Ripped off?

@kevels55 said:

Aye Don
Hi Ed, you may both have hit the nail on the head… therein might be the dilemma! This lady’s ENT department may be stuck between a rock and a hard place, they may have to charge the full retail price for fear of letting her know how much they actually pay wholesale? For instance, Phonak sells there Naida V UP to the NHS here in the UK for around £120+ VAT per aid, which = £144 or £288 for a pair = $458.09! Now the same set of aids on the UK high street will set you back around £3000 per pair or $4,771.75!!! Now I’m definitely not saying any hearing aid company has the same buying power as the NHS, because they are the largest dispensers of HA’s in the world, but lets say for the sake of argument they were paying just over double £600 per pair = $954.35… That’s still a very hefty profit margin!

Cheers Kev:D

Granted I am in the US, but if you can find me a way to be able to get a patient a Naida V and sell it to them for $458 while still covering all the costs associated with the office I am in, I will love you forever. No one I have ever heard of could possibly sell enough hearing aids to be able to get a Naida V at a price so low that it would allow them to sell them for less than $500 each let alone a pair!I would have many a happy patient if I could find a way to do that and trust me, I would LOVE to be able to have something that level of quality for a price point of basically $250/hearing aid.

I get so tired of hearing about this miraculous “profit margin” that so many people speak so fondly of. I sell a pair of Naida V BTE’s for $4600 and I GUARANTEE YOU I get no where close to a profit margin of $3600 for a pair…

People so easily forget that the money over what a professional pays for a hearing aid doesn’t all get deposited into a bank somewhere and fund someone’s trip to Maui. There is equipment to be calibrated yearly, repairs to the same equipment to make, office staff to pay, a professional to pay, rent to pay, bills associated with renting a space, malpractice insurance to pay, plus a bevy of other costs associated with running a business. That “hefty profit margin” gets chipped away at pretty fast and is all-of-a-sudden not quite so big. Now, again I am in the US so maybe it’s just different here than in the UK or other countries. I’m sure I’ll never be able to change the minds of those people out there who are convinced that we, as professionals, are only paying a few hundred dollars for the most advanced technology but it does get old after awhile to have it implied that we are purposefully inflating pricing so that we can live high-on-the-hog. It’s called capitalism…it’s a business and a medical service therefore it’s going to be subject to many of the same principals as any other business would be.

Regarding the original topic, I did ask my Office Manager if we have this previously mentioned “loss insurance” and not only do we not have it, she has never heard of it. She has run a multitude of different kinds of medical offices over the years and states that she knows nothing of it’s kind. So the office that provided the loaner most likely had no coverage for the loss, just like most other practices don’t. Although she did agree with me that the ENT office is ultimately at fault for not having the OP sign anything and because of that, should basically just eat the cost of the loss, whatever that may be. IMHO, any business that handles the situation the way they did is harming themselves more than anything. It just looks bad…

@DocAudio said:

Granted I am in the US, but if you can find me a way to be able to get a patient a Naida V and sell it to them for $458 while still covering all the costs associated with the office I am in, I will love you forever. No one I have ever heard of could possibly sell enough hearing aids to be able to get a Naida V at a price so low that it would allow them to sell them for less than $500 each let alone a pair!I would have many a happy patient if I could find a way to do that and trust me, I would LOVE to be able to have something that level of quality for a price point of basically $250/hearing aid.

I get so tired of hearing about this miraculous “profit margin” that so many people speak so fondly of. I sell a pair of Naida V BTE’s for $4600 and I GUARANTEE YOU I get no where close to a profit margin of $3600 for a pair…

People so easily forget that the money over what a professional pays for a hearing aid doesn’t all get deposited into a bank somewhere and fund someone’s trip to Maui. There is equipment to be calibrated yearly, repairs to the same equipment to make, office staff to pay, a professional to pay, rent to pay, bills associated with renting a space, malpractice insurance to pay, plus a bevy of other costs associated with running a business. That “hefty profit margin” gets chipped away at pretty fast and is all-of-a-sudden not quite so big. Now, again I am in the US so maybe it’s just different here than in the UK or other countries. I’m sure I’ll never be able to change the minds of those people out there who are convinced that we, as professionals, are only paying a few hundred dollars for the most advanced technology but it does get old after awhile to have it implied that we are purposefully inflating pricing so that we can live high-on-the-hog. It’s called capitalism…it’s a business and a medical service therefore it’s going to be subject to many of the same principals as any other business would be.

Regarding the original topic, I did ask my Office Manager if we have this previously mentioned “loss insurance” and not only do we not have it, she has never heard of it. She has run a multitude of different kinds of medical offices over the years and states that she knows nothing of it’s kind. So the office that provided the loaner most likely had no coverage for the loss, just like most other practices don’t. Although she did agree with me that the ENT office is ultimately at fault for not having the OP sign anything and because of that, should basically just eat the cost of the loss, whatever that may be. IMHO, any business that handles the situation the way they did is harming themselves more than anything. It just looks bad…

Hi Doc

I’m not saying you don’t have a lot of overheads, I’m just stating what the NHS pays for a set of Naida V UP’s and I’m sure Phonak are still making a profit at that price!

The Image below was lifted from a Phonak web site, lets just say I have access to this site and kept a copy for future reference! The Nathos is a similar aid to the Naida V and is made exclusively for the NHS, I think?

The thing is Doc, if they can sell their Naida’s at that price to the NHS, why can’t they sell them to others at a similar price? Most likely its because its in their interest to keep the price artificially high?

Cheers Kev:D

Well that is quite interesting. Unfortunately, it makes those of us who don’t have access to that kind of pricing, for whatever reason, appear to be marking our products up at a ridiculous rate.

I’d be interesting to see the difference between the two hearing aids. The Nathos is definitely not available in the US…

Hi Doc

Full spec of the Nathos below as requested.

Cheers Kev:D

Features and Benefits

             [IMG]http://www.phonaknhs.co.uk/images/products/nathos/saved/clip_image002.gif[/IMG]
             
             <b>CORE - Communication Optimised Real Audio Engine</b>
              
             The most sophisticated  audio-processing platform ever introduced  in the hearing industry and is at the  heart of each product in the  Nathos range:
             Highest capacity: CORE is a 3-chip hybrid with 6 processors and  over 8 million transistors.

• Fastest: CORE can perform over 120 million operations per second.
• Broadband Wireless: CORE supports fast, stable exchange of real-audio between instruments and accessories.
• Incredibly small: At just 1.7mm x 5.6mm x 3.6mm, CORE is an amazingly powerful marvel of miniaturisation.

             <b>SoundRecover</b>
                <b>Restoration of high-frequency hearing</b>
             SoundRecover, the innovative Phonak non-linear frequency   compression algorithm breaks the high frequency barrier. SoundRecover   compresses and shifts high frequencies which would otherwise be  inaudible into  an area of audible hearing. This broadens bandwidth for  natural and feedback  free reproduction of sound without being harsh or  tinny.
             Audibility across a broad range of frequencies is vital for   optimum hearing and understanding. SoundRecover is very beneficial for  people  with a severe to profound hearing loss who have obvious  challenges identifying  and differentiating important, highfrequency  spoken sounds such as the  consonants /f/, /s/ and /sh/. Difficulties  perceiving and distinguishing these  sounds which are crucial for speech  intelligibility are also common for people  with mild to moderate  hearing losses, so SoundRecover offers potential benefits  for this  population, as well.
             <b>With Nathos, you have a SoundRecover solution for everyone.</b>
             [IMG]http://www.phonaknhs.co.uk/images/products/nathos/saved/clip_image006_0000.gif[/IMG]
             <b>WhistleBlock</b>
                <b>Feedback free hearing</b>
              
             The WhistleBlock Technology with Nathos benefits from the new   feedback identification and tagging module. This additional step occurs  just  before feedback suppression is actually activated. It  differentiates between  naturally occurring feedback-like sounds and  true feedback. To reliably  identify true feedback means that a much  more aggressive feedback cancellation  strategy is applied. This means  increased audibility and sound quality that is  free from annoying  feedback.
             [IMG]http://www.phonaknhs.co.uk/images/products/nathos/saved/clip_image008.gif[/IMG]
                <b>SoundFlow</b>
                <b>Continuous and instant optimisation to all environments</b>
              
             The sound environments of life are varied and challenging. In  real  time, SoundFlow creates a unique program perfectly adapted to  every new  environment. The result is a seamless transition between  hearing situations,  with optimum clarity and comfort, no matter what  the environment.
             [IMG]http://www.phonaknhs.co.uk/images/products/nathos/saved/clip_image010.gif[/IMG]
             <b>WindBlock  Management</b>
                <b>Suppresses wind noise to enjoy the great outdoors</b>
             WindBlock Management utilises a newly engineered wind   identification and classification system. The powerful, adaptive  algorithm  automatically suppresses wind noise. Teamed with a microphone  shield, it allows  wearers to enjoy the outdoors without compromise.
             [IMG]http://www.phonaknhs.co.uk/images/products/nathos/saved/clip_image012.gif[/IMG]<b>EchoBlock System</b>
            <b>Understand well in reverberant environments</b>
              
             Reverberation acts as a form of connecting noise affecting a   persons ability to hear effectively in many indoor environments.  EchoBlock detects  and suppresses reverberation to improve hearing  ability in such places.
                [IMG]http://www.phonaknhs.co.uk/images/products/nathos/saved/clip_image014.gif[/IMG]
             
             <b>NoiseBlock Processing</b>
                <b>Premium comfort in situations with background noise</b>
             NoiseBlock Processing detects and suppresses competing steady   state noise in 16 independent channels to optimise ease of listening  whilst  maintaining audibility.
                [IMG]http://www.phonaknhs.co.uk/images/products/nathos/saved/clip_image016.gif[/IMG]
             
             <b>Real Ear Sound</b>
                <b>Natural sound orientation</b>
              
             When microphones are placed outside the pinna, natural   front/back localisation cues can be lost. Real Ear Sound, simulates the   performance characteristics of the pinna. The result is restored  localisation  and the ability to experience natural sound perception.

This is the same issue as the US’s VA services. They are capable of receiving far lower invoice pricing than us private sector audis because of the sheer volume of aids they order. I’m sure the NHS has a similar price structure for this reason. The government providers are NEVER going to have to pay what private sector professionals do, they have the ultimate buying power.

Private sectors audis can’t even come close to government prices, we wouldn’t be able to keep our doors open.

dr.amy

@DocAudio said:

. After looking at the specs, it is apparent that the hearing aids use the CORE platform which is Phonak’s older platform since the Spice line came out (as indicated by an “S” in the name of the hearing aid) so perhaps this is one reason why they are so inexpensive.

If it is a somewhat older model then the sales to NHS and US VA don’t have to support the fixed costs of overhead including R&D as much as a newer product. Since the market supported the fixed costs they can sell them closer to the variable costs (plus returns).

Even if they are newer aids (and successful) they can still depend on the market to foot most of the bill and give the big buyers like NHS and VA a big break (just not as big a break as in the older tech.).

Melfan3,
Have you checked with your home owners insurance or if you rent with your renters insurance? It might be worth a shot to see if the HA and streamer would be covered.

@Um_bongo said:

Hearing-Aids could be cheaper, however while people are willing to pay high prices for them, they won’t be. The existing market is a sum of all the individual purchasing decisions made - it reflects the history of ‘selfish’ individual decision making. Whether that is ethical or not doesn’t come into the situation.

Well said, but I will say it more in the eyes of a businessman. If I have a product that costs me $100 to fabricate, I would rather sell 1M of them at $1500 then 5M at $150. The 4M patients who will go without them are not relevant.

@kevels55 said:

Which begs the question Dr. Amy… If the manufacturers can and do sell at these prices to the VA/ NHS and presumably make a profit, then it would suggest that the manufacturers are guilty of price hiking? Or, is the private sector subsidizing these massive dispensers? Methinks it is in the interest of the manufacturers to keep their prices to the private sector artificially high and thereby their profit margins remain excellent, to the detriment of the disabled end user! These end users would most likely love a set of Ambra’s or Agil Pro’s and would perhaps be ideal candidates for these aids… But, they are priced out of the market and have to make do with whats available to their purse strings, to the severe knock on effect of their quality of life!!!

Cheers Kev.

UmBongo took the words out of my mouth, so I won’t elaborate.

But whether right or wrong, there is NOTHING the government pays wholesale for anyway. Like I said, they have the ultimate buying power. This doesn’t mean the HA manufacturers are corrupt, it means it is a business.

dr.amy

@Um_bongo said:

This and this.
The moral argument on here is moot. You simply wouldn’t get the type of development in aids if there was no return for features like wireless technology. It’s too simplistic to ask for the benefits of an industry without accepting it needs money to drive it along.

The NHS and VA get a ‘free’ ride on the back of this.

I would prefer that I could get a new Mercedes for £10,000, but I can’t. I ‘need’ the car to do my job, but I get taxed on it too. If Mercedes put out cars loaded with the same features for £10k I doubt they would be able to develop the next model.

Hearing-Aids could be cheaper, however while people are willing to pay high prices for them, they won’t be. The existing market is a sum of all the individual purchasing decisions made - it reflects the history of ‘selfish’ individual decision making. Whether that is ethical or not doesn’t come into the situation.

As for the NHS panacea - how long ago was the NHS still commissioning reports to ‘prove’ that one hearing aid was as effective as two? Does that reflect a greater interest in the patient or again does it just come down to finances…

Aye Steve

This might hurt a wee bit and as we aint had a rip roaring argument in a while, my profound apologies before you start reading;)

To you and most of your profession the moral argument on here might need to be moot/irrelevant, perhaps for your own peace of mind? You see Steve, you could be the best Audi/Dispenser in the world, I don’t give a sh!t! But, I do care about the millions of people out there whom are sensory impaired in this world, they are denied a better quality of life, in especial the Severe/ Profound threshold! The vast percentage of Audi’s will never ever quite grasp the nettle, they can contemplate and attempt to understand hearing loss in theory, but they will never understand how it feels! Very few Audi’s are actually deaf and of the ones I know whom are deaf, they work in the NHS… Most probs, they are trying to give a decent service to their kindred spirits? You can wax lyrical all day long about development costs etc’…Doesn’t cut the mustard with me, tis pure b@llocks and then some! I am in no way against profit or development costs, but there is a limit…

In the real world Steve and not in your or any of the other Audi’s imaginary ones… The vast majority of folks with a severe hearing loss would gladly pay for high end aids if they could afford them, but sadly because of their loss they are severely discriminated by society on a whole, for example via work; they may be in very poorly paid dead end jobs, with little or no prospect of ever being promoted, tis nothing to do with their intelligence, just the fact they are deaf, is enough! They will most likely suffer from mental health issues, being the butt end of everyone’s jokes, unable to realize their dreams takes its toll eventually! They will be ignored by their work colleagues, (if they are able to get a job? Many will not find any gainful employment) left out of conversations, denied vital information about their job, mainly because most folks can’t be @rsed communicating! To rub salt into the wounds, the majority of the Private Hearing Industry will then promise them their absolute return to the “Hearing World” via this or that Wonder Hearing Aid (More b@llocks) But, in order to reach this Hearing Nirvana, they will the commit highway robbery and charge you £5000 for a pair of HA’s that cost £200 to make, nice work if you can get it, but they have a captive audience, whom need these HA’s in order to function in a Hearing World… Yeah, screw the moral fiber or ethics if you work in the Private Hearing Industry, just deny or deflect attention, for this is all about the profit margin and hearing aid development, manufacturers blame the Audi’s for the high mark up and vice versa :rolleyes:

FFS, this is disabled people you are dealing with here and the analogy of the Merc is way off base Steve, so get a grip, the only impairment you would get buying an old Lada instead of a Merc (would still get you from A to B) perhaps your image might be slightly dented? The same can’t be said for hearing aids! You may be above reproach, but you are acutely aware of the failings in the Hearing Industry, to deny this would be a lie… The selfish manufacturers are denying millions of people worldwide the benefits of vastly improved hearing, profits before ethics, money comes before their fellow human beings quality of life…Why? Because good men stand back and do nothing!!!

Cheers Kev:D

@dr.amy said:

UmBongo took the words out of my mouth, so I won’t elaborate.

But whether right or wrong, there is NOTHING the government pays wholesale for anyway. Like I said, they have the ultimate buying power. This doesn’t mean the HA manufacturers are corrupt, it means it is a business.

dr.amy

No Dr. Amy, they are worse than just corrupt, they are downright criminal

Cheers Kev:D

ZCT, i tried to send you a PM but it says your box is full

Make some space so I can buzz you.

dr.amy

Thanks to all for your replies and help. I am the OP about being ripped off by the audiologist…the topic seems to have changed course somewhere along the line.

Anyhow, I went into the office today to try and work things out with them. I brought the one hearing aid I had to return to them in a show of good faith. When I asked for a receipt, they attempted to have me sign what should have been the original agreement that I was never shown, nor ever signed. I refused to sign it, however they ended up giving me a copy anyhow signed only by them. I tried to reason with them, asked them to show proof that that is what they paid for those aids, or proof that is what they would cost them to replace them and I would gladly reimburse them that amount. Of course they refused to show me any proof of their actual cost, as many people said they would.

They insist, although they acknowlege I was never informed and never signed anything, that that is “office policy” and they want the full $3200. I told them it’s also policy to have informed me before I took these aids of their policy to pay full retail price if anything happened to them. I might or might not have taken this risk had I known this, there’s no way to know now. I told them I would be resonable and certainlly reimburse them for any actual costs they might incur due to my son losing one, but I would not pay full retail cost. They stuck to their guns, offered no compromise but didn’t say if they would bill me or pursue collections or not. I guess I’ll have to wait and see if I receive a bill. They admitted they were in the wrong, yet did not offer any solutions, other than me paying full price for the lost aid!

Hate to spend money on a lawyer, which will probably end up being more than the cost of replacing an aid. I know I will win in court, they have no case without proof of my my having known that I was reponsible for this amount of money. However, I don’t feel like I can stop them from billing me or turning it over to collections without taking them to court. Just hate to spend the money to go that route…although, I’m so mad at this point, I would rather give that money to a lawyer than to them! Any suggestions of who I can report them to? Surely this is fraud, trying to get a patient to agree to something after the fact? Thanks!

I am glad that you are sticking to your guns on this…I think the behavior of the office is abhorrent in this situation. They screwed up and they should accept responsibility for it. The fact that they tried to deceive you into signing the form they forgot to have you sign when you came in to try to resolve the issue is incredible. You have been more than understanding and tried to resolve this without intervention, I definitely think the next step would be to contact the state licensing board.

You should contact the Audiology and/or Hearing Instrument Specialists licensing board in your state (some states have them separate, most it’s combined) and ask to file a complaint. You might even call the medical board and ask to file a complaint against the ENT’s office as well. It might not do anything or go anywhere but that would be the place I’d start if you want to file a complaint. If nothing else, it might get the office to stop threatening you and have the whole issue just go away from your end. I, personally, hope they have some kind of penalty to warning to prevent them from trying to do this again.

Don’t forget to file a complaint with the BBB (Better Business Bureau)