Winchester, Virginia Feb 19, 2020 (Issuewire.com) - There are mixed emotions regarding Obamacare, but one thing most of us can agree on is the need for reform, at a minimum. With Obamacare - or the Affordable Care Act - is the limited coverage or exclusion of coverage for pediatric therapies, such as speech therapy. Under Obamacare, there is a requirement to meet the Essential Health Benefit Benchmarks to include coverage for habilitation. Habilitation services is defined as a health care service that help a person keep, learn or improve skills and functioning for daily living. Individual states have latitude in how to define habilitation. However, each state must meet certain criteria.
Pediatric speech therapy coverage is narrow allowing insurance providers to offer limited benefits for communication disorders. If you have a stroke, chances are you will have coverage. However, if you have a childhood communication disorder whether or not it is caused by a neurological impairment, childhood apraxia/dyspraxia, or a stuttering disorder, you may not have coverage.
According to the National Institute of Health, nearly 1:12 children suffer from a communication disorder related to speech, voice, language, and/or swallowing.
Currently, an employer needs to add a speech rider to their employee insurance plans to cover speech for the majority of these cases. This is a prevalent medical condition that prohibits an equal chance for all children due to ineffective or non-existent communication skills.
The lack of communication skills places the child in danger since they cannot warn others if something is making the child feel unsafe to include physical, verbal, and sexual abuse. Or, it could be as simple as warning others of an impeding danger such as a house fire or something occurring at school. The lack of the communication many of us take for granted could cause the child to take their own life or taking the law into their own hands cause by ineffectively communicating a bully at school or elsewhere.
This can all be prevented by placing a federal mandate similar to the federal mandate for autism. A federal mandate is necessary due to the majority of American's around the country. This claim is backed by MarketWatch which ran a survey on medical care affordability showing that 1:4 Americans cannot afford medical care to include speech therapy.
My petition to provide increased access to speech therapists is a win-win for both the health insurance industry and the individual families.
Currently, the families need to fight with their insurance company by writing a letter and obtaining the necessary and required reports from the medical industry (which usually carry a cost to the family) requesting the insurance company to cover the necessary costs and typically at least one appeal. This is burdensome on the families taking valuable time away from their children and job to fight the insurance company over coverage for their child.
The insurance company can win by reducing its staff of underwriters and physicians that review these appeals. It would save the insurance industry a considerable amount of time and money that it can pass down to the employers and ultimately the families.
This will enable families to spend additional money to not only contribute towards but also boost America's economic condition.
Media Contact
Jeremy A. Angelo jeremy.a.angelo@comcast.net
