(un)Bundle of Joy

In the mid-late 1970's, the profession of Audiology went through a metamorphosis of sorts with regards to dispensing hearing aids. It was only thanks to a few brave, rebellious souls that permitted Audiologists to actually dispense hearing aids. Prior to that, hearing aid dispensers were the only ones allowed to fit hearing aids. Because of Audiology's early roots tied so closely to "speech correctionists" (now known as speech-language pathologists), the profession of Audiology has only recently started to separate itself from the field of speech pathology. Unfortunately for Audiology, it has been under the umbrella of Speech Pathology for so long, breaking free to pave the profession's own independent way has been difficult.

This has not been easy.  Because hearing aid dispensers lumped the devices (i.e. the hearing aids) and the services to fit and maintain the hearing aids together as one price many, many years ago, that trend continued when Audiologists began dispensing hearing aids. It's only been in the past decade that we've seen the trend of "unbundling"--breaking up prices completely--patients pay separately for all products and services from the hearing aids, to the tubing, office visits, earmold impressions, earmolds, etc. The benefit to the patient is that there is transparency; they see each charge and what it is for. They can save literally thousands of dollars up front as opposed to the bundled model--where everything is included but no one knows the value or price of the goods and services they are receiving. 

Several years ago, we at Coastal Audiology tried something similar. We called it Pay-as-you-Go and while we had a few early adoptees, most people were skeptical;
  •  "how will I know how many visits I'll need?",
  •  "I don't want to be "nickel and dimed" to death-I'd rather pay more and know that I won't be charged again.",
  •  "why isn't anyone else doing this?",
  •  "why are YOU doing this?".

 The list goes on and on. Because it is so different than what people have become accustomed to and heard about regarding hearing aids, they are fearful that something is wrong. Truly, nothing was wrong when we began Pay-as-You-Go. It was an effort to offer people, many who would have never been able to afford hearing aids, the chance to be fit with great hearing aids and pay for the service as they needed it, rather than up front whether they needed it or not. For some patients, a bundled plan of care was a huge savings to them. For the patients we saw each week for one issue or another, or who had to have numerous earmold remakes, tube changes, dome replacements, etc-they more than got their "money's worth" as they could come in whenever they liked and never pay anything additional.

However, for the patient that bought hearing aids under a bundled plan of care and never returned (whether due to not needing them because they were doing well,  moving away, death, etc) they paid for services they didn't need. For these individuals, an unbundled plan of care would've been a better option for them. If they moved after purchasing their devices, they would need to find a provider in the place they moved to, and that provider would most likely charge them for their professional time and talent to do what needed to be done for the patient. Essentially, the patient would pay twice for service to their hearing aid(s). 

According to several studies, hearing aid adoption rate is between 17%-25%. This basically means that of those that need hearing aids, only a quarter of them actually take the steps to purchase them. While issues such as vanity do play a role in whether someone moves forward with hearing aids once they know they need them, in my own personal office it comes down to cost time and time again. Despite the fact that hearing is healthcare, most insurance plans do not believe that it is and therefore most have little to no benefit. Which means that the patient is responsible for the majority if not all of the cost. On a daily basis, I encounter patients who assume that Medicare will cover hearing aids. They don't! For those individuals who select a Medicare supplement because they advertise a hearing aid benefit, sadly, if the plan falls under the same payment guidelines as Medicare, they won't pay either. False advertising at it's best! There are many insurance plans that have a hearing aid "discount" program such as Tru-Hearing, Amplifon Hearing, etc. but we recently made the decision to pull out of most of these plans as it hindered us from providing top-notch care to our patients because these programs limited the number of follow-up visits, limited the procedures they would cover, and many more reasons that I'll discuss in another post one day soon.

My goal has always been to serve my patients to the best of my ability. I can't do that when someone else is the puppeteer and I'm the puppet they're trying to control. They don't know my patients like I know my patients. I think decisions about care should belong to the patient and myself as the provider--NOT to an insurance company or third party who has never laid eyes on my patient and knows nothing more about my patient than what is on an insurance roster. 

So, what does all this mean for our patients? Options are coming. Over-the-counter devices, "hearables", hearing apps--they are all changing the face of hearing healthcare. The traditional model of hearing healthcare is changing and we will do our best to keep you up to speed as the information comes to us and we can figure out what it means for how we will do business. I sincerely thank you for your business. This month we are celebrating our 13th year. Hurricane Irma (and now Hurricane Maria) overshadowed and delayed our celebration but it has been an honor to serve and we look forward to many more years to come serving the residents of Pooler and beyond.



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