been generally happy with the product and service. I am the type of guy that won’t get new aids unless something goes wrong with the old ones or they don’t work for me anymore.
Such was the case with my KS9s. The fitter at a nearby Costco to me that my hearing had deteriorated enough that they could not be corrected with them any more. I got new hearing aids because of this. I am unhappy with these new aids. I think that it is a combination of the hearing aids themselves and the fitting.
Thinking that a professional Audiology office might identify my issues and having watched Dr. Cliff on Youtube promoting best practices, I thought I wouldn’t have much to lose, since his office is less than an hour from me.
They have a charge for an initial consultation. Medicare pays for some, but they have additional tests and a hearing aid exam and selection fee they also charge for. They requested that I bring my spouse, ostensibly to get her input on my hearing loss. I get to that a little later.
The audiologist interviewed us about where we found I had problems hearing and understanding and discussed different scenarios where intelligibility and hearing could be improved. It was a pretty slick presentation. She also told us that because of ‘liability’ and ‘warranty’ issues, they would not adjust hearing aids that came from Costco. She also removed a chunk of wax from one ear, so that was a bonus.
She performed a hearing test, just like the one at Costco. The results had some interesting differences at low frequencies, which is not where my issues are. Other than that, the tests were pretty close to the Costco test. She performed a ‘Speech in Noise’ test (which was an extra fee). It didn’t really provide any useful information, other than that’s not a problem for me.
Once all this was done, we got to the real reason why they wanted my spouse to attend with me. This office does not have a bundled price for hardware and services. It’s ala carte. The audiologist recommended Oticon Intent 1. Between the hearing aids, the 45-day fitting, and a one year service plan, the cost more than $7,500! They recommended 4 appointments during the fitting period, but would schedule more if necessary. During the 45-day fitting period, I could return the hearing aids and my only cost would be the fitting fee for more than $1500. Included was an annual service plan where they would adjust, clean, repair, etc. the aids. If I wanted that service for more than a year, it more than $900 per year, not included.
I felt like my spouse was there so they could sell the plan to both of us instead of relying on me to decide on an expense this great. This visit reminded me of the reason I never returned to my original audiologist after I first visited Costco after my diagnosis. Back then, the difference was Costco was less than half for a better quality hearing aid.
Comparing this with the Philips 9040, the price difference is 5 times the cost for less trial period, less service, and only one location for adjustment. I need to have a heart to heart talk with the Costco fitters to get them to do a more than cavalier job of adjustments. I also need to return the Jabras. I don’t think they’re the right fit for me.
The current plan is to wait for the Philips 9050s. I’ll use my KS9s in the meantime. If that becomes unworkable, I’ll re-evaluate.
I might have been willing to pay more than Costco charges if I thought I was getting more value. I might have paid double or more. I am not sure what services they could provide that would convince my to pay more than 5 times the price. In my opinion, unless private offices get closer in cost, they’re going to go the way of other mom and pop businesses when they come up against Walmart, Home Depot, Best Buy, etc.
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My “vote” in the good old U.S. of A. is not going to change the medical industry and its behavior one bit. That machine is far too big. Those who actually vote to make the necessary changes are corrupt and fill their pockets when they can. They’re liars. It all comes down to one thing - The Almighty Dollar $$$.
Which brings us back to that fella on YouTube…
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There’s so much insane about your story, but the one that hits me the most is charging extra for a speech in noise test. Doing a QuickSIN test takes literally only a few minutes tops and the reason most dispensers don’t utilize it is it doesn’t really tell you much (unless the person has normal hearing and claims they struggle in background noise). It can however be used as a sales tool to say “see. You do struggle without hearing aids”
The reason charging extra for it is so insane is it’s literally just a few button clicks. It takes place in the same software. You don’t have to do anything special to set it up or read the results. It’s a pure unadulterated money grab to charge a fee on top of the regular testing.
—
Side question; what were the differences in the low frequencies between costco and the private practice?
I bought a new car every three years for three decades because my job required a lot of travel and I’d lose considerable income if my car wasn’t reliable. This sounds like sleazy car dealers back in the day, pre-internet.
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It’s true that modern audiometers are more likely to include the QuickSIN, but it is not necessarily the case. Roll it a few years back and the QuickSIN was a test that the clinician would have to purchase separately and plug into their machine. For sure it only takes a few minutes, but that’s true of every single audiological test and my understanding about how American healthcare billing works is that there literally is a code for every 2 minute test. So you bill for otoscopy, you bill for tymps, you bill for air conduction and bone conduction, you bill for speech, and so on and so on. So it’s not unreasonable to bill for a single test, particularly if they are billing for the QuickSIN because it’s not something that they can be reimbursed through however your insurance works. Healthcare workers really do think about appointment time in 5-minute increments, and clinical time is tight. So it’s more a matter of what they billed for it, $30? Seems reasonable. $200? Too much.
And it does give you useful information depending on the patient. Often more useful information than WRS, which we traditionally spend more clinical time on. The piece of information I like from it is: Is this person going to continue to struggle significantly in noise even with top-tier hearing aids? That’s useful to know in advance so that you can set expectations and discuss situation-specific accessories.
Cliff’s prices do sound high, but let me ask a question that might be related and that you guys might have insight into: My clinical schedule is currently booking out 14 weeks, which is too long. I’m trying to move certain aspects of follow-up care onto other providers, particularly non-complex issues, but my patients get very cranky about this. I could stop seeing new patients, although that’s a part of my job that I enjoy. I could charge a premium for my time, which is perhaps what Cliff is doing? But I don’t really believe in tiered healthcare. I could refuse to see certain types of patients, though how on earth would I make that selection? So, imagine you are trying to get in to see a provider who has limited time and a long wait-list but who you like, what are the things that keep you from screaming at reception or stomping your feet and leaving retaliatory google reviews?
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I don’t think people truly watch his videos (on Costco) they just look at the title. If you do you don’t watch them to the end you don’t get his whole stance and often praise. Nothing he says on this topic is in a vacuum. #Context Matters.
Watch their VLOG relating to Cosco. People come in where the first fit was the only programming done. IF when was not only ran but implemented (properly) this wouldn’t be so for some (many?) of their patience. IF their patience say x and they can tell via software that the software matches what was said why would they not have an opinion?
If you like Cosco and had a good experience that is great but it does NOT dismiss the evidence that Dr. Cliff and his fellow audiologist have presented.
Is the audiogram you’ve posted for yourself current? I’m not an audiologist, but if that is your current audiogram, that looks to me like a mild-to-moderate loss, bottoming out at -70dB, that should be treatable with KS9 or Jabra Enhance Pro 20, as long as they’re set properly. I’m not sure the Philips are going to be better than or even as good as the Jabras, especially if they’re still not set optimally for you by the same people.
I would have been furious at that price proposal if they’d suggested that “treatment plan” for me. I’d have whipped out my phone and pointedly asked for directions to the nearest Costco. (And I’m a private audiologist’s patient, not a Costco patient.) If Costco isn’t working for you, maybe you just need a better skilled but more reasonably priced, different private audiologist
The Oticon Intent 1 is the top model in the Intent line. Why is that the one they’re pushing, for someone with your audiogram? Were you asking for “the best”?
Since the average price for the Intent 1 is $3900 per aid: (scroll way down on this page: Oticon Intent Hearing Aids Review), Dr. Cliff’s clinic’s price really isn’t out-of-line, except that that should be a bundled price for the many services his clinic wants to charge separately and ongoing, like a very pricey subscription plan. The a-la-carte fees in there are very high. He has every right to price his services that way and that high, if he’s decided he wants to limit his practice and cater to a customer base where price is not a concern, but it all seems to me to be much more for his need$ than yours.
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The price from audis who are in ZipHearing’s network is $4,898 a pair which includes one year of service
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ZipHearing is pretty much unbundled pricing. Sure, you get “one year” of bundled services, but do you want to replace your aids every year, at these prices? Do you have someone who will help you after one year, or will you still use ZH? What happens if they go under before your aids have worn out for you?
I think it’s important to do a self-analysis. My audiologist told me that some of his patients buy aids from him and never come back for 3-6 years until they decide they need new aids. They would be better off IMO going with unbundled pricing (which he does not offer) from a discounter like ZipHearing. But if you understand that most hearing losses and hearing aids, especially rechargeable aids, need more frequent service than once every 3-6 years, and you and your audiologist are staying put, you’re better off paying a fair bundled price that includes everything other than expensive replacement (or usually 3-year warranty) parts.
ZipHearing may not be attracting the best audiologists. You could hit the jackpot with them and get a great audiologist who goes the extra mile to fit you just right, but they’re cutting costs somewhere, and I would worry that it would be in personal service.
I’m not saying that mrschwartz might not get the best fit of his life with Dr Cliff’s clinic. But like him, I’m suspicious that this clinic’s service might not really be worth the multiples of price it would entail in the long run over a really good Costco or even other private audiologist fitting.
Most here would agree: the fitter is more important than the aid models.
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I appreciate your insights. It explains why I didn’t like Peel Audiology after a partner retired and probably was bought out.
The partner that stayed eventually sold to Sonova. They have quite a network in Canada now.
It’s hard to retire with adequate money for countless hours of service. Consulting Engineering is the same. My friend passed after multiple heart attacks.
Thank you from my heart for the skill you have and the time you take. Same to all the pros who care so much
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I for one appreciate what Dr Cliff does. I learned far more from him than some other sources. I don’t mind his pattern. When I start to mind I chose to stop watching. Then magically another title eventually shows.
An aside. I was on Bing and asked AI a question. In less than two seconds I had an amazing response.
I’d never used AI before
I’ve asked quite a few questions about hearing aids. They’re all in a post I made on this site.
A lot are about my terrible setup.
I think AI will help. Us all.
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I was looking at Zip when i was ready to get Phonak Lumity. Their price was $4600, with 3 year warranty and one year of service. Hearing test and initial fit included in that price.
Then I found out my Medicare Advantage plan included a hearing aid benefit if i used the group they specified. It was Hearing Care Solutions. I would guess it’s about 1/10 as professional as Zip.
Their price was $3500 but they had fewer local people in their network. I got the aids through HCS but the local service was not good. I’m still looking for a good audiologist. I wish i had gone with Zip.
Edit: I actually have an appointment with the audiologist that Zip recommends, so i will let you know how that goes in June.
I am not a shill for ZipHearing but I don’t follow your logic. ZipHearing has a network of audiologists they work through. Sometimes they they have more than one or several in your general area. A telephone call to Zip will get their names. You can do your own due diligence and decide if one of them is someone you would like to work with. I met with the audiologists before I purchased and found that, in my area, they were very good. Others may not have the same experience, but they have the ability to check them out and make a decision. You can decide if you are likely to need $2,000 to $3,000 worth of services in years 2+. In addition, at least when I purchased, there was an agreement on what the max appointment would cost in those future years. I am not saying that they are always the best, I am saying that like Costco they may offer a more cost effective approach which is more appropriate for some people.
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