Sunday, June 28, 2009

Intensive aphasia treatment and insurance

The current insurance system fails us in many ways, and those of you with aphasia may be only too aware of this failure. One of the first questions I am usually asked is, "Does your program take insurance?" and unfortunately, my answer is "No". The same insurance that decided that you, as a person living with aphasia, had become as useful and productive as you were meant to be with your current therapy certainly won't cover an intensive program. Policies will differ, but generally insurance policies have very limited coverage for outpatient speech therapy.

Additionally, while your insurance coverage can save you some money, it can also be very restrictive in the types, amounts, and frequencies of your treatment. When you come to the intensive aphasia program at The Aphasia Center at Steps Forward, we see you for 6 hours a day in various formats (group, individual, etc.) for 6 weeks. While there is a multitude of research showing the gains to be made using an intensive program versus traditional therapy schedules (2 hours a week), insurance is still far behind in its coverage of this treatment. If you can accept that we want to bring you to your next level of performance, or that we want to help you get back to your preferred activities, then you can accept that we are more knowledgable about your treatment and recovery than the insurance companies. Your insurance may tell you that you can only be seen 3 hours a week, and that during those three hours we, the provider, should only be working on certain goals in certain ways in certain places. I want to have the freedom to do what is best for you, not what the insurance company says is best for you. After all, what is more satisfying to you--being able to identify some numbers on the phone, or being able to read a phone number, dial the numbers, and talk to your relatives? Insurance says that you're fine at the first level and it's not medically necessary to continue, but are they concerned about your quality of life? I doubt it. I can tell you that my son needs plastic surgery to correct some birth defects and insurance doesn't want to cover it because it isn't medically necessary to them.
I certainly hope that the new President can lead us towards a better healthcare system in which the providers can get paid without a fight, the patient and the provider can determine what is medically necessary, more alternative treatments can be covered at a reasonable rate, and employers and employees don't have to shell out so much money only to ultimately argue about coverage and benefits. I hope that this blog has helped explain my current unwillingness to get involved with insurance reimbursement directly. As ever, I am willing to help you get reimbursed if I can.