If you want help with your reimbursement advocacy efforts, look in your waiting room. The mother reading the magazine as she waits for her son to finish speech-language treatment is the benefits specialist with an engineering company. The father sitting by the window left early today from his job as vice president of marketing so he could bring his daughter for an audiological evaluation. Parents of the children you treat can offer vital assistance in improving reimbursement or in upgrading a coverage policy.
As a clinician, you have probably helped with health plan appeals for your patients. But you also can enlist their help in expanding coverage through an employer, through legislative means, or by increasing public visibility through the local media or consumer organizations. Parents may have contacts in any of these settings that in turn provide you with an access point. Justin, the father of a 3-year-old boy, recently contacted ASHA seeking information on how to persuade his insurance company to cover the costs of speech-language treatment. This parent, who is employed by a large retail chain, has already taken action to get reimbursement beyond simply filing a claim and is considering approaching his employer about a policy change.
Parents as consumers of audiology and speech-language pathology services can provide real-life and heartfelt experiences about the benefits of treatment. Parents are motivated to advocate and are often in a position with employers or legislators to provide firsthand knowledge about a specific communication disorder and the benefits of treatment. Health plans often prefer to hear from consumers of services, rather than providers, when claims are appealed. Your recognized expertise in the field complements a consumer's personal experiences, which together provide for a well-balanced advocacy campaign.
ASHA members can provide parents with supporting technical documents such as ASHA's scope of practice or treatment efficacy reports, model benefit language, coverage arguments, and contacts to related groups such as state health consumer watch groups or state speech-language-hearing associations. The brochure "Speech, Language, Audiology Services: Are You Covered?" provides consumers with information about services and how to ask for better coverage.
In addition, ASHA's focused initiative on health care reimbursement has several action plans whereby consumers can be involved. For example, ASHA will develop, implement, and publicize results of a Health Plan Report Card to identify and profile employers and health plans that have appropriate coverage for services. Do you have an employer to profile? Also, ASHA will soon have available a member "how-to" checklist on approaching members' employers about including or upgrading services. A companion "consumer" checklist also will be available. Look for both on ASHA's Web site in the coming months.
Family members can be a valuable point of contact for clinicians. They can be your link to a local or federal legislator, key union contact, or large regional employer (as a purchaser of health care). In your local community, consumers may serve as key members of hospital or health care-related boards. Parents may be employed by a health plan that will allow you access to staff who need clarification on coverage guidelines. Visibility of services at many levels is an important aspect of advocacy.