Bundled hearing aid pricing hides a 100-300% markup with no itemization

The dominant pricing model in hearing care is 'bundled' pricing, where a single lump sum (typically $4,000-$7,000 per pair) covers the devices, fitting, programming, follow-up visits, and warranty service with no itemized breakdown. Patients have no way to see what the hearing aids themselves cost versus the professional services. So what? The actual wholesale cost of most hearing aids is $400-$1,200 per device, meaning the markup ranges from 100% to 300%. So what? Patients cannot comparison shop on the device versus the services, so a skilled audiologist who spends 3 hours on careful fitting charges the same as one who spends 20 minutes on a default-settings fitting. So what? This removes any market incentive for quality fitting -- the audiologist who skips real-ear measurements and rushes through appointments earns the same revenue as the one who does thorough work. So what? Patients who need fewer follow-up visits subsidize those who need more, and patients who abandon their hearing aids (about 25% do) have already paid for services they'll never receive. This persists because bundled pricing benefits providers by obscuring margins and simplifying billing, and because unbundled pricing requires providers to compete on service quality, which many prefer to avoid.