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Why Are Digital Hearing Aids So Expensive?
sglines writes "Over the last couple of years I've been slowly getting deaf. Too much loud rock and roll I suppose. After flubbing a couple of job interviews because I couldn't understand my inquisitors, I had a hearing test which confirmed what I already knew: I'm deaf. So I tried on a set of behind-the-ear hearing aids. Wow, my keyboard makes clacks as I type and my wife doesn't mumble to herself. Then I asked how much: $3,700 for the pair. Hey, I'm unemployed. The cheapest digital hearing aids they had were $1,200 each. If you look at the specs they are not very impressive. A digital hearing aid has a low-power A-to-D converter. Output consists of D-to-A conversion with volume passing through an equalizer that inversely matches your hearing loss. Most hearing loss, mine included, is frequency dependent, so an equalizer does wonders. The 'cheap' hearing aids had only four channels while the high-end one had twelve. My 1970 amplifier had more than that. I suppose they have some kind of noise reduction circuitry, too, but that's pretty much it. So my question is this: when I can get a very good netbook computer for under $400 why do I need to pay $1,200 per ear for a hearing aid? Alternatives would be welcome."
I'd suggest that you contact your state's vocational rehabilitation office, which specializes in equipping people with assistive technology so they can be productive members of society (i.e., get and keep a decent job). My fiancée is deaf, and she got a nice Phonak digital aid, a Naida V if memory serves, from the State of Nebraska last year (she uses a cochlear implant in the other ear and only needed one, but two can be arranged as well).
On a recent flight, I heard an older man talk to the woman he was sitting next to about this same issue.
Hearing aids tend to be classified as DME (durable medical equipment). Medical equipment has a higher support cost than netbooks, and the insurance companies are happy to pay. The cost of entry in the DME market is much higher the netbook market.
Although there is a huge market for the product, the liabilities involved in selling these products significantly raises the risk, and therefore the price, in such products.
Decent ones that your wear all the time are typically molded to the inside of your ear and hand-adjusted. This means a real person has to touch them and they can't be mass-manufactured, similar to dental devices like crowns and such (which are comparable in cost).
"I'm an old-fashioned type of guy. I worship the Sun and Moon as gods. And fear them."
..and you live in a country without universal healthcare
There is the songbird brand of hearing aids that are far less than a traditional hearing aid. The disposable (400 hours of use) is $80 USD plus shipping. The permanent one is $280.
Secondly, I might would consider a pocket type hearing amplifier with a traditional earphone. It may save on expensive batteries and be easier on the ear physically.
The higher cost of hearing aids came from the miniaturization, and the price has stayed high. However, with surface mount components now readily available, I expect that there will be more competition in this space.
I commend you for taking care of this. I have a family member that refuses to admit to his hearing loss, and it truly can be a miserable experience being around him because he takes offense at things that people did not really say, but that he misheared.
Also, you are in my thoughts/prayers during this time of unemployment struggle for many of us.
Take the cheese to sickbay, the doctor should see it as soon as possible - B'Elanna Torres, "Learning Curve"
And, I hate to say it but I rather think lots of people are wrong.
The few who have basically said "because they can get away with it" - congratulations.
From the tone of your post (mentioning prices in $), I'm assuming you're in the US. Which is a bit of a shame because these people have just opened up with a view to putting the proverbial cat among the pigeons. Maybe you know someone in the UK who can post a hearing aid on to you?
So my mini BTE ears (Rexton Cobalts) are about the size of a pinto bean, feature wireless bluetooth audio, house a battery that lasts for a week at 14 hours per day, is made to withstand being in a moist environment 14 hours per day for about 5 years, has a speaker that can generate crystal clear audio from about 400Hz to about 5kHz, amplified about 90dB (yeah, I am basically stone deaf), and the speaker is about the size of the tip of a pen. It has enough DSP power to dwarf a laptop from 10 years ago.
Really, someone's surprised that these things cost a lot? Yes, the markup is unbelievable, but these are not your grandfather's hearing aids.
"All that glitters is not gold"
Check out a hunting supply catalog, the same device NOT sold as a medical item cost 90% less....
You pay for the exam.
You pay for the hearing aid.
But you are also paying for the licensed technician who helps you chose the right hearing aid. Casts the earpiece for a proper fit. Adjusts the settings to properly compensate for your hearing loss.
Provides follow-up support and service.
You pay for the record-keeping.
Should something go disastrously wrong on the job, you just might be asked who installed your hearing aid.
The prescription hearing aid is a tax deductable medical expense. Topic 502 - Medical and Dental Expenses
Any medium size company can obtain an A/D, a D/A and a DSP and glue them together. Now add a microphone 4mm long by 2mm diameter that handles the frequency range 125-8000Hz, a speaker the same size that handles the same range with high power levels, and then run the whole thing off a tiny battery for a week of continuous use.
What people who compare these things to MP3 players and the like do not understand is this. Deaf people need a much higher in-ear volume than people with normal hearing. Furthermore, they usually suffer from selective hearing loss. This means that certain frequencies have to be output at levels just below that at which damage could occur. The sound quality and volume needed from a hearing aid reproduction chain is very much greater than that for an iPod or similar.
Nor is that all. It is not just selective amplification. Modern hearing aids can do tricks like identify refrigerator hum or hard drive noise and selectively reduce it so that the user can better distinguish other sounds. I had direct experience of this once in a meeting that took place in a room next to a large running Heidelberg printing press. I could distinguish other speakers because of the noise reduction, but the other participants could not and the meeting was abandoned. By switching between "music" and "speech" modes I could easily hear the difference.
In fact there is now a lot of competition in the hearing aid market with a number of new entrants, and as volumes increase prices are falling. But they are not easy toys to make. Small size, physical robustness, extremely low power consumption, high output, advanced digital signal processing and relatively low volume production means that $1800 is not really much to pay.
From scarped cliff or quarried stone she cries "A thousand types are gone, I care for nothing, no not one."
Sadly, your wrong. I work for a medical device manufacturer. The two big things that drive the cost of a device up are the FDA and lawyers. The amount of documentation we have to produce for the FDA is mind-numbing. We sent a hold box of paper when we submitted out 510k. I can't make a single change in the code base without having a signed-off requirement. I can't fix a defect without having the defect entered as a bug, and then tracing that bug back to a requirement. All because of the FDA. Some of this is good, and a good part of GMP, but a lot of it is overkill.
Most hearing aids don't amplify (well, not as their primary purpose anyway) anymore. Back in the old days, sure, that's what they did (electronic equivalent of an ear horn).
Modern hearing aids shift frequencies (usually downward, high frequencies have the most energy so you damage the short hairs in your cochlea first) to a frequency range you *can* still hear.
So if you're thinking about making your own, *please* do the proper research first. It will work better, and you will be less likely to damage your hearing further.
Clones are people two.
I just used the keyword "hearing" on Cabela's site and got in the ear and behind the ear models ranging from $40 to $400, all offerred high frequency amplification, digital filtering and noise reduction.
If you're paying $500 for glasses, you're shopping in the wrong places. if you're paying $1000, you're getting ripped off.
Last pair of glasses I bought cost $25 shipped. That's frames & lenses in my hands. Also got an ANSI approved set of safety glasses for another $30 on the same order. But those were spares - not my normal glasses.
My normal set cost $80 total, but that was because I wanted titanium half frames and next-day delivery. So all three sets of glasses, plus the eye exam, came to under $250.
Look at online eyeware makers. Same lenses, same frames, vastly lower prices. I start at glassyeyes.blogspot.com, because they have decent reviews and usually a discount coupon. I had good experiences with both eyebuydirect and 39dollarglasses.
Which is kind of insane thinking about it, a hearing aid is different from a heart stint with magnitudes order different levels of risk.
...Which is why hearing instruments are class I medical devices and stents are class III. A basic synopsis here: http://en.wikipedia.org/wiki/Medical_device#Class_I:_General_Controls
I am guessing your company creates Class II or Class III medical devices. A hearing instrument is Class I, and thus has far less stringent FDA requirements.
The first thing I'll tell you is that fundamentally they're all pretty much the same. In general they're all made with equivalent components and the only real difference is Bells and Whistles. It's the only thing the companies can do to differentiate themselves from other manufacturers. Unless you've got some special type of loss, a basic simple model will probably work just fine compared to something fancy. The biggest choice comes down to size and how self-conscious you are about it. Generally, the smaller they are, the weaker they are and more expensive. You're paying for vanity.
You can probably forget about insurance covering it. Almost no health insurance will cover them. They're considered non-essential, "cosmetic" devices. My company provides very good health insurance and only once over the past 30 years have they ever covered -any- of my hearing aid purchases. 11 years ago (during the dot.com boom) I actually had a company cover part of one ( $1000 of a $2800 purchase ) but that was an anomaly. If you're lucky they might cover the hearing exam but considering most places give you that free as part of the purchase process it doesn't do much good. I've had a couple insurance companies tell me "no we don't cover them, but we offer these great coupons" which were basically a 25% discount off of something that was marked up 100% to begin with.
The most important thing I can tell you is to get a Costco, Sam's Club, or other shopping club membership. I have a Costco membership and have bought my last two sets of hearing aids there. They were 1/3 the price that I was charged at regular hearing aid stores. Costco had audiologists that were just as qualified as the regular stores, and sold the same models/manufacturers as the regular stores. As an example, my last "hearing aid store" model cost $2800 in 1999. The three I've bought since then ( the last two a couple of years ago ) cost $890-$1000 each and were far better than the $2800 model.
This has always been my wondering too... The hearing aid just contains a tiny amplifier that is mass produced along with a tiny microphone. The only part that is unique is the ear plug part that are form fitted to your uniquely shaped ear so as to stop the escape of sound which can contribute to annoying feedback.
I lost my hearing during the 60's from the rifles and pistols going off near my ears. So I have learned to cope best I can for nearly my whole adult lifetime with a combination of lip reading and hearing only partially. Compared with many of my brothers and sister who returned greatly scarred or died during their service then i count myself lucky in comparison and try never to complain.
In my case the loud violent sounds did not kill the nerves, rather it hardened the stapes (stirrup) so it would not transmit the vibrations from the anvil to the choclea so a #40 wire was inserted but it has a great Db loss so I am forced to wear hearing aids when I am out.
Surprisingly enough, the nerves (cochlea) of mine is more sensitive than most individuals and for me it is like wearing ear plugs all of the time thus reducing the volume of what i hear. The nerves are tested by bone conduction in transmitting the sound on the skull and measuring the point at which the sound can no longer be heard... typically there is a 5 to 10 Db loss from the sound having to penetrate the skull.
One of my hearing aids went out and I picked it up yesterday from repair and the fee was $325 to replace the amplifier in it. Another form of ripoff during the repair cycle.
I am mostly retired now and insurance nor social security does not cover these costs. I did like the parent poster and checked the cost of new hearing aids but the price was so high that the repair (with 6 month warranty) was the only reasonable solution.
And in the end, the love you take is equal to the love you make
There are a number of things commenters here seem not to know about the hearing aid racket. I have a profound hearing loss and have been wearing hearing aids for most of a decade now, let me fill you in on just a few of the things I have learned.
For all of you championing some sort of cheap or build it yourself aid - unless you have a very light hearing loss, forget that. I once thought the same thing, and tried a number of them, and found that they're basically crap. Just amplifying all sound that hits the microphone doesn't work well at all. A door slamming or a dish clinking can be VERY PAINFUL if overamplified, even if a person without hearing loss barely notices them. After this consideration, there's the problem of the sounds you want to hear being buried under a bunch of sounds that are present but not bothersome in daily life: cars driving by, computer and HVAC fans running, refrigerators humming, crowd noises, air and hair moving over the microphones, and so on.
I'm not an audiologist or in any way connected to the industry other than as a customer, but what I've learned over the years from wearing high- and low-end hearing aids (I have one pair that cost almost $7000) is, human hearing is far more complex than most people realize. Most folks out there swim in a sea of sound that they are well attuned to, but like a fish, give little thought to the navigation of. It just works, like magic. When your hearing starts breaking down, though, it's an incredibly hard problem to selectively amplify the sounds you want to hear in the many situations you will encounter throughout the day. In a crowded room you want to 'focus' your ears on the person in front of you; in the kitchen you want to be able to hear several people who may be moving around as they speak yet filter out extraneous noise like the bacon frying in the pan, the refrigerator hum, the fan over the stove, the dishes rattling around. A healthy ear does all this effortlessly; hearing aids are only now getting enough processing power to do it maybe half as well.
I cannot stress this enough, by the way. NO hearing aid will bring your hearing back to what it was. At their BEST, hearing aids are about as good as a cheap car radio tuning a weak station. If you don't need hearing aids now, protect your hearing, because losing it sucks in about a jillion ways.
In the US, most insurance plans do NOT cover hearing aids. The VA does, and they are the number one hearing aid dispenser in the country. Costco is #2 and they don't even bother handling insurance claims for the patient - he will have to do the insurance paperwork on his own. (I know; I'm wearing a new $3k pair of Costco aids right now and am lucky to be one of the few in my area with a plan that covers part of the cost.)
Many if not most states have laws which require the hearing aid dispenser to take back the aids and provide a full refund with no questions asked within 30-60 days of first receiving them. And when that happens, that set of aids can't be re-sold unless (at minimum) they go back to the factory to be completely rebuilt. This creates a number of people who will comparison shop by wearing multiple aids for most of the trial period, then returning them. In their defense, that's about the only way to know if a hearing aid and audiologist/fitter work well for a person. But even so, this creates a lot of wasted time and investment for audiologists and fitters. They have to make up the loss somehow.
Usually the price of the hearing aids includes months or years of followup visits to the audiologist or fitter. And if you wear hearing aids, you'll need them. Everyone has a different hearing loss and everyone has a different set of situations they need to hear well in. So the audie/fitter will need to make a number of adjustments during the lifetime of your hearing aids. Additionally the aids are subject to a lot of moisture and earwax (your ear canal is actually a pretty disgusting place) so the audie/fitter will have to clean and recondition the aids more often
I can't fix a defect without having the defect entered as a bug, and then tracing that bug back to a requirement.
Mozilla has the same policy for code checked into its Mercurial server. Every patch is attached to a bug in bugzilla.mozilla.org, and each bug cites a requirement or gets marked INVALID.
Yes, those insurance companies need to maintain their awesome 3-4% profit margin. Disconnect the consumer purchase decision from the product pricing and pricing becomes irrational.
The hunting type hearing devices do not as a rule amplify low range. They are all almost exclusively high range amplifiers.
My very unscientific research suggests that hearing aids cost around £3,000 (approx $4,500) in Britain.
Source: http://www.rnid.org.uk/community/forums/products/hidden_hearing/
In Europe, Hungary may be cheaper. A lot of health tourists go there.
the big insurance companies negotiate them down by 90% or so. This is mostly in make sure that you don't go and get healthcare on your own. It also serves as a good way to keep some new insurance company from springing up - if you are not big enough, you can't negotiate such a discount, so you can't be profitable.
The insurance companies are all in a cartel. It would be illegal for any other business, but health insurance companies have a special exception.
There is no free market in health insurance in the USA and there has never been one, so there is no competition. Thus all the prices and profit margins are simply decided at the cartel meeting without any regard to real cost or social benefit.
Over the last couple of years I've been slowly getting paranoid. Too much reading slashdot I suppose. After flubbing a couple of job interviews because I scared my inquisitors, I had a psychology test which confirmed what I already knew: I'm prone to fits of fancy, bits of balderdash, and countless conspiracies. So I tried on a tin foil hat. Wow, my neighbors harvest organs and my wife mumbles ancient sandskrit curses to herself. Then I asked how much: $3,700. Hey, I'm unemployed. The cheapest tinfoil hat they had were $1,200 each.
I'm actually not unemployed. I work for an insurance company. Not only that, I work for a non-profit insurance company. They operate in four states as Blue Cross and Blue Shield (BCBS) plans. I've been on the host and home side which means that I have priced claims per contract with the rendering physicians (Host) and I have paid claims based on the contract that an employer has drawn up with the insurance company for their employees (Home).
Often enough lab tests (80000 cpt codes) are reduced fairly significantly in what we call in network pricing. A provider who is in network signs a contract accepting our pricing structure and in return is promoted as a BCBS provider which provides them with more patients. I've processed many a hearing aid and they do not get a significant reduction. Because of this there are exclusions that limit you to one hearing aid every three years.
I'm not sure what you're requirements are but http://www.hearaidstore.com/ appears to have cheaper models.
I know there's this myth that Canada has this wonderful healthcare system where any and everything you need is given to you for free but it just isn't the case. In the case of Canada (since that's the nation I visit all the time and have a dual citizenship with) the stuff that is both free and good is general preventative care and critical care. Your normal doctors visits and such are no cost and pretty timely. Also, should you get in an accident, they'll save your life and all that for no charge.
The rest? Well different story. Eyeglasses for example, are simply not covered. Canadian insurance doesn't pay for them, (at least not in BC, could vary slightly per Provence). So it is all an out of pocket thing. But, without evil insurance companies it is much cheaper right? Wrong. Way more expensive, nearly double in some cases. Mom is planning on coming to my optician next time she's down to get her glasses because it costs so much less.
So no, sorry, just hopping over to another country doesn't magically fix everything. Canada's plan is different than the US's not necessarily better. It is better in some areas, but not in others. Quality of life type things, it is generally not better at.
Depends on the model. My current aids cost £2200 for the pair.
They are very expensive for their complexity but as suggested, form is a big factor - mine need the battery changing once every few days and fit discretely inside the ear so it's not obvious that I'm wearing them.
I wish this were true. And to some extent it is true. You can get hearing aids 'free' in the UK under the NHS. But what sort of hearing aids are they? They are simple amplifiers, of the kind that were first made back in the fifties or sixties.
Now, the NHS supplies batteries on an exchange basis, also free. However, the problem with the aids is not the batteries. The problem is that the small pipes that lead from the mike to the speaker get blocked with moisture or wax or whatever.
So, you are an 80 year old lady with one of these things. You have a man around, reasonably handy, you are in luck, he is going to take a look, figure out some kind of pipe cleaner device, realise this has to be done once a month or every couple of weeks, and you will be OK. You will still have all the problems of analog amplification devices, the feedback, the background noise amplification etc. But at least it will work the way it is supposed to. Badly, but it will work.
You don't have a man around you are SOL.
As with many aspects of the NHS, what is happening is that treatment options are made available, but very restricted ones. So what the poster would do in the UK, as in the US, is buy his own. And it would cost just as much in the UK as in the US to get an equivalent digital device. Well, more, because you don't have Costco.
Now, ask yourself, how much better off am I really in the UK? Not much. You want as a US resident what the UK National Health Service supplies, you can go buy it. It will probably cost less than $20.
Its similar to proclaiming that the NHS makes consultant appointments for skin cancer checks free. Well, yes, if you are prepared to wait three months and take whoever's turn it is. You want to see someone next week, pay.
You got to compare like with like.
That appears to be an unusually high price. Prices for digital hearing aids seem to range from £495 - £1890
http://www.specsavers.co.uk/hearing/hearing-aids/clear-price/step-1/
http://www.affordablehearingaids.co.uk/products.html?gclid=CNK5w9OmuKACFSpd4wodTA_1-g