Heartless insurance denies needed device
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| Tue, 09-15-2009 - 1:37pm |
Sometimes people who aren't ill just don't understand. I know a few people, who are able bodied, ski, walk Disney on vacation, and love to march in bands or hike, however they need their handicapped parking. I sometimes don't understand their handicap, but fortunately their doctor and our glorious state does.
Today my failure to understand, to get it, was once again challenged. A New York Times sad story about a crippled woman who absolutely needs an iPhone as a medical device had me scratching my head. It turns out not only is the iPhone a medical device, but it MUST be covered by insurance. Failure to do so, limits the ill to only $8,000 devices.
It also turns out these poor unfortunates are often required to keep their old hardware for 5 years before a new one can be purchased under insurance. Can you imagine that, forcing someone to use a 5 year old iPhone ... how barbaric!
Yes, our health insurance companies currently don't respect the iPhone as the great medical device it really is. I'm certain that an iPhone with an unlimited calling plan will be just the trick for many millions, perhaps tens of millions, who suddenly discover this need.
I also thought our government was more enlightened, and compassionate, than the private sector. Sadly, Medicare denies this necessary equipment. People are always posting about how much better government run insurance is. Why isn't Medicare in the lead ... providing everyone with a doctors script a free iPhone?
Imagine 60 million seniors, all with handicapped parking permits, rolling around with free Medicare provided iPhones and unlimited calling plans. Wouldn't we be be proud as a nation to have such great insurance?
You know, I suddenly feel grocery shopping causes me emotional distress. It isn't just the shopping, but also the bill, the driving, the gas. Can't insurance cover this for me, to help reduce my emotional stress. I'll also need an iPhone, ohh and free internet! It is a must! I'm not certain of the basis for the medical need yet, but undoubtedly someone will enlighten me.
With needs like an iPhone, how are we going to keep costs down? If the application really helped, wouldn't an iPod do? Does she really need phone service tossed in?
Story at - http://www.nytimes.com/2009/09/15/technology/15speech.html?_r=1
SAN FRANCISCO — Kara Lynn has amyotrophic lateral sclerosis, or A.L.S., which has attacked the muscles around her mouth and throat, removing her ability to speak. A couple of years ago, she spent more than $8,000 to buy a computer, approved by Medicare, that turns typed words into speech that her family, friends and doctors can hear.
Under government insurance requirements, the maker of the PC, which ran ordinary Microsoft Windows software, had to block any nonspeech functions, like sending e-mail or browsing the Web.
Dismayed by the PC’s limitations and clunky design, Ms. Lynn turned to a $300 iPhone 3G from Apple running $150 text-to-speech software. Ms. Lynn, who is 48 and lives in Poughkeepsie, N.Y., said it worked better and let her “wear her voice” around her neck while snuggling with her 5-year-old son, Aiden, who has Down syndrome.
Medicare and private health insurers decline to cover cheap devices like iPhones and netbook PCs that can help the speech-impaired, despite their usefulness and lower cost.
Instead, public and private insurers insist that, if Ms. Lynn and others like her want insurance to pay, they must spend 10 to 20 times as much for dedicated, proprietary devices that can do far less.
The logic: Insurance is supposed to cover medical devices, and smartphones or PCs can be used for nonmedical purposes, like playing video games or Web browsing.
“We would not cover the iPhones and netbooks with speech-generating software capabilities because they are useful in the absence of an illness or injury,” said Peter Ashkenaz, a spokesman for the federal Centers for Medicare and Medicaid Services. Private insurers tend to follow the government’s lead in matters of coverage. Two years ago, iPhones and netbooks barely existed, so it may not be surprising that the industry has yet to consider their role as medical devices.
But the health care system has long had trouble keeping up with Moore’s Law, the principle that computing power rapidly increases even as costs fall sharply.
Doctors must still bring a patient into their offices instead of, say, inspecting an e-mailed photo of a rash if they want most insurers to pay for the consultation. Digitizing medical records is such a vast undertaking that the government is now spending billions of dollars to jump-start it.
In the case of A.L.S., also called Lou Gehrig’s disease, advocates spent years fighting to have any speech-specific devices covered by insurance, finally succeeding in 2001.
For the millions of Americans with A.L.S., Down syndrome, autism, strokes and other speech-impairing conditions, the insurance industry’s aversion to covering mainstream devices adds to the challenges they face. Advocates say using an everyday device to communicate can ease the stigma and fear of making the adjustment.
At the same time, current policies mean that the government and private insurers may be spending unnecessary dollars on specialty machines.
Dr. Stanley E. Harris, who helps set device coverage policies for Horizon Blue Cross Blue Shield of New Jersey, said that if enough patients requested new types of devices, the insurer would study their usefulness. “We’re looking for evidence-based data to support the effectiveness of whatever is being requested,” he said.
In the meantime, people with speech disabilities have a choice: pay for a cheaper product from their own pockets, try to borrow one from a private assistance group or spend their insurer’s money on a specialty device from a company like DynaVox Mayer-Johnson or Prentke Romich.
DynaVox, a leading maker of devices for the speech-impaired, has computers that start at $8,000 and run Windows, just like 90 percent of all PCs. To meet insurance rules, DynaVox disables the general computing tools. After the insurer pays, customers can pay $50 to DynaVox to reactivate the full functions.
The proprietary devices have some special qualities. They are sturdier than typical computers and have better speakers and links to support services.
But the prices may seem hard to justify based on components alone. One $5,000 DynaVox product is essentially the speech software bundled with a two-pound keyboard that has a six-inch screen. And the manufacturers mark up standard accessories by as much as 2,000 percent. Prentke Romich, for example, charges $250 for a Bluetooth wireless adapter similar to those that cost $20 in stores.
Jim Shea, vice president for marketing at DynaVox, says his company’s prices run high because it must do a lot of custom work and research to serve a niche that mainstream companies ignore. “We are not riding the wave of consumer electronics in terms of cost,” he said. “We’re building the devices here in Pittsburgh from scratch.”
In addition, the do-it-yourself approach isn’t for everybody, he said. “You have to be somewhat savvy, get the software and set it up,” he said.
Disease experts say companies like DynaVox and Prentke Romich make many sophisticated, helpful products. Still, advocates argue, advances in computing and easy-to use speech software have opened doors to use cheap mainstream alternatives. Indeed, the price drops have made it possible for A.L.S. assistance groups to buy dozens of netbooks, install specialized software like Proloquo2Go and lend them to clients.
Betsy Caporale, a speech language pathologist in Danville, Calif., has tested various devices and software with children who have Down syndrome and autism.
“The iPhone has been a runaway success with these kids,” she said. “It takes them about 10 minutes to learn how to use the iPhone, and there is this cool factor for them.”
Ms. Lynn, from Poughkeepsie, would like to see insurers loosen their rules to accommodate general-purpose devices and give people like her more financial flexibility. Since insurers will typically cover only one device every five years, people with degenerative conditions like A.L.S. often hold off any claims until their condition worsens, and they really need an expensive specialty product that can track their eye and head movements.
Perhaps the government could set a certain dollar limit and then let patients find the products that fit their needs, Ms. Lynn suggested. “I really would like to see Medicare do away with the dedicated-device rule and the one-device limit,” she said by e-mail.
But so far, government and private insurers are not swayed. “We look at determining the effectiveness of the technology — and not the cost — first,” Mr. Harris said.
For Ms. Lynn, the iPhone, with the special software, is cheaper, more effective and essential. “Technology has become as important to me as air, food, water,” she wrote.
Edited 9/15/2009 1:42 pm ET by postreply

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I'll tell you when pregnant women need to park close to the door...when their feet and legs (and every other part of their body) have swollen up so much that walking even short distances is darn near impossible, combined with excruciating sciatica. (speaking from experience here, if you couldn't tell already) ;-)
I'm sure you are right that some people are using the spots who have no business doing so. However, no matter how many times it is said otherwise, one cannot tell just by looking at somebody if they need it or not. In other words, it is not always OBVIOUS that somebody needs the parking placard. I'll leave that up to the person's physician to make that determination and thank goodness that I don't need one at this time.
Edited 9/17/2009 8:45 am ET by nvshannon
~I assumed the insurance company paid for an I-phone simply because the woman said she needed it for her disability.~
No, only a much more expensive ($8000) and far less practical computer was permitted under insurance.
The woman in the OP bought the iphone herself because it was a more mobile and practical form of addressing her speech disorder than what was provided via Medicare.
She can use it anywhere, including while caring for her son who has special needs, rather than only sitting at the computer.
"Medicare and private health insurers decline to cover cheap devices like iPhones and netbook PCs that can help the speech-impaired, despite their usefulness and lower cost."
"Instead, public and private insurers insist that, if Ms. Lynn and others like her want insurance to pay, they must spend 10 to 20 times as much for dedicated, proprietary devices that can do far less."
The leap for some (incl. insurance companies) is that iphones, ipods, and netbooks (all of which you can use for speech disorders for far less $ than the currently approved technology - and with much more practicality) can also be used for non-medical purposes such as games.
"The logic: Insurance is supposed to cover medical devices, and smartphones or PCs can be used for nonmedical purposes, like playing video games or Web browsing."
~he original poster posted the article, I assumed, to demonstrate how people and insurance companies abuse each other- thereby making the point that if there were government-funded healthcare the abuses would...~
The person who posted the OP is under the impression that millions of people will chose to - and be able to successfully - fake having severe speech disorders (caused by strokes, etc.) in order to get their hands on free phones.
Also, the poster had questioned why people would need to have an iphone covered rather than an ipod.
I explained that either way you need to access a website (and via that a dedicated server) in order to make the iphone and ipod text-to-speech feature work when it's you putting in the text (ie. not a talking book).
ie. If you do so via an iphone then the speech aspect of it is portable within 3G networks, whereas the speech aspect of the ipod will only work if it is connected to to the internet via wifi.
Given that she is caring for her son who has special needs, and that much of life is conducted outside of wifi access, it is a lot more practical for the woman in the OP to use the iphone rather than the $8000 computer that Medicare would cover.
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***most people I know who legitimately need the spot, avoid using it as much as possible and put off getting the placard in part because they don't want to deal w/ people confronting them.***
I know this was the case for me, until I realized I had no reason to be ashamed of having a disability. It was the people who confronted me who should be ashamed, which is why I embarrass the heck out of them when they do.
I waited to get one until my quality of life was really detrimentally effected. I would literally drive away without the food my family needed, because the parking lot was full and the prospect of the hike through the lot, the store and back through the lot, the night agony I'd go through afterwards, were overwhelming. But after hearing my 3 year old ask for cereal, again and again, and not being able to give it to her, because there was no milk or cereal, and feeling like the worlds worst mother, a friend finally convinced me to use the resources that were out there, to improve me and my families quality of life. It really HAS improved since I've reached that level of acceptance. It has improved my relationship with my partner as well, because in the past, at the end of the day, I couldn't participate in any kind of family life with him and our daughter. All I could do way lay there.
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