The Sordid Little Secret About Hearing Care Networks
“Thousands of hearing care locations for your members to access!"
That’s what nearly all hearing benefit administrators will proclaim — but is it true? The reality is, even if you have 7,000 in-network locations, members may have access to a fraction of those providers. The likely reason: The hearing benefit comes with a limited hearing aid formulary, which effectively dictates where your members can seek care.
Let’s take a closer look at why this is, what the impacts are, and what you can do about it.
Key Indicator: Hearing Health Administrator Ownership
Except for Amplifon Hearing Health Care, each of the major hearing-only administrators is owned by a hearing aid manufacturer. Specifically:
- TruHearing, Hearing Care Solutions, and HearUSA are all owned by WSA Audiology, manufacturer of Signia and Widex hearing aids.
- Birdsong is owned by Demant, which manufactures Oticon hearing aids.
- Great Hearing Benefits is owned by GN Hearing Group, which manufactures ReSound hearing aids.
Amplifon Hearing Health Care is different — we’re not owned by a manufacturer. This means we work with all the leading brands, and in fact, our parent company, Amplifon, is the largest distributor of hearing aids globally.
How This Plays Out in the Marketplace
An analogy from the optical industry helps illustrate a key challenge in hearing care. When you walk into an optical shop, you see a wide selection of stylish frames from well-known brands like Ray-Ban, Oakley, Dolce & Gabbana, and Coach. But behind the scenes, most shops offer only one or two brands of lenses—and most people don’t think to ask about them.
In the hearing space, locations operate much more like how lenses work in optical. There is no big board of brands because most providers only offer one or two brands of hearing aids. Consequently, members may experience difficulty finding a close-to-home provider who carries the hearing aids covered by their hearing benefit.
By contrast, providers in the Amplifon network, which consists of 8,800+ locations, can offer any of the products in our formulary.
A Limited Formulary: Impacts on the Member Experience
More than a decade ago, manufacturer-owned hearing benefit administrators created a solution that focused on their specific products. It served their self-interest, as it continues to do today. An administrator’s typical formulary offers less than a dozen hearing aid options (we’ve seen as few as eight), all representing the manufacturer-owned brands.
How does a limited formulary affect the member experience? Let’s say your formulary only includes two (e.g., Signia and Widex) or one (e.g. Oticon) products. Suddenly, the number of locations in your network plummets from the advertised 7,000 locations to roughly 2,000 locations because they are the only ones offering these brands.
Here’s a look at the real-life impacts on your members:
- Convenience — Members are steered to locations much farther away from their homes (an especially big deal for seniors), and they may wonder why they have to travel 30 or more miles to receive care when there’s a provider only a few miles away.
- Quality of care — Members are less likely to get a hearing aid that matches their specific needs and lifestyle; consequently, they may return the devices or simply not wear them.
- Utilization — We’ve observed a hearing benefit utilization of 1% or less among our competitors. In contrast, Amplifon can improve appropriate utilization by 2x.
Hearing aid choice is critical for both members and providers. More than 80% of hearing care providers rate it important to have a wide range or product choices for their patients, and close to 90% believe they should be able to choose whichever hearing aid best serves their patients.[1]
Regarding utilization, let me make one important point. Health plan leaders often perceive “utilization” as a dirty word because it equates to higher costs. For a hearing benefit, however, increased utilization makes sense. Because health plans often have a copay/PMPM benefit in which costs are capped, you want as much utilization as possible to maximize its value. Plus, hearing care represents a lower-cost expense than other benefits, and it can have a significant positive impact on chronic health conditions and comorbidities related to untreated hearing loss. For more information on this topic, read this article.
Hearing benefits: What members want
In a national survey commissioned by Amplifon Hearing Health Care, an independent global market research firm examined the differences between consumers' current hearing benefits and what they actually want.
The survey found that consumers prefer a wider variety of hearing aid brands and expect health insurance to cover the cost of hearing aids. However, most consumers do not currently have access to these benefits.
Provider Reimbursement Also Plays a Role
Besides product availability, another key factor driving the member experience is how network providers are reimbursed for their services.
Our competitors in the hearing care market use a “graded” reimbursement schedule, meaning providers are rewarded for upselling members to higher-priced hearing aids — even if the member doesn’t need all the “bells and whistles” of that technology level. For example, a senior who leads a mostly sedentary lifestyle probably doesn’t require a high-end product that’s designed for someone who’s much more active. But the provider is incentivized to upsell the member to maximize revenue and return on investment.
Amplifon, by comparison, is the only hearing health administrator that uses a universal reimbursement rate.[2] This means the provider receives the same reimbursement rate for services, regardless of the level/cost of hearing aid technology. We implemented this structure to put the focus on quality of care rather than maximizing ROI.
At Amplifon, we also believe that our universal reimbursement rate can help protect our health plan partners from potential regulatory issues arising from the graded model. Consider this: The state of California has launched an investigation into inappropriate provider incentives. Should this investigation lead to action, it would likely require all of our competitors to re-contract their entire provider network, inevitably causing disruption. It also would likely lead to similar actions by other states. Amplifon partners can feel protected by our proactive steps to avoid these potential issues.
Wrapping It Up: How Amplifon Stands Apart
[1] Amplifon commissioned The Marketing Audit, an independent global market research firm, to conduct surveys of consumers and hearing care providers nationwide in 2021.
[2] Based on recent inquiries with providers, we verified that Amplifon is the only major TPA in the U.S. that offer universal provider reimbursement.
[3] Based on Amplifon Hearing Health Care CAHPS data from 2019-Q2 2025.
Good hearing matters
