Speech-Generating Device Insurance Denial

Perhaps you or a loved one has had your doctor’s request for a speech-generating device refused by your insurance company. These devices can make a world of difference for those who are isolated by their inability to communicate, leaving them trapped inside a body they may be unable to control, without the ability to communicate with others. While your insurance company should be there when you need it, in reality, many insurers fall short of providing necessary support, particularly when that support is expensive. 

Similar to other types of corporations, insurance companies have a primary goal – a healthy bottom line and bank account. To this end, insurers too often deny treatments or procedures that are pricey. If you have received a speech-generating device denial, Attorney Scott Glovsky can help you or a loved one get what you need by making the insurance company pay what it should. Scott has been fighting for his clients for more than 20 years. He knows nearly every trick and tactic that insurers use – and how to counter those tactics. 

What Is a Speech-Generating Device? 

A speech-generating device (SGD) is a tablet-like device that allows an individual who cannot speak to communicate his or her thoughts via electronic voice generation. Speech-generating devices are highly personalized and programmed for each individual.  These devices can help create a sense of independence that results in enhanced communication and social interaction levels. One of the most common brand names of speech-generating devices is Tobii Dynavox. 

Speech-generating devices can be used in the workplace, to present at conferences, to complete college courses, or simply to communicate more effectively with others. When there is a clear gap between what a person wants to say and what they are able to say, a speech-generating device (also known as an augmentative and alternative communication (AAC) device) can enhance communication. 

When using a speech-generating device, the user must recognize an image or icon and then touch it to have the device speak the message. Speech-generating devices can be helpful for those with aphasia, which is a language disorder that affects an individual’s ability to communicate and is often the result of a stroke, head injury, or brain tumor. Aphasia affects a person’s ability to express and understand written and spoken language. 

Speech-generating devices are also commonly used for those diagnosed with autism, cerebral palsy, epilepsy, and other genetic disorders. A child with one of these diagnoses may first learn to ask for objects with a speech-generating device. For example, the child might want a cookie or juice and can touch the symbol that corresponds. 

From single-word utterances, children often progress quickly to simple sentences by using the speech-generating device. Children who use speech-generating devices often progress quickly, as they can now better communicate with loved ones and peers. 

Why Would a Speech-Generating Device Be Denied by Insurance?

Insurance claims may be denied for a variety of reasons. Some of the simpler reasons include errors in the claim or insufficient information. If this is the case, those issues can be fixed, and the claim resubmitted. A claim could also be denied because the individual did not obtain necessary prior authorization, the insurer specifically excludes the treatment, or the treatment was not obtained in-network. 

Other reasons for a claim denial have to do with the cost of a treatment, which is often stated as “not medically necessary,” “experimental,” or “investigational.” Speech-generating devices can cost anywhere from $300 to $7,000, depending on the type needed and how customized the device is. 

What Should You Do if Your Insurer Denies a Speech-Generating Device

Your doctor can be of significant assistance after receiving a speech-generating device denial from your insurer. Ask that he or she write a letter detailing why the device is necessary and how it will help you or your loved one. This letter can be independent of an official internal appeal or can be a part of an internal appeal, which essentially asks the insurer to reconsider the original denial decision. If the insurer still denies the speech-generating device, you can file an external appeal with a neutral third party. The decision made by this independent review organization is binding on the insurance company. For this reason, we suggest speaking with a highly experienced health insurance denial attorney before filing.

What Insurance Companies Are More Likely to Deny a Speech-Generating Device?

While Medicaid (called “Medi-Cal” in California) may be more likely to pay for a speech-generating device than a private insurer, especially for children, any insurer could potentially issue a speech-generating device denial. Health insurance companies define medical necessity in different ways. While some have very narrow definitions, others are more accommodating. 

Many insurance companies will only cover these devices when the device qualifies as “durable medical equipment,” meaning it will withstand repeated use (a lifespan of at least five years) and is medical in nature. Many speech-generating devices will not meet such narrow criteria. While Medicare may cover device programming and training, it may not cover the actual device. Any of the following California insurance companies could potentially issue a speech-generating device denial:

• Anthem Blue Cross
• Blue Shield
• Health Net
• Kaiser
• Cigna
• Aetna
• Medi-Cal Managed Care Plans (Anthem Blue Cross, Promise Health Plan, Health Net, Molina)

How the Law Offices of Scott Glovsky Can Help with a Speech-Generating Device Denied by Insurance 

To fight against a speech-generating device denied by insurance, you need professional assistance from an attorney like Scott Glovsky. A denial of the device can be devastating. When you are ready to give up, let Scott step in and do what he does best – fight for justice. Attorney Glovsky founded the Law Offices of Scott Glovsky in 1999 to hold major insurance companies accountable for putting profits ahead of people’s lives. As a skilled trial lawyer, Scott Glovsky makes a real difference in the lives of his clients, changing the system so others do not suffer similar fates. Contact the Law Offices of Scott Glovsky today for the justice you deserve.