If you listen to any business that sells hearing aids over the internet, you’ll hear statements such as “Stop paying huge hearing aid markups…why spend thousands of dollars on hearing aids when you don’t need to…cut out the middle man, save money and buy directly from us.”
On the surface, these claims have some validity, as they are partly true. But as you’ve probably guessed, I have issues with all three, as they are half-truths and a bit misleading. While addressing all three of these flawed assertions is important, I really want to dive into the “cut out the middleman” claims. I think if we can tackle this adequately, it will expose the distortion of the other claims, too.
The middleman assertion is of particular ire for us because, whether we like it or not, being called a middleman is a derisive term. It comes with a rather negative connotation that suggests that hearing aid providers are not worthy of the prices we’re charging or we are flat-out taking advantage of people by artificially and unjustly inflating the price of hearing aids. These are valid fears of any consumer in any industry that’s out there. I have personally felt these fears in the last 18 months when I was car shopping, HVAC shopping, and looking for dental work for my children.
The hearing care industry needs to wake up and address these real fears. Since we have not, some businesses have already taken those fears, spun their own narrative full of half-truths, and painted hearing aid providers as bad guy middlemen (ironically, these businesses are railing against middlemen but they themselves are doing nothing but providing middleman services).
Are these online hearing aid retailers correct? Are traditional hearing aid providers just grossly overpriced middlemen? Are hearing aid providers unfairly jacking up the price of hearing aids? Is my ire about the middleman label a bit misplaced? These are fair questions that deserve an honest answer because both your hearing health and your money are at stake.
Let’s dive into this a bit deeper.
Defining the Middleman
To truly answer these questions, we need to get on the same page and define what a middleman is.
In general, middlemen act as facilitators; they don’t enhance or create anything themselves but simply help to move products from one place to another. For many industries, middlemen play a crucial role by streamlining processes and providing some semblance of structure. Middlemen help connect sellers to buyers, and for their trouble they make a small commission on the transaction. This is a very reasonable set-up and there’s nothing inherently negative about a middleman.
However, a middleman’s role doesn’t necessarily justify a hefty payday. This is true in any profession and certainly in healthcare. In healthcare, you deserve a person who solves problems, creates favorable outcomes, and provides value beyond the selling of a product.
If someone is facilitating a transaction, then paying a small fee for that service is absolutely reasonable. What rubs people the wrong way, and it should, is the perception of being unfairly price gouged. When someone is trying to sell a product far above the cost for that person to acquire that product, it will undoubtedly raise suspicions. Especially if that person is only providing middleman-level services.
The True Value of a Provider
What you should expect from a true hearing aid provider is a partnership that goes beyond merely selling you a device. A real provider must also have a plan and vision for your long-term hearing success. A true provider contributes to solving your hearing challenges by leveraging their comprehensive knowledge of the auditory system and their specialized technical skills and applying these insights uniquely to each patient’s needs. A true provider listens to patient concerns, provides a patient-centered, relationship-based care model, and, most importantly, spends the necessary time with you, holding your hand if need be, to ensure the highest quality outcomes are both achieved and maintained.
A true provider accomplishes things that a product-focused, transactional-based middleman approach cannot. A true provider is worth every penny spent.
Real Providers vs. Middlemen
Now, let’s address the elephant in the room: Are hearing aid providers just middlemen or true value creators worth every penny you spent?
The answer is everyone’s favorite response: It depends. In my 15+ years in the hearing care profession, I have met both types of people. There are those who follow audiologic best practices and earn the distinction of being a true hearing care professional (a value creator), and there are those who talk the talk but only provide a middleman-level experience: they provide nothing of value beyond the selling of a product.
I have encountered both types of providers while I was practicing in Orange County and in the more than four years I’ve been practicing here in Tulare County. To be clear, this is not an Audiologist vs. licensed hearing aid retail salesclerk distinction. Don’t get me wrong: I’m proud of my title as Doctor of Audiology, and, generally speaking, I believe Audiologists will provide better care/experience/outcomes. But what I’m getting at here is not about title or credentials; it’s about an individual’s commitment to best practices and doing things the right way. Yes, more credentials might be reassuring, but it’s the individual’s attention to detail and dedication that count the most.
The real issue, and the reason that the online hearing aid retailers’ claims are half true, is that yes, some hearing aid places are charging thousands of dollars above their cost of goods for devices but are providing no more than middleman-level services. Practices doing this are, in my opinion, overcharging their patients. Unfortunately, those few bad apples are spoiling the reputation for an entire industry.
Are There Good Ones Out There?
We can break down the prescriptive hearing care industry into three categories. Two of these are perfectly legit business models, and one you need to be on the lookout for in order to avoid it:
- Middleman Approach: Product only, transactional in nature, minimal professional services, lower cost, the “pay less, get less” model. Acceptable approach.
- Best Practices Approach: Product plus gold-standard professional services, patient-centered, higher cost, the “pay more, get more” model. Acceptable approach.
- Hoodwinked Approach: Product only, higher cost, claims of providing professional services but none delivered, the “pay more, get less” approach. Unacceptable approach, the bad apples, what online retailers try to make all in-person clinics look like.
If you’re paying more than $5000 for a set of hearing aids, you should absolutely be expecting someone to provide you with real professional expertise and exceptional customer service. You should be getting the Best Practices Approach.
Here are some easy ways to identify a real hearing aid provider:
Audiologic Best Practices
If your provider adheres to best practice principles, such as a thorough analysis of your auditory system (inter-octave testing, recorded speech material, speech-in-noise testing, etc.), provides in-house ear cleaning services and aural rehabilitation, as well as performs real-ear measurements and cognitive monitoring services, then they are not a middleman. They’re delivering personalized professional services that a run-of-the-mill facilitator does not.
Proactive Preventative Maintenance Services
Prescheduled visits (don’t leave the office without the next appointment scheduled), looking around the corner for your care, anticipates patient needs.
Problem Solvers
True providers adapt when necessary. They can think on their feet and deviate from the script when needed. They understand theory and can apply theoretical concepts to any situation they enter to get results. A true provider can answer most questions without the need to turn to others for help. Consistent reliance on external assistance is a red flag.
How to Identify a Middleman
Additionally, here are some more tips to help you identify if your hearing aid provider is behaving like a middleman:
Basic Services/Generic Approach
If the testing that you’re receiving feels equivalent to an online or smartphone-quality hearing test, you’re dealing with a middleman.
If real-ear verification/speech mapping does not take place, you’re dealing with a middleman. If the person you’re working with takes the hearing aid out of the box, sets the hearing aids to the default, out-of-the box settings (manufacturer’s first fit algorithm), asks you how it sounds and then says I’ll see you in “X” number of weeks, you’re dealing with a middleman.
If their idea of teaching you how to care for and use your hearing aids is directing you to an online video, you’re dealing with a middleman.
If your provider isn’t proactively scheduling you for routine maintenance at least annually (biannually is even better), you’re dealing with a middle man.
Your hearing deserves more than the bare minimum approach mentioned here, especially if you’re paying top dollar for your hearing aids.
Lack of Innovation
Providers who apply a one-size-fits-all philosophy, have dated electronic equipment, are still using paper charts, and/or only work with one hearing aid brand are essentially following the middleman playbook.
Only fitting one hearing brand demonstrates an utter lack of intellectual curiosity. I’ve been doing this for 15 years, and I can tell you without a doubt there is not a single hearing aid brand that can meet the needs of everyone who walks through our door. It is intellectual curiosity that drives innovation. Adapting to and applying the most current research, staying on the cutting edge of technology, undergoing voluntary Board Certification, and innovating for individual needs are all indicators of a real provider.
Innovators are, by definition, not middlemen.
Fear of Advanced Techniques
If a provider is uncomfortable with or poorly skilled at tasks like taking precise ear impressions or cerumen management, you’re probably working with a middleman.
Lack of a Long-Term Plan for Your Care
A middleman’s focus and energy are on the initial transaction/sale, and their goal is completing as many sales/transactions as possible. A true provider has a long-term vision for your hearing care and works to be proactive in all aspects of their practice, and their real work happens after the hearing aid transaction.
A middleman only provides services on a reactive basis: Patients are only seen when there’s a problem. For a middleman, the ideal patient is the one you don’t see again until they’re ready to make another purchase. The exact opposite is true when you’re working with a true hearing aid provider. A real provider wants to see you on a routine schedule to ensure your hearing continues to be as optimized as possible.
Emphasis on Same-Day Hearing Aid Fittings
The only way same-day hearing aid fittings would work is if that practice had a large quantity of stock devices sitting on their shelves. Instead of understanding what is important to the patient and searching for a solution to meet their specific needs/requests, a middleman approach will take what they have on their shelf and tell the patient it’s exactly what they need (they also tell every other patient it’s what they need, too).
Essentially, middlemen deliver product-centered care (which again happens to conveniently be on their shelf), while a true provider starts with a patient and then helps them find the right hearing aid (patient-centered care). Patients who want to have their hearing fully optimized need to demand more than the corner-cutting, same-day hearing aid fitting approach.
Hearing Aid Services Only
A true provider cares about more than just selling as many hearing aids as possible. If the practice you’re investigating/working with also offers diagnostic hearing services (e.g., pre- and post-op surgical evaluations, compensation and pension evaluations for the VA, ototoxic monitoring, etc.), auditory processing disorder (APD) services, cochlear implant services, and/or vestibular services, you’ve likely found a true provider.
Again, middlemen are focused on sales only, and offering anything that’s not product sales is of no interest to them.
Fair Value for Your Healthcare
Let’s be clear: A real provider justifies their fees by creating and delivering value to patients beyond the sale of a product. A real provider is not a middleman. Paying substantial amounts for hearing aids ($5000-$8500) should equate to receiving more than what a middleman offers.
Now back to those online sellers of hearing aids. Why are their prices so low? Plain and simple, it’s because you are getting the middleman approach. Audiologic best practices are not followed, your hearing is nowhere close to being optimized, and they are not contributing anything beyond facilitating a transaction. The reality is you’re paying less because you’re getting substantially less. This isn’t necessarily a bad thing, as you are getting exactly what you’re paying for. But it’s not a true apples-to-apples comparison to receiving in-person care from a center that’s following audiologic best practices.
The Power of a True Provider
Not all hearing aid providers are created equal. Some indeed act as strategic partners in your hearing journey, while others clearly fall into the realm of middlemen. This is one of the reasons why there’s such a wide range of outcomes and prices with hearing aids. Those who successfully optimize their hearing are overwhelmingly working with a true provider (and are paying for those results), and those who tend to fail overwhelmingly worked with the middleman approach (and paid much less).
We believe strongly that real hearing aid providers earn their higher pay by providing highly specialized knowledge and services, both at the time of your fitting and for years thereafter. You’ll hear Visalia Hearing Center say repeatedly, “Premium hearing aids do not cost $7600, but premium hearing aids with a four-year, all-inclusive hearing care and optimization plan certainly do.”
Hopefully, this information will help the public understand the distinction and ensure they aren’t hoodwinked by a middleman trying to pass as a real provider (unfortunately, they’re out there). And when you see the online prices of hearing aids being much lower than in-person care, you know you’re paying less because you’re getting less.
To work with true providers who have your best interests at heart, feel free to request a callback or call our clinic at (559) 625-8960.
