Below are some quotes
and links that might help with the insurance submissions. If you receive
a denial, hang in there -- it's common. Get the insurance company's reasons
for the denial and refute the reasons one by one. Insurance companies'
representatives (like so many others) don't always know what apraxia is
and leap to make presumptions that it's something it's not.
Insurance Letter
For A Child With Apraxia Written By ASHA Posted in the Keystater (the
publication of the Pennsylvania Speech Hearing Language Association),
September, 1992.
"In July (1992)
ASHA provided consumer assistance in obtaining payment for a child's speech-language
pathology treatment that the insurer had previously denied. ASHA sent
a letter recommending payment by PA Blue Shield for speech-language pathology
services for a young child diagnosed with verbal apraxia. PA Blue Shield
denied payment stating the plan covered only illness-related speech-language
therapy, and then only to restore speech to previously attained levels.
Further it noted that 'articulation disorders are not covered'.
"ASHA responded
to the PA Blue Shield denial by describing verbal apraxia as a medical
condition consistent with the definition of illness and disease, and that
it is 'a disorder of body function'. ASHA pointed out that the requirement
that one must first possess an ability and then lose it does not allow
for the medically related needs of infants and young children. Excluding
'articulation disorders' was noted to be perplexing because articulation
disorders refer to many types of speech impairments that otherwise would
be covered under the policy, such as cleft palate related speech impairments
and dysarthria. ASHA observed the 'policy language was akin to saying
it provided treatment for broken bones, except for breaks of the arm or
leg...'"Source: ASHA, Rockville, MD"
Megan Hodge, Associate
Professor of Speech Pathology and Audiology, University of Alberta, Associate
Professor of Speech Pathology and Audiology, University of Alberta, indicates
that apraxia is neurological, whether it's inherited, genetic, or due
to injury:
"...This disability
has a neurological basis of unknown origin. It may reflect neuro-anatomical/physiological
differences that are inherited (see Hurst, Baraitser, Auger, Graham, and
Norell, 1990; Shriberg, 1993) or damage that occurs pre- or postnatally
during the period of speech development (Crary, 1984; Marquardt and Sussman,
1991)..."
Part of an insurance
appeal quote from a parent whose child has apraxia:
"It is illogical
to say that (my son) only needs to communicate for educational purposes.
(My son) is a three year old boy that can not tell anyone what his basic
needs and wants are. Asking and telling is the only way for a toddler
to communicate. What if he were to get separated from me? He can not tell
anyone his name, where he lives, or who his parents are. His verbal skills
must be developed, and not just for educational reasons, there are also
major health concerns. (My son) can not tell me when something hurts..."
For
more information:
What
Insurance Stategies are Good To Use?
What Insurance Codes Are Good To Use?
