Open Letter to Hard of Hearing Consumers and Patients

Dear Esteemed Hard of Hearing Consumer and/or Patient,

I am an audiologist and have been involved in this industry for over 30 years.?I am very supportive of consumer initiatives whose goal is to change the hearing aid delivery model and the industry.?I support and have fought for Medicare and insurance coverage of hearing aids, telehealth, value-based prescription hearing aids, over the counter hearing aids and direct to consumer prescription options. ??I desperately want all consumers to have access to accessible, affordable solutions for the treatment of hearing loss and tinnitus.

I believe that you, the hearing aid and hard of hearing consumer, have the following rights:

·?????You have the right to control your own hearing healthcare and amplification journey.?YOU are the captain and providers are merely navigators. I, as a provider, do not have the right to judge your personal healthcare decisions. My responsibility is to create a more comprehensive, evidence-based care plan for you at the lowest cost.

·?????You have the right to have access to a wide range of amplification and care delivery options, including telehealth and remote fitting, over-the-counter solutions, prescription amplification, personal sound amplification products, assistive listening devices, FM systems, and implantable devices.?These devices should have technologic and manufacturing specifications to reduce the risks of over-amplification, as well as ensure the quality and integrity of the product.?

·?????There should be clear labels on all products that explain the intended use of each class of product and provide warnings of the risks of improper use.?

·?????If you seek an evaluation from an audiologist, you should receive a copy of your diagnostic audiologic evaluation and a copy of your plan of care.?These are your rights under the Health Insurance Portability and Accountability Act (HIPAA).

·?????If you purchase hearing aids from a provider, those hearing aids should not be proprietarily locked.?In other words, those devices are yours and you should be able to go to any provider for those aids to be reprogrammed, adjusted, or modified.?At the very least, you should be informed that your devices are proprietarily locked prior to purchase.?Ask about who and where the devices can be adjusted prior to purchase.

·?????Prices should be itemized and transparent and they should reflect the costs of the device as well as the separate costs of the evaluation, treatment and follow-up services. Long-term service should be an optional purchase.?

·?????You have the right to see any provider and pay for the services they have rendered, yet not purchase a product from them. You should never be pressured to purchase.?

·?????Every hard of hearing consumer does not require premium technology.?Their communication needs may not warrant them. Providers have a responsibility to assess you and your listening and communicative situations and to find you the hearing aids that best meet your individual listening and communication needs at the most affordable price.?

·?????You have the right to have access to value-based amplification solutions that are audiologically appropriate for your type and degree of hearing loss, whether it is OTC, DTC, retail, telehealth, or provider delivered.

·?????You have the right to access any available health plan benefits from in-network providers and be informed, in writing and prior to care, of any out of network charges.

·?????Provider driven care should be readily available and accessible.?Providers should offer evening and weekend hours as well as telehealth services.

·?????Providers should consistently provide research evidence based care and treatment.?You, as the consumer, have the right to demand that level of care.?Cerumen management, speech in noise testing, inventories, cognitive screenings, electroacoustic analysis, real-ear measurement, and auditory rehabilitation should be the norm in every practice.

·?????Providers should utilize all available treatment options and delivery modalities, including telecoils, assistive listening devices, FM systems, over-the-counter products, and auditory rehabilitation.?

·?????Providers should teach you how to use and care for the devices and should teach you listening and communication strategies to maximize your satisfaction and performance.

I, personally, support these consumer rights and will advocate with you for commonsense industry regulations that minimize risk, ensure quality and safety, and allow for increased access and affordability.?

But, with rights also come responsibilities. It can be a trying time for healthcare providers (which audiologists are).?Providers need hard of hearing consumers to acknowledge and accept their roles in a successful care delivery process.?Consumer responsibilities include the following:?

·?????Audiologists are NOT sales people.?We are advance degreed healthcare providers. We respectfully request to be treated in the same manner you would treat your optometrist, your dentist, your podiatrist, your physical or occupational therapist, or your physician.

·?????Hearing aids, regardless of their cost, do not cure hearing loss. They maximize your communication and listening abilities. Your expectations of amplification should be realistic for the type and degree of hearing loss you exhibit. You have as much influence on the outcome and performance of amplification as does the provider and the devices themselves.?Become an educated advocate.

·?????There are significant differences in the providers in this industry. Consumers should educate themselves on the differences between hearing aid dispensers, audiologists and physicians, over the counter, retail, telehealth and clinic delivery, their different roles in the delivery process, and their different motivations.?

·?????The evidence suggests that patients have better satisfaction, performance and outcomes if they receive an evidence based audiologic evaluation and communication and functional needs assessment. In other words, you would, if possible, be best served to be evaluated by an audiologist prior to any purchase. These evaluation services are not always completely covered by every insurance plan and, as a result, you should not expect all services to be free.

·?????If you experience tinnitus, dizziness, drainage from your ear, earwax buildup, a sudden or rapidly changing hearing loss, a hearing loss where one ear is poorer than the other, an ear deformity, or ear pain, please seek an audiologic evaluation and medical intervention prior to any over-the-counter, telehealth, mail order or internet purchase.?Otherwise, you could be wasting your money or missing a treatable or serious medical condition.

·?????Over the counter hearing aids are NOT appropriate for every hearing loss.?They are appropriate for mild hearing losses to moderate hearing losses only.?It is difficult to know this without an initial, provider driven audiologic evaluation. You may experience insufficient gain/volume, difficulties in noise, and feedback if your hearing loss is more significant and you are wearing an OTC solution. ?This will lead to poor performance and satisfaction.?No one wants to see you waste your money on an inappropriate option.?

·?????Over the counter hearing aids are NOT appropriate for children.?Children have unique audiologic and communicative needs that require the professional intervention and engagement of an audiologist.?

·?????There are pros and cons of purchasing hearing aids over the counter (OTC) or direct to consumer (DTC).?If you purchase hearing aids OTC or DTC, please understand that audiologists cannot adjust or modify all these products. Also, it is important at you understand that providers will charge you for the care, treatment, and guidance we provide on these OTC/DTC products, even if it is to tell you that they are not appropriate. Audiologists cannot and should not provide care at no charge.?

·?????There are costs when you seek the evaluation and guidance of a provider.??Many consumers currently demand free hearing tests, communication and functional needs assessments, and hearing aid evaluations and consultation. “Free” though was never really free.?"Free" has only worked so far because of elevated bundled pricing.?The consumer who purchases products in this model actually ends up paying for the evaluations of themselves and those of every other consumer who opted to not purchase products. When hearing aids are unbundled or itemized, the consumer may need to pay for the hearing test and they will need to pay for the communication and functional needs assessment or hearing aid evaluation/consultation, even if they opt not to proceed with a purchase. Providers cannot be expected to provide their doctoral level expertise at no charge.

·?????Medicare does not cover routine hearing testing or testing for the sole purpose of fitting of modifying a hearing aid.?The provider is responsible for charging you, the consumer, for the costs of this testing. They, again, cannot provide it at no charge.

·?????The evidence indicates that consumer have better satisfaction, performance, and outcomes when they receive evidence-based care and treatment.?This includes inventories, verification, speech in noise testing, and auditory rehabilitation. Many providers, as a result, have a non-negotiable, no exceptions standard of care.?It is our right as providers to practice in a manner which we know, through research, benefits the patient.?Often, this is a level of care that is not covered by your insurer.

·?????You cannot expect for insurance to always pay for everything you want or need.?They do not always cover features, like connectivity or rechargeable batteries, that are merely for your personal comfort. The allowable rates within provider contracts with third-party payers often indicate the level of technology that we can provide. Insurance often does not cover our costs of premium technology and many payers do not allow in-network providers to allow you to pay the difference between basic and premium technology.?This is not our rule, but theirs. Payers often do not cover long-term follow-up or service. They do not often cover batteries, battery chargers, earmolds, wax filters or accessories. ?They do not typically cover rehabilitation. Remember, insurance coverage is an agreement between you and your insurer.?The provider is just executing that agreement, to the best of their ability, within the confines of their own contracts.?Sometimes, you, the patient, are just financially responsible.?This is consistent with what you might experience in dentistry and vision.

·?????If you have a Medicare Advantage plan, please know that MANY of these plans are “discount” plans where you, the patient, pay the full cost of the hearing aids and related services. These programs can and do dictate and/or limit the product offerings available through the plan. These plans also, typically, allow providers to bill you for follow-up care after the first year.?Please weigh the pros and cons of these programs prior to joining the Advantage plan and again prior to activating these “benefits”.?Sometimes hearing aids through the plan are more expensive than an unbundled solution available directly from the provider.

·?????If you want to minimize your out-of-pocket provider costs, you should personally take on as much of the daily care of the device as is possible.?You should clean your hearing aids every day.?You should keep them dry and free of hair products, perfumes, and sprays.?You should change your own batteries or put them safely into a battery charger.?You should replace your own wax guards and clean your own earmolds.?You should follow the instructions outlined by your provider.?

·?????Bluetooth connectivity is an amazing feature available with many hearing aids and certain cell phones. Sometimes it does not work. Your audiologist is not solely responsible for maintaining this connectivity.?The responsibility also EQUALLY falls on your cell phone manufacturer, cell phone carrier and YOU! There are many options available to help YOU maintain Bluetooth connectivity.

·?????Costco is typically a great option for purchasing hearing aids. Costco is an excellent retail solution. There are though better, more comprehensive options for audiologic and hearing care.?Please note that Costco does not provide comprehensive communication and functional needs assessments, remove ear wax, offer CROS/BICROS options, evaluate or treat tinnitus or auditory processing issues, evaluate for or manage cochlear implants or bone anchored devices, and does not provide auditory rehabilitation or comprehensive counseling. They dispense hearing aids. Period.

The purpose of this is letter is to improve the dialogue between audiologists and consumers. Speaking for my audiology colleagues, we want to help each of you maximize your hearing, listening and communicative abilities.?We want to be partners in your success and help YOU navigate your hearing loss journey. We are available to evaluate, educate, manage and treat. But we both have to realize and appreciate our roles in this journey and be understanding and respectful of each other and those roles. I feel as though if you are successful, I will also be successful as well but we need our relationship to be a win-win for both of us.?

Respectfully,

Kim Cavitt, AuD

Audiologist