The California Department of Managed Health Care (DMHC) has reached an agreement with UnitedHealthcare (UHC) that requires the insurer to cover speech therapy services for its members. California requires health plans to arrange for and cover speech therapy whenever those services are medically necessary. A review of consumer complaints identified a pattern of denials by UHC for speech therapy services, because they were not due to a medical condition. According to the agreement between DMHC and UnitedHealthcare, the insurer will:
- provide coverage for medically necessary speech therapy services, as required by state law;
- reimburse members who paid out-of-pocket for such services in recent years;
- revise all current health plan documents to reflect the changes.
The settlement took effect on August 23 and requires UHC to notify all affected members of the change within 60 days and to notify all of its membership of the agreement in its November newsletter. Members have until July 30, 2014, to file for reimbursements. The notice will include information on how to request reimbursement for past out-of-pocket expenses for speech therapy. DMHC Director Brent Barnhart said the agreement "ensures UHC enrollees needing speech therapy will receive the care to which they are entitled under the law." In a statement, UHC said that its original policy "was appropriate," but that the agreement was reached "to resolve this old issue."
In 2012, DMHC reached a similar settlement with Kaiser Permanente Foundation Health Plan. DMHC had received complaints from more than 100 Kaiser policyholders who were denied coverage for occupational, physical, and speech therapy, because they lacked a physical or mental health condition, for example, people who may stutter or lisp or who have developmental delays. Kaiser agreed to cover medically necessary occupational, physical, and speech therapy services and to reimburse members who paid for such services out-of-pocket since January 2009.
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For more information, please e-mail Janet McCarty, ASHA's private health plans advisor, at JMcCarty@asha.org, or Laurie Alban Havens, ASHA's director of private health plans and Medicaid advocacy, at LAlbanHavens@asha.org.