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

 

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