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Brad whitneyb at erols.com
Tue Oct 7 16:58:16 EST 1997

Discussion of hearing aid pricing is just one aspect of consumer
issues.  I have spent the last several weeks trying to become
educated enough about aid prices and selection to make a purchase.  

Mr. Wood's comments do not reflect this consumer's experiance
and I feel obligated to present a balanced position. 

In article <199710071500.KAA05951 at dgabby.mfldclin.edu>, 
woodd at DGABBY.MFLDCLIN.EDU says...
>Mr. Kaminski:
>You raise several interesting points in your posting, and they really
>need be addressed.
>1) Audiologists are NOT physicians. Not in the US. We are required to
>spend minimally 6 years obtaining a BS & MS (or MA), spend thousands
>on this education, and when we become certified-our base salary is
>on average 1/5 that of an ENT physician. The last reason most choose
>to become audiologists is to make money or to have status, like so
>many do that choose medicine.  Audiologists DON'T make money & as your
>attitude suggests, DON'T have status. Audiologists are a heterogenous
>bunch, but many chose this field because they enjoy the work. 
>Interesting point, though. I have never known a doctor that posted
>prices for services or discussed this freely. 

This is a very valid point.  I appears from the audiologists and
dispensers I have talked to, they do not make large incomes.  They all
seem very interested in their work.

Doctors generally do not freely discuss prices.  However, I do know of 
Opthamologists that freely advertise their RK and laser surgery prices
on the radio, Internet, and in the newspapers.  I have also seen 
plastic surgery prices published for cosmetic surgery.
As with hearing aids, all of these services are usually not covered
by insurance.

>2. Hearing aids are regulated as medical devices by the federal
>gov't. As such, any comparison to gasoline, stereo equipment,
>computers, etc. is at best, ridiculous. The only similarity is that
>in both instances, they must be paid for. The similarities end there.
>3. Hearing aids as medical devices are fitted individually. To this
>end, they require clinical evaluation of hearing, custom fitting of
>the device, and follow up care in both the short and long term.
>A generic posting of price does little to describe the skills of the
>person testing the auditory system, taking the impression, fitting
>the aid or performing follow up care. It also does not describe what
>is covered, warranty, long term service, and other service related
>issues. Yet, it is these competency and service issues that are the
>crux of most successful fittings. Price is relevant, of course, but
>if it is the primary concern, then you should expect, as the saying
>goes, "to get what you pay for".

Hearing aids are a different beast.  They are not consumer devices
for the reasons stated above.  However, they are not medical devices
under medical insurance coverage.  Medical insurance is
not watching hearing aid services as they do on all my other medical
insurance coverage (including eyeglasses).  They do not send me
an insurance claim statement telling me what is "usual and customary"
charges for aids.  They do not have consumer published prices.  They
do not have published "product reviews" as do all other consumer devices.
Consumer's Report has not done testing of currently available aids.

For consumer protection purposes, hearing aids are not consumer devices
nor are they medical devices.  They are regulated as medical
devices, but normal consumer price protection methods for medical
devices (i.e. insurance companies) are not present.  Insurance 
companies have become the primary comsumer price protector in
the US because of our medical system.  Any "medical device" not covered
by insurance is outside the normal medical checks and balances system.

>Most audiologists are not afraid to discuss prices, but if all that
>is discussed is numbers with little or no concern for the all
>important intangibles, then the comparisons are not just silly, but
>they are detrimental to good hearing health care. You would not be
>better off as a consumer armed with an array of numbers-you would just
>have a bunch of numbers that are, in and of themslves, meaningless.
>There is no "trust" or other conspiratorial network to conceal the
>prices of hearing aids. Pick up the Yellow Pages and call the
>audiologists listed. Discuss your concerns, and of course, prices. You
>will undoubtedly find an intelligent and forthright individual who
>is happy to discuss these things in their proper context.
>But don't expect intelligent, highly trained, and educated professionals
>to willy nilly post numbers here because you (individually or as a
>group of consumers) say we should! In the end, you, as a consumer, may
>do as you please. Wishing to educate yourself is a noble undertaking,
>but it should be done in a thoughtful and reasonable manner. 

I have "picked up the yellow pages" and have found informative
intelligent people willing to help me over the phone.  I have also
found many that will not discuss prices over the phone.

My experiances started when I first visited my ENT and the staff
audiologist shocked me with the cost of a Widex Senso CIC.  I was
too surprised, and uneducated about aids, to question him
technically as to his recommendation.  All he kept saying was
this was the best solution for me and "don't I deserve the best"?

Thats when I called and visited other audiologists, just as Mr. Wood
suggests, and things got confusing.  Out of four audiologists I talked
to, they contradict each other on most issues.
1) All but the first say the Widex Senso is not good for me (one
	even sells Widex, but recommends ReSound for me).
2) Two say forget CIC but use a regular canal aid.
3) One says K-amp CIC, all the others say no K-Amp.

I then posted my problem on this newsgroup and got many responses
from audiologists and users alike.  The results were similarly mixed.
The most common suggestion was the smallest ReSound (IC4, I think),
with little support for the Widex Senso.  Some posts were very anti-
CIC, but some were very pro-CIC.  A few were for no aid, as my loss
is in only one ear.  My ENT says it is my decision as to what, if
any, aid I should buy.  He trusts his staff audiologist's opinion.  

I have concluded that the fitting of hearing aids is an inexact 
science at best.  It appears to this consumer there isn't even
a standard starting place for fitting my "classic" (so I'm told) 
hearing loss (up to 2K-20db, 3k-45db, 4k to 8k-65db).  

The hearing aid's best consumer tool is the 30 day trial period.  
I hate going into a purchase mode where I know I have to try at least
two aids (Widex CIC and ReSound) to try and get a feel for what
is best.  This must drive up costs for audiologists, because I 
will only buy one aid, but two will have to be fitted.

What other choice does the consumer have?  It was because of
a 400% increase in the price of my last aid (five years ago), with
little explaination from my ENT's staff audiologist, that sent
me to the yellow pages to get additional price information.  
Conversations with other audiologists uncovered not only diverse
pricing, but very diverse opinions about hearing aid solutions.

This has the effect of giving a consumer the impression of a
profession in disarray.  Wide pricing variances on the same aid,
opposing opinions on the technical (fitting) solutions, with
little information directly available to the consumer, leads
to confusion.

Wide pricing disparities do not concern me as much as the diverse
technical recommendations.  All normal consumer factors apply to
pricing- quality, service, support, warrenty, etc.  But we consumers
are not well versed to evaluate why audiologist A recommends
CIC and audiologist B disputs this recommendation. 

I firmly believe that audiologists within ENT office settings 
should be prohibited from dispensing aids and turned into an 
unbiased patient adviser.  The closest I have come to this
model is the method used by www.ahearingaid.com. Pay a flat
fee to the dispenser for whatever aid is fitted.  This removes
most financial confict of interest from the dispenser and he or
she is free to recommend an aid purely on technical considerations.

For me, I am taking a wait and see approach to my purchase.

a confused hearing aid consumer

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