The rising cost of health care benefits was cited as a top concern by 100 companies surveyed by Deloitte recently, as reported by the Enquirer's John Eckberg on Nov. 9. One CEO, however, told Eckberg that by switching insurance companies he was able to reduce his health care benefit expenses by 15 percent while maintaining the same coverage for his employees.
Employees signing up for health care coverage during open enrollment should follow this example and research all available plans to ensure that coverage is provided for the services they need.
Many insurance plans do not cover speech therapy services for children. As a pediatric speech-language pathologist, I am often the first person to inform surprised parents about this lack of coverage.
When a pediatrician refers a child for a speech and language evaluation, parents often assume that the services must be medically necessary and are therefore covered. But it is the health plan, not the doctor, that determines medical necessity, and health benefit language can be confusing.
Many insurance plans state that speech therapy is covered for acquired disorders resulting from injury, illness, or disease, requiring that the patient has had the skill and then lost it in order to be covered. This plan language does not cover developmental disorders, and it means that people at the end of life are more likely to be covered for speech therapy than those at the beginning of life - the children who need these skills in order to reach their full potential.
A disorder or condition affecting a child's speech and language will always affect his or her development. However, on Jan. 31, the Michigan Insurance Commissioner ruled that speech disorders in children are often both developmental and neurological, and that these conditions are not mutually exclusive. The commissioner required the insurance plan to reimburse payment for speech therapy. This case demonstrates that families can be successful when appealing an insurance plan's denial of benefits.
If your employer offers more than one plan, research the speech therapy benefit in all plans and switch to the best one during open enrollment.
For families that seek improved coverage, the American Speech-Language-Hearing Association (ASHA) offers an Employer Insurance Packet, which provides treatment efficacy and cost information to share with your employer. To obtain a packet, call ASHA at (800) 638-8255.
Katrina Zeit is a speech pathologist and project manager/insurance for Cincinnati Children's Hospital Medical Center.
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