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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."
It's a guess but a solid one: competition.
Shh.
It's not complicated, hearing aids need to be very small. Neither your 1970's amp nor your netbook will fit in your ear. Making something small and reliable enough for this kind of use is difficult and expensive.
It is a medical device which means that it is subject to insane levels of litigation. Mostly you are probably paying for insurance.
Well, if you have software on your $400 laptop that can do the digital to analog / analog to digital just like you say, the solution is clear: hold one laptop up to each ear.
That's still going to be $800, but that's a lil' cheaper than the $1200 pair you were looking at.
I too have to wear one and it's ungodly expensive. My argument is the fact I need them to have a normal life and work. So if people can get glasses for fairly low price and it's a item that people need then why can't insurance companies provide coverage too? Reason for that it's very specialized market and expensive.
Don't get one of those cheapie $49.95 hearing aids from the ads as they do not provide the proper specs to the type of hearing loss you have. In fact it'll make your hearing worse. It'll be like listening to iPod all day long.
See if they can offer a payment plan.
Good luck.
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."
Why Are Digital Hearing Aids So Expensive?
What???
But this is why it's important to wear ear protection for such seemingly innocuous tasks such as mowing the lawn (or any loud task, really). So many kids back then and still these days listening to their personal music players via headphones where you can hear the music from across the street. It's just stupid and a few $ of protection today will save you $$$ in the long run.
I have relatives going deaf with age, watching TV with them is not fun. TV volumes set at a level wear I have to wear ear protection.
First, it's a medical device, not a commodity consumer item like a netbook, so its manufacturer must prove both its safety and effectiveness, with independent tests, before it can be licensed for sale by the FDA in the U.S., or the corresponding medical regulatory authority in other countries. That process is time consuming, and expensive. Those costs must be paid for, and are reflected in the price. Second, its technology requires extremely low power circuitry, and a much higher level of miniaturization, than a netbook. These factors too, naturally increase the cost of the device.
So you heard it everyone. Geekmux has issues a challenge!
First someone start a wiki to organize the project.
Someone make the hardware specs. Some A/D, D/A converters, some processing. Someone write the software. How small can an Arduino be made? Someone contact Bre Pettis about cheap fabbing of the housing body.
It doesn't have to be commercially viable. It just has to work and be easy enough to make that the local hackerspace can make them for their friends and loved ones. The threat of competition alone will drive down prices enormously. Don't worry about patents and trademarks. We aren't going to be selling these, we're going to give the plans out FREE in so many places any hacker can make one.
This is the new world Cory Doctorow has been writing about.
GO!
- For the complete works of Shakespeare: cat
Entitled attitude? This guy is trying to save money or find an alternative solution to a problem, as he can't afford the options he's seen so far. We should frikkin' elect him to public office.
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?
But how would he hear the voice of the people?!
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."
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.
There already is an iPhone/iPod app for this. It's called SoundAMP, and is $10. So for $210 you can get an iPod touch and SoundAMP, and have way more features than a normal hearing aid (unless the new ones can play music, surf the web, etc). It even has a playback feature in case you missed what someone said (presumably in the case where you can't ask them to repeat it, such as TV, or an announcement or something).
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.
Doing anything as low-power as a hearing aid needs is bloody complex and expensive. Your $400 netbook probably would't run more than a few seconds on the kind of power reserves that a hearing aid has. And your '70s amplifier, well, give me a break. Didn't you need half a power plant to power that thing? It wouldn't even turn on on a hearing aid battery.
These things contain mostly custom chips designed for a single purpose - that is delivering the computing power necessary for a hearing aid with the least power consumption possible. We're talking microwatts here. Designing such a thing costs a lot, and they're not selling in numbers as huge as netbook hardware, because, well, everyone wants a netbook, but most people sure as hell don't need or want a hearing aid if they still hear just fine.
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
Lowest taxes? Wtf? Between Federal, State, Local, and Sales tax, I pay upwards of 35-40% in taxes. And then when I don't have shit for savings when I get laid off because of all the taxes, I get barely enough in unemployment to float me for 3 months.
I see the glass as full with a FoS of 2.
The hunting type hearing devices do not as a rule amplify low range. They are all almost exclusively high range amplifiers.
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.