Final Word | April 2016 Hearing Review

Last month, I received an email from a hearing aid user who I didn’t know. She mentioned that she had found my name through reading this column in Hearing Review. She noted that she has a set of CIC hearing aids that are about three years old. One recently failed and went back to the factory for repair. When she went to the professional office to pick up the repaired hearing aid, she noted that it did not sound quite right. She was told that the hearing aid was re-programmed at the factory with the same settings that she had satisfactorily used before. The patient told me that she didn’t feel the professional was facile with this particular model of hearing aid, and couldn’t determine how to program certain parameters without calling in someone for help. The patient also noted that the provider was at an inconvenient distance from her home and work. She asked me for a referral to someone who could help her.

This put me in an awkward position because I don’t want to interfere with the continuity of care that she has been receiving, but clearly the patient’s perspective is that the care is less than optimal. I checked with a professional office near her home and work that is quite familiar with this particular brand of hearing aid. I asked what their policy is on “adopting” a hearing aid patient who had been fitted elsewhere. I needed to know what they would do for the patient, and how much a visit would cost so I could prepare the patient as I made a referral.

This situation brings up issues regarding our system of bundling service charges up front for products and services with the expectation that the patient will receive follow-up services within limits in return for the bundled price. When a patient moves away, or leaves the provider, they are abandoning services that they have already paid for. The new provider will be well within their rights to charge for the follow-up services sought by the “new” patient. There is risk for both the patient and the new provider in a situation such as this.

One way to approach the situation is for the provider to simply bill for the services, but the patient may feel that they have already paid for the hearing aid, and are entitled to some level of service for care under a warranty. As a result the patient may choose to go elsewhere before learning about the quality of service that the new provider may offer. The new provider may offer an initial consultation at a reduced rate in an effort to show the patient the level of service that they are capable of providing. Standard of care would dictate that the new provider should know about the patient’s history, any recent testing, and what their needs are. There wouldn’t be time for all of that in a brief visit, but some level of triage and service could be performed yielding satisfaction for the patient, and a reasonable investment of time on the part of the provider.

In my private practice, I offered to see people for short consultations, and would perform some services to establish a relationship. I then would make recommendations on additional testing, hearing aid repairs or replacements. I probably let some people take advantage of me, but I was comfortable with the process, and gained many new and grateful patients this way. Those patients eventually paid for the service as they acquired new aids, or opted for fee-for-service visits.

In this case, I opted to see the patient for a brief consultation, took care of her concerns, explained that I do not have an office where I could see her on a regular basis, and let her know she could return to the original provider, or change to one of two providers I could recommend close to her home and work. In my mind, doing what is best for the patient is the primary concern, followed by observing standards of care, and being fair to myself with the time invested.

The Final Word? The bundled fee service model may not survive over time as disruptions come into play in the hearing care marketplace, but there are many patients who need full service care, have purchased hearing aids under the model, and may have relocated, or do not want to return to the original provider. We have options when these “orphan” patients ask for service. We may not know what they need until we spend a few minutes with them. I’d recommend taking a risk to find out what they need on the phone, email, or face to face before setting up rigid policies on fees and what needs to be done. The woman who emailed me is a professional in her 40s and buys hearing aids every three years on average. Why wouldn’t we want to talk to a patient like this and establish a mutually beneficial relationship that may last decades?

Dennis Van Vliet, AuD

Dennis Van Vliet, AuD

Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Hearing Technologies, Eden Prairie, Minn.

Correspondence can be addressed to HR or: [email protected]

Original citation for this article: Van Vliet D. The Final Word: Where Do You Refer a Disgruntled Patient, and How Do You Do It? Hearing Review. 2016;23(4):50.?