Yes in So. Calif Kaiser has 2 in network preferred AAC
manufacturers. I would think this trend would continue with other
managed care plans. If more manufacturers are willing or
able to become preferred it would help everyone. I suspect it would
be difficult for smaller manufacturers to appy.
Molly Doyle MS
CCC
CART-Rancho Los Amigos National Rehabilitation Center
Downey CA
90242
www.rancho.org/cart
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>>> Alisa Brownlee
<
xxxxxx@xxxxxxxxxx>
05/13/09 6:44 AM >>>
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