Dear Esteemed Hard of Hearing Consumer

Kim Cavitt, Au.D.

Dear Esteemed Hard of Hearing Consumer,

I am an audiologist and have been involved in this industry for over 30 years. I am very supportive of your initiatives to change the hearing aid delivery model and industry. I support the Medicare coverage in Build Back Better and the Over the Counter Hearing Aid Act and have fought for these initiatives. I desperately want all consumers to have access to accessible, affordable solutions for hearing loss.

I believe that you, the hearing aid 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.
• You have the right to have access to a wide range of amplification options, including telehealth and remote fitting, over-the-counter options, provider delivered 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 overamplification, 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.
• 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 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 aids that best meet your individual listening 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, retail, telehealth or provider delivered.

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 and real-ear measurement 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. Providers need hearing impaired consumers to acknowledge and accept their roles. Consumer responsibilities include the following:

• 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 completely covered by every insurance.
• 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 flat hearing losses. 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. 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). If you purchase hearing aids over the counter, please understand that audiologists cannot adjust or modify all of these products. Also, it is important that you understand that providers will charge you for the care, treatment, and guidance we provide on these OTC products, even if it is to tell you that they are not appropriate. We cannot 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 bundled pricing and provider driven care. The consumer who purchases products 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.
• 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 cover things, 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.
• 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.
• 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 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, Au.D.
Audiologist