I had a recent patient with a medical diagnosis of Parkinson’s disease, who is self-insured with a commercial payer. The payer, like many of them, does not always like to pay for needed services, and in fact looks for ways to NOT pay, despite the high monthly premium from their customer.
So, when I received two requests in the same week asking for a physician’s statement of medical necessity for out-patient speech therapy, I was fit to be tied. After all, what 50 yr. old man would choose to attend speech therapy several times a week if NOT medically necessary? In addition to being medically necessary, what about speech therapy that is necessary to his work and livelihood so that he can pay for health insurance and support his family? Speech therapy that improves swallowing, reduces his aspiration risk and chance of a hospitalization?
The insurance company should not be the one deciding if your treatment is medically necessary. All providers have a responsibility to provide treatment that is medically necessary and supported by evidence based practice standards established by each discipline. So, the health care that you access and receive, must be appropriate for your condition, provided by a skilled provider, and yes, medically necessary.
Your responsibility in all of this?
Follow your healthcare provider’s recommendations, adhere to medication schedules and healthy lifestyle habits and exercise, and if you have been prescribed a home program by your therapist, complete that practice, so that, it will be evident to anyone that asks, that the services you received were medically necessary.
And now, join me in a little song…
Twelve Days of Speech Therapy: Does Insurance pay for this?
On the first day of therapy my patient said to me: will insurance pay for my speech therapy?
On the second day of therapy my patient said to me: I know I need to practice, will insurance pay for my speech therapy?
On the third day of therapy my patient said to me: I think I’ve stopped choking, I have been practicing, will insurance pay for my speech therapy?
On the fourth day of therapy my patient said to me: I’m speaking clearer, I have stopped choking, but does Medicare pay for speech therapy?
On the fifth day of therapy my patient said to me: no more thickened liquids, I have stopped choking, and I practice every day, did you get my Aetna EOB?
On the sixth day of therapy, my patient said to me: I‘m speaking clearer, no more thickened liquids, I have no more choking, every day I practice, but I worry they will not pay for speech therapy?
On the seventh day of therapy my patient said to me: I’m so grateful for speech therapy…I am speaking better, and no choking do I see, can you tell me if they paid for my speech therapy?
On the eighth day of therapy my spouse didn’t say: “REPEAT” I am feeling grateful, I am talking better, no more thickened liquids, no choking when I’m eating, can’t they see I need this? Please don’t take away my speech therapy.
On the ninth day of therapy my patient said to me: Why can’t Blue Cross understand the need?
I am one of millions who can’t talk or eat with ease that is why we need out-patient speech therapy.
On the tenth day of therapy my patient said to me: my doctor, friends and family all agree…
I am talking better, eating with less impact of disease; I am benefitting from speech therapy.
On the eleventh day of therapy my patient said to me: finally I feel free…
I am speaking clearer and no coughing when I eat, and I hope they don’t slash my speech therapy.
On the twelfth day of therapy my patient said to me: I will pray for others who have needs…
health insurance helps us in our efforts to succeed, Santa don’t let Congress ruin this, pretty please.
Happy Holidays, Peace on Earth, and Good Health in the New Year
Enjoy this jazzed up version of 12 Days of Christmas
My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice
Voice Aerobics the heART and Science of Voice Practice
of course, Patricia, you can always share or reprint any blog post, I only ask that you note the source. Maybe you can get that group of yours to start counting in unison and get the room to light up with their Hi-VOLT bracelets!
Hi, Veronica, thank you for your feedback, and first of all, let me say that Malta is on my short list of places to visit:) It sounds as if your system of payment for health care services is restrictive and potentially expensive, in particular for people with a chronic disease diagnosis. Access to affordable care is one of the reasons I created Voice Aerobics 20 years ago. Although it was created as an after therapy program, I have seen it be help people who have never undergone speech therapy as it may serve as a tool for heightening perception and some behavioral change in voice use.Community-based speech classes can also be a great avenue for ongoing speech practice benefitting mose people with speech and voice changes from neurodegenerative diseases.
I find this really interesting as the system in Malta is very different – with free national health service but many people still choose to go privately for what they feel is a better service. Private health care providers will only pay for 4 or so sessions of what is documented as a chronic condition (that’s for the persons whole life) so 4 SLT sessions, 4 physio, 4 neurologists etc. After that you pay your own way. A lot needs to be done to change the system so patients with degenerative conditions can receive the care they need where they choose to do this.
Ha Ha, Dino, yes, someone’s gotta do it!
Give them hell sis , DINO
Hi Mary, Might I be able to share this with our Parkinson Support Group of the Finger Lakes email list? You have hit the nail on the head – plus I think it’s cute and informative! Please let me know and thanks! (Also, the Hi-VOLT bracelets are very popular with our members, BUT they won’t hold still for a picture, not even my husband!) Trish Haggett, Victor, New York