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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'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).
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"
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.
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.
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