What's with the crazy hearing aid pricing differences in Costco versus chain hearing clinics?

@CombatWombat said:

I couldn’t get the Roger Upgrader to work. Had to use my husband’s PC for that one.

I use window 10 and 11 in a virtual machine on my Linux pc everything works except for the Roger Upgrader … it is slightly slower than the windows on the hardware directly

@CombatWombat said:

I run Phonak’s Target software through a program called Parallels on my Mac. It’s less than $100

Virtualbox, which is maintained by Oracle and is free, works too. Although fitting software like Target is noticeably faster on a Windows PC than it is with Virtualbox and my 2019 Mac mini. Also, there is…

@tenkan said:

sometimes the firmware won’t update either, this is why it’s always best to use a windows PC if possible.

To run the SW in a windows virtual machine on a Mac, the Mac bust be intel based. The M1, M2, M3 processors are ARM based and aren’t compatible with the drivers needed

Besides having the market clout to negotiate great deals with HA manufacturers, Costco also makes most of their money from membership dues. This allows them to charge a minimal mark-up on their products.

Hearing aid manufacturers charge Costco less than 10% what they charge an independent clinic for their product and Costco only needs 4% profit to stay in business. Their overhead is lower. Their scope of practice is smaller. Their sales targets are higher and their churn is faster.

That’s the difference.

In Canada, clinician reimbursement is higher at Costco, not lower, although I’m not sure that’s the same in the States.

This is great for you or bad for you depending largely on where the best clinician in your area works, since your success with hearing aids, particularly if something about you and your loss isn’t totally average, depends more on them then on the device. If they don’t work at Costco, no luck. If they do, great!

@glucas said:

I think there are a lot of similarities and shared tech.

It doesn’t mention DNN - but if you look at this link here it mentions AI:

https://www.hearingsolutions.philips.com/en-gb/professionals/soundmap2-soundtie2

You talk about the open paradigm - well - that is what is being experienced by Costco customers of the hearlink 9040. It is allowing a lot of sound through.

The point is this is essentially Oticon technology.

Yes, we know that Philips is using AI, but that doesn’t mean they have DNN.

Philips is using directional microphones. Oticon is not. They’re not the same.

@user777 said:

I believe that most people who need HAs will hear no perceptible difference between Oticon and Philips.

What are you basing this belief on?

I would add that the cost difference between Costco and the local clinic is quite a lot as well, this alone could steer a lot of people away from Oticon clinic prices to Costco.

@billgem said:

Philips is using directional microphones. Oticon is not. They’re not the same.

@tenkan said:

Yeah but so what, Oticon does have directional microphones as well, they may not use them for noise reduction but is there really going to be this “big difference” in how people perceive the sound between them, but I agree that it’s not the Real in disguise, More like cousin Sonic or Bernafon, which we know are not More/Real.

Regarding the question in bold above, we first will need to classify the difference you may hear in the context of 2 different environments, simple and complex. There are medium simple and medium complex environments as well, but we’ll ignore those for now and just focus on the 2 extreme (simple vs complex) ends to keep the discussion more straightforward.

In a simple environment, you probably won’t be able to tell much difference between the Oticon aid and the Philips aid, because the environment is simpler, more quiet, with less sounds, easy to focus on what you want to hear, so you will most likely hear all the sounds equally well with either of those aids. That is the case with other brands as well, not just between Oticon and Philips. The simple environment is simple enough with very few sounds that it’s easy to hear everything clearly with probably any brand aid.

In a complex and noisy and loud environment, this is where the big difference comes in. The big difference does not make one aid more superior than the other. It just makes one aid more suitable to a user’s taste compared to the other aid. If all a user cares about in a complex environment is to understand speech, and in fact, the user has a distaste to have to be bothered hearing anything else but speech, then the Philips and many other brands’ aids will be best suited for this type of user. This type of user is seeking for a “comfortable” listening experience for speech in a complex environment.

But if the user doesn’t mind but in fact even wants to hear everything that’s going on, and they don’t consider non-speech sounds as noise in a complex environment, but as desired sounds they also want to be able to hear as well, although their priority is still speech clarity and speech understanding, then the Oticon aid with their open paradigm would be more suited for their taste. Oticon aids let all the sounds in, but balance them in favor of speech. But note that Oticon aids don’t “suppress” other sounds in favor of speech like the Philips and the other brands. The operative word here is “balance”, not “suppress”.

So the Oticon aid is not superior to the Philips aid, nor is the Philips aid superior to the Oticon aid. They just fit users who have different tastes on how they want to hear. One extreme prefers comfort hearing with priority on speech only. The other extreme prefers “comprehensive” hearing, and as a trade-off are willing (even more than happy) to “put up” with all the sounds that may be considered noise, as long as these sounds are not allowed to intrude in and overwhelm speech. This extreme is not about comfort hearing. This extreme is about willing to work the brain hard to sort out all the sounds they hear, because they want to hear them all.

So there is really no need for folks (and the Costco dispensers) to keep saying that the Philips aid is just the same, or very little different than the Oticon aid, because this implies that even these folks who say this are in fact acknowledging that the Oticon aid is superior/premium, hence the need to equate the Philips aid to Oticon to bring it up to the same premium status. And this implicit acknowledgement is actually wrong. Instead, we should simply say that they’re both different in terms of serving the specific tastes of the users. One brand is suitable for one taste, while the other brand is more suitable to a different taste. Neither taste is better than the other. It’s just a matter of personal preference.

And by the way, Oticon aids do have directional microphones, and can be programmed to give a directional frontal beam forming if desired. But it’s best to leave Oticon aids in the Neural Automatic value in the Directionality Setting, so that the DNN AI can make the decision when to be in omni mode and when to be in directional mode, or even something in between, in the spirit of balancing everything out effectively in favor of the open paradigm.

Also note that my analysis above is not necessarily applicable to everyone. Folks with very heavy hearing losses may be more limited in what works better for them. If their heaving hearing loss results in a very narrow and compressed bandwidth of gain to begin with, the open paradigm is probably not suitable to them because there’s simply not much room at all in the narrowly compressed bandwidth to “balance” most of the sounds out. Then all sounds will probably sound almost equally loud to them in this narrowly compressed band because there is no room to create volume nuances that are needed to create a balanced sound scene in the first place.

Funny, I recently went through the same thought process. I’m in California, so US$. I have a premium Medicare B policy that covers up to $750/year for hearing aids, but only if you get your HAs from an “in network” provider. However, even with the benefit, I would pay $4500-$5000 more for the Oticon Real 1 compared to the Philips 9040. Like you, I asked myself, “Why would I do that?” These will be my first HAs and I’ve tried out both brands. Needless to say, I will be going to Costco for my purchase. Worst case scenario, I have 6 months to decide if I want to return them. And, as many have noted, Costco was rated the best HA provider in Consumer Reports.

@Torbill said:

With the 9040 I hear sounds all around me like never before. In a busy restaurant it used to be that the hearing aids would try to suppress sounds behind me. Now in a busy restaurant I can hear conversations going on behind me, and crashing dishes to the sides of me, etc. When I am on a walk I hear more sounds, of birds, traffic, playing kids, trains in the distance, on and on. It’s just a very different experience from what I’ve had in the past.

So I would say two things. First, the 9040 provides a far more open listening landscape that any hearing aid that I have ever worn in the past, my last pair being KS10/Phonak. I would definitely classify it as open and not highly directional. This hearing aid does not seem to suppress sounds. Rather it seems to try to grab and enhance voices that it thinks I might want to hear in an open sound landscape. And normally it gets things right.

I think this is a great observation! The Philips aid uses the AI engine specifically to do its speech in noise magic, so it really doesn’t need to use directional beam forming to suppress the noise to make speech clearer like many other aids’ brands do. It cleans up the speech so that the speech can stand out, it doesn’t have to suppress the noise so that the speech can stand out.

In a way, it helps get it closer to the open paradigm compared to other brands’ hearing aids. The question is whether it’s as close to the open paradigm as the Oticon aids are. Only the users can decide this. And the only person I can recall who had the Philips 9030 then returned it to buy the Oticon More is @Abarsanti . If you do a search on his thread about his experience with the Philips 9030, I think he said that the 9030 was great, but he went with the More in the end because the More gave him a more open experience. But he came from the Oticon OPN background, so he was probably more accustomed to the very open paradigm from the OPN, so decided to stick with the More and not the Philips because the More gives him that same open experience.

Maybe he can chime in here to share more with us about this since I’ve tagged him above.

@billgem said:

Philips is using directional microphones. Oticon is not. They’re not the same.

Do you actually realise how ridiculous this statement is? ALL modern RIC/BTE use at least two mics to establish nulls at various points around the wearer by mixing different delay filters between their signals. Whether you call this open hearing and swing the nulls around to meet the same orientation as your noise sources or you point the nulls to the rear to achieve better forward hearing performance; it’s all ‘directional’ in one sense or another unless you deliberately set the aids to Omnidirectional.

@billgem said:

Philips is using directional microphones. Oticon is not. They’re not the same.

@Um_bongo said:

Do you actually realise how ridiculous this statement is? ALL modern RIC/BTE use at least two mics to establish nulls at various points around the wearer by mixing different delay filters between their signals.

Yes, @billgem is drawing inferences (on the differences that he learned) which are not correct. But he’s not a professional or technical person, so I would cut him some slack. But I agree that it’s necessary to clarify that the inference he drew is not correct.

The Oticon aids definitely uses 2 mics for directionality controls, just like all the other brands’ aids. They just employ the directionality control differently, and maybe more actively by changing between full and omni and various different degrees in between more frequently in order to balance out the sounds and give speech priority, all the while with the open paradigm in mind. But there is directionality control nevertheless. They may give the appearance of having an omnidirectional state most of the times, but that’s not technically true. In their built-in MyMusic program, however, the mics are forced into the omnidirectional mode for good.

But even the newer Phonak Lumity now doesn’t focus solely in frontal beam forming anymore for speech in noise like their previous models. The SmartSpeech technology in the Lumity now uses the Speech Sensor to detect where the speeches are coming from and adapt the directionality to pick up where the speeches are detected, even from behind.

@Torbill said:

This hearing aid does not seem to suppress sounds. Rather it seems to try to grab and enhance voices that it thinks I might want to hear in an open sound landscape.

@firenzel said:

This is the experience what i have with Oticon Reals, i had Phonak Marvel 90 before, and the Oticon Reals enhance voices.

I would even go one step further to say that on top of enhancing the voices, the Reals also rebalances the sound scene. What I mean by this is that if there are non-speech sounds going on at the same time, especially in a noisy environment, the non-speech sounds don’t get “suppressed”, but they get “balanced out”. What it means is that they don’t get aggressively blocked like how beam forming directionality would normally suppress them, but they get “subdued” just enough, but still are allowed to maintain a presence as to be noticed and heard by the hearing aids wearer.

I would characterize the 3 approaches of speech in noise handling this way:

1. The conventional directional front beam forming leaves the front speech intact (but still mixed with diffused noise) and blocks surrounding noise. It’s like hiding all the dirty kids under the water in a bathtub so you can see the one dirty kid (whom you want to see) remaining. This is the “make the speech stand out” method by hiding other sounds.

2. The Philips 90x0 aids cleans up the speech from diffused noise so that it stands out enough, and this allows the surrounding noise to remain, albeit maybe suppressed a little. It’s like cleaning up the dirty kid you want to see so that you can spot that clean kid more easily amongst the other dirty kids, without having to hide all the other dirty kids under the water like in method 1 above. This is the “clean up the speech” method via the AI engine.

3. With the Oticon aids, all dirty kids get cleaned up well enough that you can spot any of them clearly. Then you can pick and choose which kid you want to look at easily. This is the “balance the whole sound scene” method via the DNN.