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@xxxxxxxxx> 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