Reimbursement for Apraxia Services

Question

Answer

It is difficult to address this question specifically, because the issue tends to vary locally. There are a few insurance companies who pay for these services but they are a declining breed. The trend has been that if the condition is "developmental" (i.e., present from birth and subject to change as the child matures) insurance companies are not inclined to cover it. Recently, however, an insurance commissioner in Michigan ruled on a 2002 case that Childhood Apraxia of Speech, while developmental, might also be considered neurological, in which case it could qualify for coverage. The Michigan case might be one that could be cited in a "denial of coverage" appeal elsewhere. Click here to read the ruling itself. Also see the ASHA Leader (Vol 9, #10) for a current article on the ruling.

Title 19 (Medicaid) often pays for services for developmental apraxia but not everyone qualifies for Medicaid. Some don't know, however, that Medicaid operates on a "spend down" system, which covers expenses in inverse proportion to the family income. So some families may qualify for partial payments and not know it. One other source to check is local Sertoma Clubs. Sertoma is a service organization whose philanthropy is speech and hearing (www.Sertoma.org). Some of these clubs (not all) take applications for certain expenses on the part of individuals. They might involve transportation costs, equipment and perhaps fees under certain conditions.

Dr. Clifford L. Highnam's interest areas are normal language acquisition and language disorders. He teaches classes in children's language disorders, language transcript analysis, communication problems of special populations and children's narrative. He conducts research in school-age language disorders. His doctoral work was completed at Bowling Green State University. He is affiliated with the Department of Communicative Disorders at the University of Northern Iowa where he serves as department head.