Well, apparently if you are an insurance company, you can tell subscribers anything you want!
 
Also, this puts therapists in a delicate position.  If a PALS hears that they will receive 100% in network benefit for a product and we are clinically recommending a product that they will only get 80% out of network coverage for, they will be confused if not angry at the therapist.  So what these insurance companies are asking us to do is to make SGD recommendations based purely on finances and who is in network--not what is clinically appropriate for a client
 
A

Antoinette Verdone <xxxxxx@xxxxxxxxxx> wrote:
I don?t understand how the insurance companies are getting away with this.  It is one thing to have ?in-network? vendors, but it is another thing to have in-network products!  Is this not violating some sort of insurance rules?  Can they say ? you HAVE to get a Buick, and a Toyota is never appropriate?
 
Antoinette Verdone, MSBME, ATP
Assistive Technology Specialist
The ALS Association, Greater New York Chapter
NEW ADDRESS:
42 Broadway, Suite 1724
New York, NY 10004
 
Phone: 212-720-3054
Fax: 212-619-7409
Email: xxxxxx@xxxxxxxxxx
www.als-ny.org
 
"One cannot consent to creep when one has the impulse to soar"  -- Helen Keller
From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Alisa Brownlee
Sent: Wednesday, May 13, 2009 9:45 AM
To: AT National Listserv
Subject: [Assistive Technology] another AAC funding question
 
Hi all,
 
Since we have started a dialog on funding, I wanted to ask for feedback on another problematic problem.
 
We have had several incidents on a insurance company--primarily Blue Cross, giving our SLP's a difficult time on funding specific devices.  For example, a SLP may write a report for a My Tobii system and the Blues will call us and say  for example, "ATI is not part of our network, but "X" company is and I have already checked with the family and they say it is okay to change out the device for one that is covered in our network".  This has happened at least three times to us and now yesterday, I heard from an SLP in New York that Aetna has denied coverage for an ERICA System and will only fund one in their network--another vendor of an eye gaze product.   SLP is justifiably angry since this woman has been using an ERICA for the last four years!  (it was originally covered under a different insurance, is now broken, and she needs a new one under her new insurance plan)
 
Is this happening to others?  I want to try to keep track of this issue so I appreciate any feedback.  Insurance companies are bypassing therapists and doctors and making decisions based on in-network vendors, not what is appropriate for our PALS.
 
Thanks,
Alisa
 
Alisa Brownlee, ATP
Clinical Manager, Assistive Technology Services
ALS (Lou Gehrig's Disease) Association, Greater Philadelphia Chapter
 
Assistive Technology Consultant, ALS Association, National Office

Direct Phone Number: 215-631-1877
 




Alisa Brownlee, ATP
Clinical Manager, Assistive Technology Services
ALS (Lou Gehrig's Disease) Association, Greater Philadelphia Chapter
 
Assistive Technology Consultant, ALS Association, National Office

Direct Phone Number: 215-631-1877