(This is the second of two articles discussing the Executive Order regarding OTC hearing aids. You can find the first at OTC Hearing Aids: Who Needs Them? (Hint: Maybe You!)
by Christine Gilmore Eubanks, Clinical Audiologist
Part one of this series was a discussion of the “unintended users” of over-the-counter (OTC) hearing aids and how they should be anticipated and accounted for. But who are the appropriate users, and why might they benefit from OTC aids?
Cost is generally thought to be the factor that prevents people with hearing loss from using hearing aids. However, hearing aid use is low even in nations where aids are available for free (e.g. the U.K). So it may be that even high-quality, lower-cost aids may not be enough motivation for people to seek improvement in their hearing. Many people do not know that a trial period is mandated in most states, so they can get their money back if the aids do not provide enough benefit.
Some of the features that make hearing aids more helpful are things that increase the cost of the aids. For example: rechargeability, Bluetooth streaming directly to the aids, sophisticated noise reduction strategies, etc. Most audiologists have a range of price and technology options available. Basic aids come with fewer convenience features, but will still be programmed to make speech audible and comfortable, and verified by the audiologist. Down the line, OTC aids may fill that niche for people with milder hearing losses, and the provider will be able to recommend one that is of high quality.
Ultimately, it is up to the professional to explain the value of their services and why they are recommending a specific device. In that same vein, it is up to the consumer to evaluate the information they are receiving and ask questions if they are not satisfied with the process. And two people with the same hearing loss may have very different needs – some may be satisfied with an OTC aid, while another will not.
Professional services are frequently bundled with the cost of the aids, and “unbundling” is often cited as a way to reduce the cost of hearing aids. However, both strategies have pros and cons. Hearing aids are not like eyeglasses, which are ready to use once the optics are determined and lenses created. Amplification often needs to be introduced gradually, while the brain becomes used to sounds that have not been heard for many years. Multiple visits are needed at the time of the fitting and so are part of the fitting fees (think of the visits you may have had pre- and post-surgery). These devices are also subject to perspiration, earwax, dust in the microphones, and twisting of wires and tubing during insertion. They need maintenance that many users are not able to do easily, particularly if they have cognitive challenges, poor eyesight or limited fine-motor skills.
Even when the cost of aids is covered by insurance, hearing aid fitting and follow up are usually not separately reimbursed. If visits were separately billed in time increments, many users would stay home with limited hearing rather than come in to troubleshoot problems. Many audiologists do offer unbundled fees or “service plans” that can be purchased, but most offer unlimited visits during the warranty period for a service fee that is built into the cost of the aid. It is true that some hearing aid wearers do not return frequently, but the people that really need the services are able to get them at a reasonable cost. Most audiologists will help the user determine what services are needed to help them get the best performance out of their investment in better communication.
Insurance reforms could help with this imbalance. Medicare, by statute, does not pay for anything related to hearing aids or their care (Medicare Advantage plans are commercial secondary insurance plans that sometimes offer a discount on hearing aids.) Medicare does not pay for diagnostic testing without a physician’s referral, which often increases the burden on the patient to have to make an extra visit to get that referral. If audiologists were reimbursed for their services, then hearing aids could be sold in an unbundled model and patients would get the care they need when they need it. To that end, the Medicare Audiologist Access and Services Act (MAASA)—which calls for increased access to audiology for beneficiaries—has been introduced in the U.S. House and Senate.
Changes are coming, but in the meanwhile, how can a consumer make the best decision about better hearing?
- Get your hearing screened, by your doctor or other trusted health provider. A quick check can tell you if you need more testing by an audiologist to evaluate your hearing further.
- If you do need more than an OTC aid can provide, seek out the services of a licensed professional. If you buy aids online, you might luck out and get something appropriate, but if they need to be adjusted, you will still need expert services. You may also end up buying a device that was reported lost or stolen and cannot be repaired if needed.
- The audiologist who diagnosed your hearing loss can help you determine what your communication needs are, and how to choose hearing aids that are appropriate for your lifestyle. Be honest during your evaluation:
If you are worried about the aids being visible to others, ask the audiologist! You may be surprised at how they actually look when worn. The smallest aids may not be ideal for your hearing loss. But aids that aren’t worn aren’t helpful. There is usually a compromise that will fit your needs.
If you want to be able to manually control how things sound (volume, noise reduction, quality), tell the audiologist that, too. But if you don’t keep your phone around at all times, don’t get aids that need an app to function optimally. You may prefer buttons on the aid itself, or a separate remote control device.
On the other hand, some people want to put the hearing aids on and not have to “think about hearing”. There are aids that adjust to background noise automatically, but you will pay extra if you need to hear in lots of different listening environments. For example, if you are a realtor who needs to communicate effortlessly indoors (in empty echo-y rooms), outdoors (in the wind), and hands-free in the car.
And if you love gadgets and want to stream calls, audiobooks, or TV directly to your aids, you can get that, too! Make sure that you get answers to all your questions, so you will feel confident that you are getting what you need.
Christine Gilmore Eubanks is the Clinical Audiologist at the Longwood Speech, Hearing and Learning Center, She can be reached at eubankscg@longwood.edu
Posted: Aug 21, 2021