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What a con, man

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The best practices man himself. A doctor of audiology. Putting his “network” above the patient. “We will not support that type of behavior”

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So, you expect him to supplement the activity of (what he would regard as) a competitor business supplying an inferior product with an inferior service model?

Well, he can charge a fee for his time can’t he?

After all, if he is meant to be a medical “professional” and not merely a businessman, doesn’t he have certain ethical standards to meet?

In reply to @thecaz

Yes, but refusal of service or at least taking money for it releases his obligation in that sense. His argument runs along the lines that you purchased a service from a different supplier against his given (and well publicised) advice, in the full knowledge that you were paying a for cheaper form of delivery and (in his eyes) inferior service model.

Look at it from this point of view - You buy a Ferrari, take it to Costco to put the Tyres on it. It’s handling like a dog. You take it to the Ferrari garage: are they obligated to fix the handling that your purchase imposed on the situation or do they tell you that they won’t see you unless you buy a new set of wheels/tyres?

If you’re still in any doubt, tell me who picks up the tab if the aid gets bricked halfway through the programming process too? (Or ends up sounding worse?)

In reply to @Reginald

@Reginald said:

He’s a hypocrite who is trying to dress his sales tactics as an unbiased and professional opinion.

There’s a fraction of merit to the second part of your argument.

I don’t think he’s hypocritical though. He’s got a very well developed marketing method and delivery which translates to monetisation and manufacturing sponsorship. If you note, he never slates any particular product, just some particular channels that erode the message he’s trying to sell.

Costco’s commoditization of the industry is not great, as anything that encourages a ‘race to the floor’ might seem like a good idea in the short term, while there’s a sufficient experience pool to tap from legacy dispensers in the system. However if you don’t allow enough money to come back through the market, you kill the local dispensing, lose the intermediate sales and aftercare and squeeze all ok the other purchasers in the market. Then DeMant (Sonova/whoever) works out it can charge Costco more at the next gen as they have oligopoly control and the price goes up. This yeilds a longer term centralised/poor service model with similar subsequent pricing.

Many private audiologists make a living off of high insurance coverage. Not everyone has such high insurance coverage to pay for the high cost of Hearing Aids from a private audiologist. The rest of us without glorious health insurance coverage, like many of us on social security, would not have hearing aids if there was not a Costco. I argue they both have their purposes and should not be dismissed whole heartedly as Dr Cliff did.

@RSW said:

Many private audiologists make a living off of high insurance coverage.

That’s a peculiarity of how your system is funded: in the UK private provision is 100% paid by the consumer, but there are NHS alternatives.

You can’t really get bent out of shape by professionals within a private/insurance based healthcare industry that you (collectively) keep voting for. I’d take a reliable decent salary and pension over the peaks and troughs in the market if that was an option. Other than that it’s my risk and my profit when I see people.

I believe he has the right ideas, but he has gotten caught up in the YouTube crowd and then to keep his YouTube videos he got caught up with the need to advertise. At that point his great ideas went off the rails. I did much better video information out before he had to do the advertising. At that point i stopped subscriping to his YouTube videos.

I guess I’m not understanding the logic of this approach. My understanding is that the underlying problem is Phonak/Sonova and other manufacturers selling aids to Costco at prices well below what they require small clinics to pay. So of course Costco can resell them for cheaper. That’s definitely a problem, and not one with an easy solution so long as that two-tier pricing continues. It’s something that needs to be addressed between manufacturers and clinicians. But I don’t see how encouraging small clinics to effectively boycott all Costco aids is helping anything here.

In the US, a lot of audis charge a bundled price for devices, programming, plus a service package that often includes unlimited follow-up visits, programming tweaks, etc. The devices themselves cost the audi a certain, discrete amount to buy. Say it’s $2000 (just making that number up). Now say the bundled price is $6000 (again, making that up, but it’s in the range I’ve seen). Once the cost of the aids is factored in, that means the audi is getting paid $4000 for the programming and follow-up services. If someone goes to Costco and buys the same devices for $1000, then goes to a small clinic wanting the programming fixed, the small clinic doesn’t lose anything by offering them a full-service package for $4000. In that scenario, the only party worse off is the manufacturer, which sold the devices to Costco for a lower price than the small clinic would have paid for them.

The bundled pricing model is becoming less sustainable over time anyway, because people move around so much more. If I know I’m going to move to the other side of the country in six months, I’m not going to pay an extra several thousands dollars for aids that come with a service package specific to that clinic, because I’ll just have to pay some other audi to perform all the same services somewhere else. Likewise, if every audi in the new location refuses to work on aids they didn’t sell, that’s a problem… but not a big enough problem to stop me from moving. Costco may have accelerated the process, but I think the only sustainable model here is for providers to make their peace with working on devices they didn’t sell, and structure their pricing so that they can make a reasonable living by doing so.

Edited

I think the problem is the way that hearing aids are marketed.

The manufacturer sells unfinished hearing aids to the audiologist or hearing aid dispenser who sells them with a markup to the person that uses them. (That’s us.)

Some of us are served well. If you find the right dispenser they will set the hearing aids up well for for our hearing disability.

if the setup is done improperly the hearing aids won’t work for the user.

Isn’t it kind of like buying a car?

Maybe Mr Tesla will start selling hearing aids. He’s reinvented the car, and how it’s sold.

edit:
The gentleman who sold my my Paradise Audeo P90R’s explained there were two ways to make money.

  • provide new hearing aids
  • service what I had.
    Mine are provided by workman’s comp. The hearing aids he replaced were just 2 years old; new hearing aids are provided every 5 or more years. He worked a miracle. I got new hearing aids that solved the safety problem I had. I couldn’t hear anything behind me.

Honesty is crucial. Costco’s current aids are no longer locked.

I think there’s an opportunity for profit for skilled practitioners who are willing to take on support for aids purchased from others. I think the opportunity is especially good for ReSound and Signia dealers because the Jabra and Rexton aids seem to be just re-brands, whereas Philips looks unique among the Demant offerings.

One provision of any such service agreement is likely to be caveat emptor WRT the possibility of bricking the aids, etc., so not everyone will put their Costco aids into the hands of a non-Costco practitioner. But some will.

Edited

In reply to @CombatWombat

@CombatWombat said:

My understanding is that the underlying problem is Phonak/Sonova and other manufacturers selling aids to Costco at prices well below what they require small clinics to pay. So of course Costco can resell them for cheaper. That’s definitely a problem,

@CombatWombat I don’t think this is correct; Costco has specific “*low performance” hearing aids that independent hearing care provider don’t have (sort off).
Independent hearing care provider have a wide range of portfolio from manufacturer, from base to top tiers performance HA.
I don’t see it as a problem, since in this area have the advantage when it comes to technology.

Going after Costco will definitely alienate lots of people seeking affordable hearing aids and he is dragging the profession of audiologist/HCP to the gutter.

I wonder why he isn’t after the , knowing that VA pay peanuts for the HA and they do offer top of the line HA?
My guess is volume-wise, VA must have a huge order book and Costco will not even make 10% of that volume!!!

For me, he lost a sub and 2 letters, from now on he is #angrycliff :face_with_symbols_over_mouth: :face_with_symbols_over_mouth: :face_with_symbols_over_mouth: :face_with_symbols_over_mouth: :face_with_symbols_over_mouth:

Interesting! I thought KS10s were the same as Paradise 70s, and were sold at the same time. There’s definitely not the same range, but weren’t those towards the higher end of what was available at the time?

They were (Phonak Audeo Paradise P90 & KS10), apart from tinnitus management that wasn’t enabled on the KS10 (Costco doesn’t want to enable it); Apart from that they are pretty much the same.

In reply to @Baltazard

@Baltazard said:

Costco has specific “*low performance” hearing aids that independent hearing care provider don’t have (sort off).
Independent hearing care provider have a wide range of HA portfolio from manufacturer, from base to top tiers performance HA.

This is patently false. Costco only sells premium level hearing aids

Not really, they aren’t premium if you look at manufacturer’s portfolio, there is always something missing in Costco’s HA, so as not to cannibalize HA manufacturer’s premium model, that’s why I did put “low performance”.
KS10 and Audeo Paradise P90 are similar and they are different, the P90 will still be above the KS10, hence “low performance”.

In reply to @Baltazard

@Baltazard said:

My guess is volume-wise, VA must have a huge order book and Costco will not even make 10% of that volume!!!

Quote from the Hearing Tracker Site:
From 2011 to 2017, sales at Costco hearing centers grew at approximately 20% per year, and Costco has now emerged as the nation’s leading hearing aid retailer, making up an estimated 15% of the US retail market in 2023. That suggests only the Department of Veterans Affairs () dispenses more hearing aids in the United States.

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