Carriers to Cover Communication Devices: ASHA Helps to Reverse Exclusion Policies in Northwest States Thousands of children with communication disorders in Northwestern states could benefit from the reversals of health insurance policies that excluded coverage for augmentative and alternative communication (AAC) devices and speech-generating devices (SGD). The reversals of two separate policies—which may also benefit adolescents and adults who qualify for the coverage—followed ASHA’s ... Features
Free
Features  |   November 01, 2008
Carriers to Cover Communication Devices: ASHA Helps to Reverse Exclusion Policies in Northwest States
Author Notes
  • Angela Foehl, director of private health plans advocacy, can be reached at afoehl@asha.org or 800-498-2071, ext. 5677.
    Angela Foehl, director of private health plans advocacy, can be reached at afoehl@asha.org or 800-498-2071, ext. 5677.×
Article Information
Augmentative & Alternative Communication / ASHA News & Member Stories / Features
Features   |   November 01, 2008
Carriers to Cover Communication Devices: ASHA Helps to Reverse Exclusion Policies in Northwest States
The ASHA Leader, November 2008, Vol. 13, 1-9. doi:10.1044/leader.PA.13152008.1
The ASHA Leader, November 2008, Vol. 13, 1-9. doi:10.1044/leader.PA.13152008.1
Thousands of children with communication disorders in Northwestern states could benefit from the reversals of health insurance policies that excluded coverage for augmentative and alternative communication (AAC) devices and speech-generating devices (SGD). The reversals of two separate policies—which may also benefit adolescents and adults who qualify for the coverage—followed ASHA’s strong advocacy.
The companies are Premera and The Regence Group, both Blue Cross Blue Shield carriers based in the Northwest. Neither company explicitly excluded coverage, but did so indirectly, characterizing the devices as “investigational” for relevant speech disorders. Premera excluded AAC devices and SGDs for disorders “due primarily to autism or other pervasive developmental disorders.” Regence’s language was slightly different, excluding the devices “for the treatment of autism, autism spectrum disorders, or mental retardation.”
“Investigational” or “experimental” are terms used by insurers to preclude coverage for a given treatment or device because they are not accepted practice in the field and do not meet the “medical necessity” prerequisite for coverage.
Premera Blue Cross
Premera’s coverage change for AACs or SGDs could affect nearly 9,000 children with autism spectrum disorders (ASD). Adolescent and adult subscribers who require the devices for ASD or pervasive developmental disorders also will be eligible.
Under the revised policy, SGD and AAC devices still must meet the durable medical equipment (DME) and medical-necessity criteria. Devices that are not dedicated SGDs, such as computers and personal digital assistants that perform other functions, will not meet the DME definition. AAC/SGD-enabling software is covered, but installation and technical support costs are not.
The Premera companies include Premera Blue Cross of Washington and Premera Blue Cross Blue Shield of Alaska—with more than 1.6 million subscribers in Washington, Alaska, Oregon, and Arizona—and other non-Blues subsidiary plans.
In correspondence with Premera earlier this year, ASHA documented how the use of SGD and AAC devices for autism-related speech-language impairments conforms to the national practice standard for speech-language pathologists and is not considered investigational.
In advocating that autism-related disorders receive the same treatment as other etiologies in coverage determinations for SGDs and AAC devices, ASHA emphasized documented research, such as the 2006 meta-analysis by Diane C. Millar and Janice C. Light (Journal of Speech, Language, and Hearing Research, 49, 248–64), which demonstrate communication improvements in clients with autism through the use of AAC devices.
The Regence Group
Up to 18,000 children covered by Regence could have ASD; there may be adult patients who would benefit from these devices as well.
Regence comprises several Blue Cross and/or Blue Shield Plans that serve Idaho, Oregon, Utah, and much of Washington. ASHA used documentation from the Premera advocacy package with Regence, emphasizing that Premera reversed its policy on the same basis. In response to ASHA, Regence removed the investigational status of AAC devices and SGDs effective Sept. 1.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
November 2008
Volume 13, Issue 15