The conventional method for offering hearing aid devices and services is in a "bundled" or "packaged" format, where fees associated with the hearing aid evaluation, selection, purchase, fitting, follow-up care, and service are billed in a single charge. However, according to ASHA's 2012 Audiology survey, a number of audiologists (ASHA, 2012a [PDF]) are adopting the practice of "unbundling" or "itemizing"-breaking out the costs of the device, accessories, and services associated with hearing aid dispensing and billing for them separately as they occur.
Factors influencing an audiologist's decision to unbundle include
- a desire to position audiology as a doctoring profession (itemization of the full range of services highlights the value of professional services over the cost of the device);
- a desire to educate medical professionals and consumers about the full scope of practice an audiologist provides and identify the best practices in hearing health care;
- consumer demand for affordability, transparency, and portability of services and concerns that hearing aid cost and current service delivery models are barriers to accessing hearing health care (Romano, 2012);
- health care reform and regulatory trends that indicate a possible shift toward requiring unbundling for reimbursement purposes (ASHA, 2013; see ASHA's public policy agenda);
- the entrance into the market of Internet-based, big box store, insurance company, and direct-to-consumer business models, creating increased cost competition;
- the opportunity to increase market share by assisting consumers who have purchased online without the benefit of audiologic services and support;
- the opportunity to remain relevant as advances in technology allow for remote testing, programming, and fitting of devices.
The entrance of insurance companies into the field of hearing health care and hearing aid delivery creates a truly unique dynamic, given that these companies have the infrastructure-including resources and access to millions of subscribers-that may enable them to negotiate lower rates on hearing aids, create direct-to-consumer delivery models, and develop networks that may not necessarily include audiologists.
Creating a fee structure that separates the cost of hearing aid(s) from the services associated with the evaluation, fitting, orientation, delivery, counseling, and long-term care and management of these devices provides audiologists the opportunity to highlight the importance of the professional services they provide, rather than the device. However, based on the local market, practice considerations, and consumer profile, unbundling may not be appropriate for every practice.