How much do hearing aids cost? Part 2 of our series

Filed Under: Costs, Patients

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How much do hearing aids cost? Part 2 of our series. Part 1 is here. Part 3, next, is a conversation about hearing aids among our experts.

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Hearing aids are expensive, and often they don’t work. They can be hard to choose and to buy, and are often not covered by insurance. And the costs are all over the map.

We thought it would be easy to answer the question: How much do hearing aids cost? But no:  it’s complicated.

I have some experience with relatives seeking good hearing aids, and I also sought advice from three terrific experts:  Brad Ingrao, an audiologist and independent consultant, and a former consultant for the Rehabilitation Engineering Research Center (RERC) on Hearing Enhancement at Gallaudet University, and a former columnist  in Hearing Loss Magazine; Richard Einhorn, a composer who had a sudden hearing loss, and who has developed a strong expertise in various forms of hearing aids; and Katherine Bouton, author of “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” and a blogger at Psychology Today writing at “What I Hear.”

All our experts agreed: anyone with hearing loss should be seen by a trained professional. There’s not a good reason to do it yourself with a big issue like this. Yes, people resist, because — people will tell you — there’s a stigma attached to hearing aids. But go anyway.  Serious issues can accompany hearing loss: isolation, depression, loss of employment and other major consequences. Also, there is scholarly work associating severity of hearing loss and severity of dementia.

–Hearing loss is a problem for many people, not just old people. There are many causes  — and many solutions, depending on the cause. About 20 percent of adults in the United States, 48 million, report some degree of hearing loss, according to the Hearing Loss Association of America; 55 percent of all people with hearing loss are under 60.

–Audiology and hearing aids are a multimillion-dollar industry annually. Hearing aids can be really expensive. We heard of solutions for $100 and solutions for $6,800. Often insurance doesn’t help, or helps only a little.

The implications of hearing loss can be profound: There is a statistical association with dementia — not a cause-and-effect relationship, but a statistical association.  “By following 639 people ages 36 to 90 for nearly 12 years, Dr. Frank R. Lin, an otolaryngologist at Johns Hopkins Medicine, and his colleagues there and at the National Institute on Aging showed a direct relationship between the participants’ degree of hearing loss and their risk of later developing dementia or Alzheimer’s disease,” Jane Brody wrote in The New York Times.

Bouton, my former colleague, has written extensively about hearing loss and hearing aids, in her recent book titled “Shouting Won’t Help” and also in her column. She wrote recently about hearing aids in a piece titled “Where Is the Steve Jobs of Hearing Loss?” and quoted extensively from Einhorn, a friend.

“The problem with hearing loss is that often it is not just a volume loss or frequency loss but also often includes frequency sensitivity loss and other distortions (look up hyperacusis and hearing loss/recruitment). These are all but intractable problems that cannot be compensated for” easily, Einhorn wrote to Bouton for her blog post.

“That said, you are also right that hearing aids are overpriced, sound crummy … The tech in hearing aids is, by my estimation, between 5 to 15 years behind what you and I know from live performance, recording studios and even home recording. And the hype the companies use to sell hearing aids is scandalous.”

Pricing is confusing: often prices are given for one hearing aid, when two will be needed. Or add-ons aren’t included. “Bundling,” the practice of including follow-up visits for fitting and adjustment, often comes into play. This is a good time to be a smart shopper, and if you’re shopping for someone older than you are who needs an advocate, it pays to do your homework and keep notes.

trained audiologist should always be in the picture or somewhere near, all our experts agreed. Are the hearing aids they sell often pricey? Maybe. But audiologists have expertise.

Ingrao explained the cost structure: “When I buy a hearing aid for a patient from Manufacturer X, I pay for the hearing aid, the marketing, the shipping, the help desk, the 800 phone number, the local, regional and national sales team, the trainers and the janitors at the factory. I have no choice but to then pass that ‘bundle’ on to the patient in the form of a high price for the ‘hearing aid’ with all the follow up (programming cleaning, troubleshooting, ‘rehabilitation’ and repairs) included or ‘at no additional cost.’

“So, I don’t think it’s a good idea to make any statements in this piece specific to any brand or provider unless you know and can reveal ALL the details.  Even then, I don’t see value in that kind of approach as the availability of that specific solution set may be limited or non-existent in a reader’s area, and may not even be around in 6 months given the current climate of mergers and acquisitions.”

For people with moderate to severe hearing loss, our experts agreed, hearing aids are important for general health. But there may be other solutions. In fact, for many people, several solutions are optimal depending on the situation.

A fairly recent aid for those with impaired hearing: T-Coil, or telecoil, t-coil (telecoil) or hearing loop technology.  The hearing loop telecoil “wraps” a room in a loop. Typically it’s  a copper wire looped around the periphery of the room that sends out electromagnetic signals  that can be received by hearing aids including a T-coil.

An assisted living/continuum of care home we know of for older folks has a policy of wrapping the entire place. A woman I know moved in  after the standard set of horrible hearing-aid experiences and is now pretty much plugged in to conversations – in person and on the phone — that were previously murky and are now audible. T-coil is also used in theaters. Apparently this has been common in Europe and elsewhere for quite some time, but is not universal here. Here’s a New York Times article with more detail.

We are told that all new hearing aids will be T-coil equipped; Wikipedia tells me that Florida and Arizona have passed legislation requiring hearing professionals to inform patients about their usefulness. People who have old hearing aids should be aware of this, and people getting new ones should also be aware.

A light, quick solution: personal sound amplification products. They don’t work for everybody, but they do work for many people, in some situations, far better than very expensive hearing aids. Einhorn said he’s used products by Sound World Solutions, Able Planet, and Etymotic, though he points out that everyone is different.

Another recent development is the availability of directional microphones for smartphones. People with hearing loss can plug in a directional mic, put earbuds in, and get clearer sound with variable volume.

There is also a range of apps in the Apple store to help use the iPhone as a tool to improve hearing. We found that Einhorn has become an expert in this: here’s an article from The New York Times about using the iPhone as an assistive device. The writer, Anne Eisenberg, interviewed Einhorn, listening to people in a noisy restaurant: “He pops on a pair of in-ear earphones and snaps a directional mike on his iPhone, which has an app to amplify and process sound.

“I put the iPhone on the table,” he said. “I point it at whoever’s talking, and I can have conversations with them. Soon we forget the iPhone is sitting there.”

A  version of the directional microphone Einhorn uses, Blue Mikey, is available for $99.99. One app he uses is soundAMP R, which is $4.99. For earphones, there is the Etymotic hf5, at $149.

“Using an iPhone is NOT A substitute for a hearing aid, but I have found it helpful in situations which are difficult for hearing aids,” he wrote.

Mr. Einhorn also is enthusiastic about he telecoil hearing loop from Contacta that he attaches to his television and boosts sound for the periphery of the room.

And then, there’s the Costco solution,  and other big-box stores, used by, among others, a friend of a friend.

He’s 46 and lives in Westchester County, north of New York City, and has had hearing loss for several years. He chose to go to a local audiologist, knowing that repeated trips for fitting and so on are the norm. He spent $3,600 for hearing aids that never really worked, despite repeated trips, over the course of 15 months.

His next stop was at a big teaching hospital in New York City, where repeated appointments and a complicated procedure left him unenthusiastic.

Then he went to Costco. He wound up buying a pair of hearing aids for $2,000, in the Kirkland brand, Costco’s own line. They are made by Siemens, he was told, and he’s been happy with them. They have rechargeable batteries, and four settings: one for regular situations, one for bar/restaurant situations, one for TV and one for the telecoil loop. He’s happy.

But, as all our experts pointed out, your results may vary. Do your homework, and don’t expect that your friend’s solution will also work for you.

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Here are some resources:

Bouton’s blog at Psychology Today

Ingrao’s online presence at Docotoblock.com

Einhorn’s piece in Hearing Loss magazine from May-June 2012, detailing his story and his solutions.

New audio devices that give new choices. The technology is changing quickly, so it makes sense to do your own market research — Einhorn and his iPhone are featured.

iPhone apps include this one: Aud-1, an open-source app, which gets good testimonials. Also here’s a list of other apps that preceded it.

Consumer Reports on hearing aids

A New York Times piece about how a repair to an old hearing aid for $100 could be much better than a whole new set.

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Next: Our experts in a conversation about hearing aids.