Ethics in the hearing aid industry
In recent years the Audiology profession has come under scrutiny surrounding its ethical behaviours regarding the sale of hearing aids. We share the concerns expressed in this debate and furthermore we have witnessed questionable behaviour right here in Canberra.
On consideration, Brindabella Hearing & Speech Centre has decided to publish this page detailing some of our experiences and observations, with the aims of informing potential hearing aid buyers, helping to prevent abuse of the Government hearing program, and promoting competitive fairness among hearing service providers.
On this page
- In the news
- Aggressive marketing tactics
- Aggressive sales tactics
- Lack of disclosure
- Unrealistic expectations
- Lack of customisation and follow up
- Recommendations for hearing aid buyers
Follow these links on investigation into financial incentives and other questionable practices in the hearing aid industry:
ABC Radio National - Have I got a hearing aid for you! (2014-11-30) [external link]
ABC 7.30 Report - Is the hearing aid industry taking patients for a ride? (2015-10-05) [external link]
ABC's The Checkout [external link] ran this story:
Cold calls: "You've got a hearing appointment!"
Anecdote: a client arrived for his appointment and our front desk had no knowledge of it in the appointment book. He had been a client for many years. On further examination, it turns out the appointment was with one of the national chains. He had not requested it - it was seemingly booked on his behalf by the service provider - and he had assumed it was us calling for his annual checkup.
Anecdote: we received a request via the Australian Government Hearing Services Portal that one of our elderly clients had decided to relocate to a competitor for reasons of convenience, and that we were to transfer the patient files to them. As we have a clinic that is very convenient indeed to this person, we requested and received permission from the Government to contact them. It turns out they knew nothing of the transfer and preferred to remain our client.
These stories are neither isolated nor unique, and often seem to involve elderly clients. We are concerned that people from older generations are often too polite to say no, which combined with a declining memory system can put them in an awkward position where they feel obliged to accept what someone on the phone is telling them.
Marketing dressed up as research
Anecdote: one of our staff members received a letter in the mail from a national hearing aid chain claiming to be conducting a research survey on hearing. Towards the end of the survey it asked whether the respondent would be interested in a free hearing test, and to provide their personal details. It seemed clear to us that the real research being conducted was whether they could sell you a hearing aid.
Anecdote: a man rang us recently on the recommendation of the Department of Veterans Affairs. His 95 year old mother had been to another hearing clinic and had been recommended $12,000 top-range hearing aids. We explained to him that we would only recommend top-range aids for people with very active lifestyles, for example those still in the work force with high hearing demands. The mother was eligible for the Australian Government Hearing Services Program [external link] and had not been informed that fully subsidised hearing aids were available to her.
Commissions generally work on a simple formula: the more expensive the item sold, the more commission that gets paid. What is disturbing is that a person's audiogram (hearing profile) often seems to be cited as the justification for many high-end hearing aid recommendations; while the hearing profile does indeed have implications for the style and power level of aid being fit, the same cannot be said for the level of technology (which tranlates into price) as this should rather reflect lifestlye and budget considerations. For example, a person with severe or profound hearing impairment will require a hearing aid with sufficient power, but such power aids are available across the full price range of hearing aids, including the Government Program 'free-to-client' range.
Many, if not most, hearing aid clinics are now owned by multinational companies that manufacture, or have subsidiaries that manufacture hearing aids. This is known in the industry as 'vertical integration'. We feel the affiliation should be clearly disclosed without a potential buyer having to specifically ask the question. Be aware that some of these clinics will even carry competing brands to provide a veneer of choice.
As of June 2016, some of the affiliations that we know of include:
- AudioClinic and Hearing Life are owned by William Demant Group, which also owns the Oticon, Sonic Innovations and Bernafon brands [all external links].
- Connect Hearing is owned by Sonova Group, which also owns the Phonak and Unitron brands [all external links].
- Bloom Hearing Specialists is owned by Widex [all external links].
- ihear is owned by Starkey [all external links].
As part of our commitment to finding the best possible solution for clients, Brindabella Hearing & Speech Centre offers all of the above brands and more. If a hearing aid is available in Australia we can fit it. We never favour one brand or model except based on experience and client suitability.
The other lack of disclosure issue we see is with commissions, incentives and sales targets. In fact, when we rang around recently and asked this specific question, knowing full well what the answer should be, we got answers that ranged from "I don't understand what you're asking" to flat-out denial of the practice. The Government Hearing Services Program contract with hearing service providers specifically stipulates that such disclosures must be made where they exist, and we encourage people to lodge a complaint with the Australian Government Hearing Services Program [external link] if you determine that such disclosure has not been made.
Hearing aids are an aid; they help hearing but they cannot fix it. No matter how expensive the technology, hearing in noisy environments will continue to be a challenge. If the person recommending a hearing aid promises too much, or is not careful to ensure that you understand the limitations of hearing aids, you might be wise to seek advice from another hearing professional.
The fitting of modern hearing aids is highly tailored to the individual; this process takes time and cannot be rushed. The new hearing aid user must recalibrate to new sounds over time and provide feedback to their Audiologist to enable fine-tuning of the built-in programs.
Sometimes physical modifications are required too, for example:
- The tube length in open fit (RITE or BTE) hearing aids must be accurately matched to the wearer's anatomy.
- Domes and receivers come in a variety of sizes to suit different ear canal shapes.
- An improperly fitting ear mould can result in whistling or feedback.
Our point here is that successful hearing rehabilitation takes time and attention on the part of both the user and the hearing professional, and is somewhat incompatible with a relentless focus on sales.
The old saying "caveat emptor" - quite literally "buyer beware" - certainly applies when shopping for hearing aids. We have put together a list of recommendations to assist potential hearing aid buyers in their journey:
- Look into your eligibility for the Australian Government Hearing Services Program [external link]. If you are a pensioner, DVA Gold Card holder, or otherwise meet the Government's criteria then you will be eligible for free services and subsidised hearing aids.
- If you qualify for the Government program, look out for whether your hearing specialist specifically mentions that there are fully subsidised (i.e. free) options available to you. They are obligated to disclose this under the Government contract, so if they do not your suspicions should be aroused.
- Understand the role of the hearing services provider - to present options and advice - and that of the buyer - to make decisions. You should never feel pressured regarding one option over another.
- Be alert for hearing professionals that recommend a certain level of technology due to your audiogram or hearing profile, rather than on lifestyle and budget considerations.
- Ask about the payment of commissions or other incentives in relation to the sale of the hearing aid at every step of the way, especially of the actual hearing specialist who may be under stricter ethical guidelines than the person answering the phone. Consider requesting this in writing.
- Ask about affiliations or preferential pricing arrangements with specific hearing aid brands or manufacturers. Consider requesting this in writing. Be alert for subtle pressure to choose one brand over another.
- Ring around and ask for quotes. Do not be fooled into thinking that you are getting the best price just because you are buying from the manufacturer; we often find they price themselves considerably higher than local independent businesses.
- Understand the terms of the trial period, and what freedom you have to upgrade, downgrade, change brands or receive a refund should you not be completely satisfied. Ensure you are aware of any non-refundable costs and time constraints.
- Look for responsiveness to wearing issues, and do not settle for ongoing annoyances or issues.
- Do not be afraid to ask a provider to honour the terms of their trial period. If warranted, consider returning the aid and trying another service provider.
Finally, if you feel like you are being pressured to make a decision, we would advise you to walk away - at least temporarily. Your hearing health is worthy of due consideration - and possibly a second opinion.