Ashlee Vance, “For Speech-Impaired, Insurance Fights Remedy”, front page of the NYT, September 15:
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.
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.
The ways of health insurance in the U.S. are often confounding. Some companies do not cover the expense of a wig following chemotherapy, on the grounds that a wig is merely “cosmetic”, but some do (at least in part), given a doctor’s prescription for an “extra-cranial prosthesis”. (Since 1998, federal law obliges insurance companies to cover prostheses or breast reconstruction following a mastectomy, but before that some companies did not cover such devices or procedures, again on the grounds that they were not medical treatments, but merely cosmetic.)
Some years ago, when my partner’s pituitary gland basically shut down and all the hormones controlled by the pituitary had to be replaced, I ended up spending lots of time over a year or so in fighting with his insurance company over the testosterone injections prescribed for him; every claim for the shots was initially denied, on the basis that some people got prescriptions for testosterone to increase muscle mass and strength, sexual performance, and energy, which are not medical uses. The company systematically disregarded the diagnosis of hypopituitarism in his records, and every month I had to wear them down.