I’d prefer a transparent solution, where you pay for what you get. I dont wanna pay an audiologist for setting up a device that is useless if he hadnt set it up. The first fitting is not a service, it’s part of the product. If I bought an unadjusted HA online and bring it to an audiologist who needs perhaps 3 hours to set it up there is a common sense for what the compensation should be. After that, why not just pay for service like the things you mention when the customer needs it to be done. Why does hypothetical service in guarantee time have to be priced in, thus making the prices so much higher than in the store you name?
So glad that I’m not the only one thinking the way I do. Thanks for you reply.
Quote: Ziploc. "How did you come to understand this “pitch shift”?
While singing in a church choir I found that when I sang what seemed like a simple run I ended up on the wrong note. I checked that on my piano at home, and sure enough, what sounded right in my head was wrong on the piano. Then I played octaves - one note below 256Hz and the other above. Yikes! So, no audiologist involved and when I inquired of my audiologist and others on this forum, there was acknowledgement, but no solution. I have to keep my music simple.
George W.
hz R L
250 55 50
500 55 60
1k 65 75
2k 75 70
4k 100 75
6k 105 100
8k 100 100
Thanks for the response, GWerkema. Here’s an article that might help you understand what might be happening to you: The Case of the Missing C# | The Hearing Review2 (hope the link works).
Also try this: Go to onlinetonegenerator.com2 and play tones at several different frequencies. While listening to the tone, plug first one ear, and then the other. For me, when I do this, at some frequencies, the tone sounds as much as a half-step off in one ear compared to the other ear. I am currently dealing with this problem by removing my right hearing aid and putting an earplug in that ear when I sing. That way, at least theoretically, I am hearing with only my left ear when I sing. This is helping me sing in tune. Apparently, an audiologist can determine which frequencies in which ear are affected and then create a hearing aid program in which the offending frequencies in the affected ear are turned way down. Like you, I have been unable to find an audi within reasonable distance who can do this. It’s frustrating. Hope this helps.
I don’t mean to hijack this thread but I think GWerkema, as a new member with few posts, is not yet eligible for PM’s.
I’m gonna try to respond to a few different posts here.
First…
frankbo…
your post:
"I’d prefer a transparent solution, where you pay for what you get. I don’t wanna pay an audiologist for setting up a device that is useless if he hadnt set it up. The first fitting is not a service, it’s part of the product. If I bought an unadjusted online and bring it to an audiologist who needs perhaps 3 hours to set it up there is a common sense for what the compensation should be. After that, why not just pay for service like the things you mention when the customer needs it to be done. "Why does hypothetical service in guarantee time have to be priced in, thus making the prices so much higher than in the store you name?
This sounds good in theory, but where you say “there is a common sense for what compensation should be.” That is not the case. I know a lot of people who disagree significantly on what that compensation should be, so it is NOT common sense.
Common sense might say to charge maybe a couple hundred bucks an hour. So if it took 2 hours to set up that hearing aid, I should charge maybe $400 (maybe). And do you charge that per aid? Because it takes about the same amount of time to set up ONE aid versus TWO since the computer will connect to two at a time. But then is fair that someone with unilateral loss would pay the same as someone with bilateral loss? Thats just one small example. But the real problem is the cost of obtaining my knowledge. I have to be prepared for the most complicated and worst case scenarios, even if that scenario never applies to you. These complicated, worst case scenarios only happen to a small percentage of people, but I have to invest thousands upon thousands of dollars and hours on training, equipment, etc so that I can be prepared for it (There are a lot of crappy half-assed audiologists and dispensers and garage-shop shady dispensers who don’t do this but use the the titles and certifications to muddy the waters). So it is impossible to pass that cost down to ONLY the people who make use of that knowledge. Think of it like a surgeon. There is no “common sense” reason why a 6 hour surgery should COST $60,000 or more. And MOST surgeries go pretty smoothly. But you want that surgeon to be prepared for the worst case scenario so that they don’t panic if you happen to be the ONE case out of hundreds that goes wrong.
Businesses like Costco or buyhear.com or any of those don’t care even a little bit about you as a person. They don’t even care that much if their staff are prepared for those worst case scenarios. Of course, some of them will be, and some of them won’t be. But the company doesn’t care because for them it is simply a volume game. If you happen to be a worst case scenario and you return your purchase because they couldn’t solve the problem, they DON’T CARE. Because 10 other people just bought devices from them. You are lost in the game of cash flow. If Costco lost EVERY worst case scenario ever to a competitor, they would be fine with that because those people make up a small percentage of the overall market and they cost the most to take care of in terms of return appointments, followup, support, etc… So if helping all the “easy patients” is what you care about, then you must be Costco. But MOST individual providers and small practices DO CARE. Whether they are competent or not is another question, but they at least care about YOU as a person and are TRYING to do the best they can. Costco is not trying to do the best they can. They are trying to do just enough to provide some help and get some money.
As the consumer, of course, you always want to see things from your perspective. Notice how you want to only pay for the service you use right then, but when it behooves you, you will conveniently say, “The first fitting is not a service, it’s part of the product.” So when it is in your favor, you are happy to bundle things together. So what if I am insistent that my first fitting was correct and I will no longer make further adjustments and I will no longer accept returns? Because that first fitting was part of the product, and I KNOW that I did it right. I don’t care that YOUR perception is that it is too loud or too soft or whatever. By your logic, I have a right to say, “Sorry, it doesn’t SEEM right to you because you are not used to it, but scientifically speaking, it IS right. Therefore, I will not give your money back and I will not provide further adjustments for free. Every time you want to have a 2dB gain increase, you must pay me $150 for the office visit and adjustment, whether it SEEMS right to you or not.”
So to answer your question, “Why does hypothetical service in guarantee time have to be priced in, thus making the prices so much higher than in the store you name?” It has to be priced in because consumers only want transparency when it is in their favor (during the initial purchase). But when it comes time to pay for each individual service, then suddenly consumers start saying, “How come you have to nickle and dime me? When I spend $3598 on something, you should back that product up with your life or else you should not have recommended it to me in the first place.”
The other interesting thing about humans and the bundled versus unbundled argument (This is an ongoing argument in the industry) is that outcome satisfaction is higher with the bundled approach. My patients who purchase a bundled price are more active, healthier, more social, and happier people. They come in for batteries and supplies and cleanings. They come in for annual checkups. They come to my seminars and educational events. They come to charitable events and participate in focus groups. And in their datalogging, their devices show that they wear the devices more hours per day on average, and their devices typically last longer because they are taking better care of them (with our help). My patients who buy unbundled packages typically wear their devices less, don’t come in for annual checkups, don’t buy batteries from me (even though my prices are half of most retail stores here - including Costco), don’t come to seminars and educational events, don’t take advantage of auditory training offers, don’t lead as active lifestyles, don’t refer as many friends and family members to me, etc… Yet, they are wearing the same devices. So what is the difference? The difference is that when they invest their money in the bundled package, they invest themselves in their success, and they are more determined to follow my recommendations and to get the best results. When people only look at the number of dollars they write on the check, and try to keep that number as small as possible, they are not invested in their success as much as they are trying to “just get a good deal”.
I know its long winded, but obviously I feel passionately about this. I know there are people who are exceptions to the rule, but I have seen this enough times through my continued expansion that generally speaking, I am right. I know that a lot of people THINK they want transparency, which in all honesty, I we could give them. But it would have to go both ways. Consumers always seem to WANT the business to be fully transparent, but you don’t want to be fully transparent with your audiologist or dispenser. Take one of my patients the other day… Bought entry-level devices from a practice about 18 months ago. I bought the practice about 12 months ago. I have seen him 10 times in the last year because he wants to hear better in noise. I have advised him every time he has been in that in order to achieve that he must invest in better devices. He has told me every time that he does not have the money and lives on only $800/month from social security and blah blah blah. Finally, one of his devices broke and needed to be sent for repair (it had a 1 year warranty one it). So I put a pair of loaner Alta2 Pros on him (which I sell for $6000 - yes, my price dropped with the launch of Opn) just to get him by. He called me the next day and told me to cancel his repair because he wanted the new ones. I asked how he planned to pay for them, and he asked me if I would accept a check or if he could put them on his Amex. And THEN, to cap it off, he asked if he could buy a second pair for his wife (Who has refused to come in because she has had so little faith in hearing aids because of what he had been wearing). So this guy who could not afford it in any way, shape, or form, suddenly pulled $11,400 out of a hat (I give 10% off for husband/wife purchases at the same time)? I don’t think so. He always had the money, but didn’t want to be fully honest and open with me.
Interesting pedestal you built yourself to put you head and shoulders above all others.
As to Costco, it is a membership and prides itself on service. Nowhere is that more apparent than the department. They have modern equipment that they are trained to use in the proper Costco way in seminars that the //MS fitters must attend. That detail extends to the entire department’s functioning. I was told by a MS with 20 years experience that the last seminar dealt with properly fitting molds. The reps visit the store and provide the same support/advice they provide you with.
You are a fine merchandiser and I feel you try to give value. But your view of value hits +$7000. And, that is a valid discussion/decision point.
Now I am one of those hard to serve people with WPS in the teens. And I had more followups than the normal waterfall types. It does seem that once the person is tested, the audiologist has a pretty good idea for successful outcome.
I tried Oticon before going to Costco. Right now I couldn’t call a difference. Costco did a very professional job of working with me to get the results I have. Doubt many could do better.
Businesses like Costco or buyhear.com or any of those don’t care even a little bit about you as a person. They don’t even care that much if their staff are prepared for those worst case scenarios. Of course, some of them will be, and some of them won’t be. But the company doesn’t care because for them it is simply a volume game. … Costco is not trying to do the best they can. They are trying to do just enough to provide some help and get some money.
Pretty wild claim you make with absolutely NO evidence or case studies to back you up. l have purchase hearing aids from BOTH a normal clinic and from Costco and have found Costco to be just as professional in every area. I would love to drive a Ferrari but I have a Hyundai that is within my budget and is just fine. Same with my hearing aids. My Costco aids work just fine for me. Should I spend $6,000 for a pair of Oticons so I can hear a mouse sneeze, don’t think so.
Take one of my patients the other day… He has told me every time that he does not have the money and lives on only $800/month from social security and blah blah blah.
Oh, my. I have many thoughts in response to your latest posting, but this line definitely caught my attention. I wonder what “your patient” would think about your obvious disregard for his ability to pay. (blah, blah, blah) What if the patient ended up not getting the Altas due to costs? Would you care enough to make it affordable for him? Would you suggest that he go to Costco, so that he can get what he needs, assuming they have it? (Although, I’ve not purchased from Costco, I have seen the audis and tried out aids there. They were very helpful and caring with no high pressure sales tactics.)
It looks to me that the future of the hearing instrument industry is going through a significant change. From a patient/customer perspective, it sure seems that Costco, BuyHear, Hearing Revolution, Hearing Care Solutions, Truhearing, ziphearing, etc. are making it possible for many people to afford the level of aids they need. I do believe that there are people who are not buying hearing aids due to the high costs. Then, there are people like me, who are prime for these options. I am an experienced wearer, knowledgeable about technology, frequencies, etc. My last audi said to me, “you certainly know what you want.” I am fine with transparency, are you? Would you be willing to share how much aids cost you? I certainly respect your level of training, knowledge, and skill. But, I am the one “writing the check” and I am the one deciding if it’s worth it to me.
Your original posting suggested that I was “selfish.” Nope, I’m not. I’m trying to be reasonable in my expectations and how much I spend of my “limited” income. I cannot afford your service, but I am sure that there are many who find you reasonably priced for what you provide for their situation.
Now, after this critique, I am glad to hear your new Oticon Opns are working very well for you. I look forward to receiving mine tomorrow and will give an update on them and on my experience with buyhear. If things crash and burn, I will definitely share that as well.
In defense of Justin’s position, I trialed aids at Costco, and after several attempts at adjustment, I returned the aids. Later when newer aids were released that I was interested in, I returned to Costco to ask about them. Although the audiologists and staff were pleasant, when they checked their notes on me, it was pretty obvious to me that Costco had labeled me as a problem patient. They discouraged me from getting my aids through Costco.
In contrast, I got my current aids at a private audiology practice through TruHearing. They were much more expensive than Costco’s offerings, but they were Phonak’s top-of-the-line aids. Costco’s aids were a generation older than top-of-the-line aids. Even though TruHearing only provides three adjustments, my private audi provided many more adjustments for free.
I admit that I am a much more difficult patient to please than most. I am often in extremely challenging hearing environments. But my experience with Costco led me to believe that Costco’s model is an assembly-line model where they fit customers, do a couple of adjustments, and move on to the next customer. Customers who need and demand the best aids and multiple adjustments do not fit that model.
This probably works fine for the majority of customers. But for people like me who need and will pay for the very best hearing aids available, I am a bit concerned that Costco will eliminate independent audis just as Home Depot has largely eliminated good local hardware stores. That would be unfortunate, in my opinion.
Very interesting read. I have also looked at the internet pricing and actually found a good price on OPNs. I have BCBS insurance so I found a local specialist that was in the BCBS network and also in a competitive internet pricing network. Costs was $2500 ea. So I am getting the full local HA specialist support along with a good price. Not as good as $1800 ea mail order deal, but I really want full local support and willing to pay the extra $1400 for that. I went to several other Oticon HA specialist in my local area and the OPN price was pushing $7K.
Just stating facts, not supporting either side of this “DISCUSSION”.
I understand and appreciate the possibility to link to lights, alarms and other “Internet of things”. However can this stream music to two hearing aids, in stereo?
While I appreciated the ability to hear my lighting system buzzing (I do not see any other advantage of this) I would rather they spend the time on improving clarity of speech and possibly music. just a thought.
IoT is interesting. There is a lot of talk about “intelligent” devices. It is a bit like TV. Early channel changers changed the way we watch TV, became couch potatoes, didn’t need to get up to change channels. Some of the early devices for IoT don’t seem all that desirable. But others are doing well. Smart thermostats are attractive to me. You can lower the temp from bed or car. On the way home, you turn it up. Seems a nicer feature than the old, unconnected smart thermostats. Telling the coffee pot to start from bed seems more useful than a timer.
Most of the device in the current iteration are prone to hacking. Also, we all seem to have a phone that can do the IoT in our pockets. For some the IoT aids might become more than a duplication of the service.
The only one I currently find of great interest is the thermostat. I’m not jumping up to turn on light like I did with channel changing so why bother with the expense.
First some background: I am an Oticon Agil Pro wearer for 6 years. I went to local audi through Truhearing.com1 agreement. I trialed some Alta Pro 2 Ti and liked them very much; but during the trial I became aware of Oticon Opn upcoming launch, so I returned Altas. (Altas costs $4,400 for a pair through TruHearing.) Audi was not very familiar with Oticons, so I decided to look elsewhere. Found another audi (45 minute drive) that was familiar with Oticon. He suggested I try Signia Pure 7x while I waited for him to get Opn demos. I liked the Signias ok (4 days), but while waiting, I came across buyhear.com1.
I sent buyhear.com my . They talked with me on phone about Opns and whether they were a good fit. I purchased Opns for $3,600 for the pair. They received the Opns a couple days later, called me and discussed how they should program the aids. I received the aids 3 days later (7 days after initial purchase).
Opns are great. The fluttering or warbling of some tones that I experienced with Alta Pro 2s is much less with Opns. I expect after one adjustment, I will be pretty good to go. I am a music minister, so I need to hear in many different settings to be able to let buyhear know what I need. For the adjustment, buyhear will send me something for a couple of days, so that they can adjust remotely. Next week, I will be around a ton of different musical groups, so its a good week to give Opns their first big challenge. The staff at buyhear have been great thus far. (I’ll continue to update during my 60 day trial period.)
By the way, I did speak with hearingrevolution (also known as Hearing Care Solutions). They have Opns for $2,100 per ($4,200 for a pair). You can go to local audi and purchase through hearingrevolution.
Sorry, this is the one where I had more to say, but lost my internet connection…
A few things…
#1, when I say “blah blah blah” it is not disregard for his financial situation. It is that I hear the same talk about financial issues all day every day, from almost every patient, whether they are worth a million bucks or a million pennies. Patients talking about their financial hardships is like salesmen talking about technical jargon. It is just something people will say to strengthen their justification for getting a discount. In this particular case, I say blah blah blah because we have all heard it before and it would not have changed the point of my rant.
#2, the individuals doing the work (the Audiologists and Dispensers) at Costco DO care. But Costco, as a retail company, does not. They are objective. I’m not saying they are BAD. I am saying they are impersonal. It simply doesn’t matter to them. Do you think the VP of hearing instrument sales loses sleep if you return your hearing aids or if you are still struggling even after buying 3 pairs of devices from them? Nope. Do they care which product you buy or if it is the best one for your hearing loss? Not really. They just want you to buy one of them. Pick which one you want. They will do the best they can with what you pick, no matter what you pick. Costco, owning 10% of hearing aid sales in the USA, and doing the volume that they do, COULD potentially contribute massive amounts of research data to improve hearing aids and customer satisfaction. But they don’t. Why not? Because doing that doesn’t make them any money. All that matters to them is that you buy something. Yes, they want to provide good service (a nice general term) because if they provide good service, more people will come there and buy something. If they provide bad service, fewer people will go there and buy something. But they try to provide good service as a marketing tool, not because they inherently CARE. Again, I am not saying they are bad. Just have different motives.
#3, JustEd - They invest more money into speech clarity and music by far. The IFTTT capability in the Opns probably cost very little, as it is an open source internet initiative. And if you look at what can be done with testing and verification technology now, for the most part, hearing aids can practically restore your ability to respond to sound to the level of normal or near normal. Most of the difficulties people have with sound clarity and music are a result of changes in the patient’s brain as opposed to deficiencies in the hearing aids.
#4, LouisInTexas - Evidence and case studies are not necessary (this is common sense). I can give you case studies, however. But case studies are not representative of a practice as a whole. I didn’t say anything about professionality of Costco, or value. Costco’s prices are on the low end, so their value could be just as good as mine, even given my higher prices. A value proposition is simply getting what you pay for. Part of my value proposition is that I answer my patient’s emails, phone calls and text messages at all hours. Costco doesn’t do that. My patients get a trade in value when they upgrade. Costco doesn’t do that. My patients get batteries included for life (I recognize this is not a HUGE cost, but it IS A cost), and Costco doesn’t do that. There are many other things as well. I am not talking about hearing a mouse sneeze. I am talking about being able to respond to conversations, in quiet, or in noise, just as well as someone who does not have hearing loss. I have known MANY MANY patients who said exactly the same thing you just did, “My Costco aids work just fine for me.” Thats great. But that doesn’t say anything about how well you are ACTUALLY hearing. It just says your standards are where they are, and mine are possibly higher. Nothing objective about it. I have known MANY MANY patients who said that… until they tried something better. But the attitude of “this is good enough for me” is the same attitude that reduces the incentive for the manufacturers to innovate and come out with products that will solve MORE peoples’ problems.
#5, KenP - I do put myself on a pedestal. I put myself on the highest pedestal that I possibly can. If I can think of anything else that will elevate me further (and as a result, elevate my patients’ success), I will do that too. You said, “It does seem that once the person is tested, the audiologist has a pretty good idea for successful outcome.” How about not “seems” or “a pretty good idea”, but “knows” and “precisely”… If your is in the teens, then the problem is not your ears, so for YOU, the end result will not be terribly different no matter which device you use. And if your WRS is that low, you’re probably right, nobody could do better, because significantly better is not really possible. But for many many people, BETTER IS POSSIBLE, but they don’t know it because Costco does not give them precise outcome expectations. Instead of saying, “Whats a better deal, $2000 or $7000?” why can’t we say, “Whats a better deal, $2000 for an improvement of 30 percentage points, which will make things better but you will still miss quite a bit or $7000 for an improvement of 80 percentage points, which would essentially eliminate your hearing deficit?” That changes the conversation, doesn’t it? Given that information, many people might still choose the lower priced option. But many more people might suddenly find the money to afford the higher priced option.
#6, RForbes - “I’m trying to be reasonable in my expectations and how much I spend of my “limited” income. I cannot afford your service, but I am sure that there are many who find you reasonably priced for what you provide for their situation.” What you can afford is up to you. As with any client/patient/customer, you have your own way of determining what is affordable (And you could afford my service, but you have made it all about the product, not the end outcome) - there is not one hard definition for the term. But I’ve had people who live on $500/month, whose homes have holes in the mud-brick adobe walls (I live near reservations) figure out a way to pay me $7500 for the best hearing aids I could get them, and I’ve had people who own multiple homes who could barely stomach paying $1500 for slightly used Alta2 Pros on the grounds that they couldn’t afford them. As to your question about whether I would care enough to make it affordable for someone… The first point is that I am not rich. I don’t drive a luxury car. I don’t live in a mansion. And it is not REALLY my responsibility to take a financial loss in order to make sure that everybody gets what they want/need. The prices I sell hearing devices for do not provide me this mythical 1000% markup that people think they do. In all reality, if I take my business expenses into account, my net profit margin is less than $700/pair on $7500 hearing aids. So if I take very much of a discount, I will lose money. The cost of the devices themselves are not that high, but overhead will kill you. The second point is that actually, I have set up my own charitable foundation to provide hearing devices to people for free if they cannot afford them. And I do not EVER put low end devices on people who apply. They get Agil Pros (Up until this month - I am phasing them out since we’ve moved on a generation) Alta Pros, Alta2 Pros or Opn 1s. My only requirement when applying for assistance is that people disclose all of their financial information to verify they actually need the help. And I can tell you, maybe 20% who apply actually cannot afford the $7500. For those patients, we still offer devices at $5500 and $3500 and $1500/pair. And we offer unbundled pricing and payment plans as well. I could find a high quality option that was affordable for EVERY SINGLE PATIENT that walked through my door… IF they would communicate with me instead of playing the “I can’t afford it because its so expensive” game.
I’m sorry if I seem upset, I’m really not. I just feel like I have a lot to say and I am trying to say it between other things I’m doing so it comes out really pushy and direct. I am not trying to put anybody down or trying to be condescending or anything. Just trying to be quick.
JustinHIS I appreciate having your perspective. I’m only 64 but I find it sad how many small business owners have gone out of business by not being able to compete with big-box and online sales.
I’m sorry if I seem upset, I’m really not. I just feel like I have a lot to say and I am trying to say it between other things I’m doing so it comes out really pushy and direct. I am not trying to put anybody down or trying to be condescending or anything. Just trying to be quick.
Didn’t seem like a rant to me. Seems like a well thought-out and reasonable business philosophy. If you were in my neck of the woods, you’re the kind of person I’d be happy to do business with.
Like it or not hearing aids are a medical instrument much like most Prosthetic devices that are covered by insurance.
there are most likely good people in management at Costco as well as some profit only people. Like any corporation
After reading the specs. on the OPN they appear to be better than the Alta 2 ( a very good ha) but until more people use them and discuss it, it is just marketing
I do not use Costco as the ones in my area are to busy and I wish to see the same audi each time which you can only get at a practice. but I will not deny that they are a good option for others. As for batteries I am sure it does not cost $3,000 over the life of a set of H/A
I am sure you are a good as you appear to be passionate about your industry but so are others. If you wish to make a difference on cost how about pushing congress to pass a bill requiring insurance co to pay their fair share so you could be more competitive
The issue for many is should I buy H/A when they are expensive and no one can guarantee that the ones you sell for 6,000. to 7,000 will be as good as the next guy with a different brand for the same money. Or should they just buy a good used car.
this appears to be a good post for Dr. Jake to reply to.
The first point is that I am not rich. I don’t drive a luxury car. I don’t live in a mansion. And it is not REALLY my responsibility to take a financial loss in order to make sure that everybody gets what they want/need. The prices I sell hearing devices for do not provide me this mythical 1000% markup that people think they do. In all reality, if I take my business expenses into account, my net profit margin is less than $700/pair on $7500 hearing aids. So if I take very much of a discount, I will lose money. The cost of the devices themselves are not that high, but overhead will kill you.
Hi Justin,
I started another thread about the price of OPN. Your info in your post was helpful to me. If a local business sells a pair of OPNs hearing aids for $7500 and “internet” business sells the same for $3600. That difference is $3900. You said you are making only $700 which leaves $3200 + (what the “internet business” has for profit and overhead) for your overhead. The “internet business” has to be making money and they too must also have some overhead. This seems surreal.
I have found a local brick & mortar business that sells the OPNs for $5390. The $5390 they sell are the exact OPNs that that you sell and the "“internet business” sells. My conclusion is that his price is a fair one based on your forthright data.
I have never said I could not afford Good , but I do not spend money unwisely. That’s why I was able to retire at 55 and live comfortably.
Please don’t get me wrong but that is a BUNCH of overhead.
NW Indiana
