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Quotes that May Help With Insurance Submissions For Apraxia

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…”

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  1. Pingback: Insurance Coverage Tips For Speech And Other Special Needs Therapies ยป Pursuit of Research

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