People with voice disorders often have a hard time getting their health insurers to pay for treatment. Although private health plans increasingly cover voice treatment for vocal nodules, they often exclude other voice treatments. One major insurer, for example, excludes voice treatment if there is “no evidence of anatomic abnormality."

Clinicians often help clients appeal coverage denials. ASHA has developed advocacy letters that clinicians can use in advocating for coverage of treatment for two conditions: paradoxical vocal fold motion disorder, and muscle tension or functional dysphonia.

Crafted with Special Interest Group 3, Voice and Voice Disorders, these payment advocacy letters define the disorders and present supporting evidence that voice treatment is effective. The letters may be especially valuable at the external claims review level, when reviewers from outside the health plan review whether or not coverage is appropriate.

Paradoxical vocal fold motion disorder is inappropriate movement of the vocal cords, which close when they should open. The PVFM letter states that because the condition causes a wheezing sound in the larynx, it is often misdiagnosed and mismanaged as asthma, allergies or severe upper airway obstruction. One study of patients diagnosed with asthma found that up to 10 percent had PVFM alone, and an additional 30 percent both PVFM and asthma. Speech-language treatment, the letter notes, is the cornerstone of treatment for PVFM, which typically requires behavioral intervention by a trained speech-language pathologist who teaches patients how to maintain an adequately open airway during respiration. The letter references a number of studies that support speech-language treatment for PVFM.

The second letter addresses voice treatment for patients with muscle tension dysphonia or functional dysphonia. The letter indicates that voice treatment is effective for MTD, and that patients with untreated voice disorders experience fatigue, discomfort, poor voice quality and impaired communication ability. People with these symptoms often visit multiple physicians seeking accurate diagnosis and treatment—costing the insurance companies—only to be placed on ineffective and expensive medications.

In reference to functional dysphonia, the letter cites a 2009 Cochrane Report that states: “Because functional dysphonia is a non-organic voice disorder there is no indication for surgical or medical interventions, and it is treated with behavioral (i.e., voice) therapy … A combination of direct and indirect voice therapy is effective in improving vocal functioning when compared to no intervention. The achieved results may still be apparent after a year."

To receive these two voice advocacy letters, contact Janet McCarty at jmccarty@asha.org.