May 25, 2004 Feature

Michigan Insurer Rules on Childhood Apraxia of Speech

A 2003 ruling by an insurance commissioner in Michigan that the diagnosis of childhood apraxia of speech (CAS) can be viewed as both developmental and neurological has facilitated reimbursement for speech-language pathology services and may have broader implications. The ruling, made on a review, stated that developmental and neurological issues are not mutually exclusive, but both may exist in relation to a diagnosis.

Neurological Aspects

In December 2002, a father in Michigan filed a request on behalf of his young son that the Commissioner of Financial and Insurance Services review the denial of benefits for speech services by Blue Cross Blue Shield of Michigan (BCBSM). 

The child had initially been diagnosed with suspected CAS and delayed expressive language skills. After a period of treatment, the speech-language pathologist subsequently confirmed the CAS diagnosis. The child demonstrated improvement through treatment and both the SLP and the child's physician stated that with further treatment the child would continue to improve.

While BCBSM admitted that speech treatment was a covered benefit under the insurance contract, they argued that the contract specifically excluded coverage for speech and language conditions that were "developmental." BCBSM claimed that the child's condition was developmental and was therefore not a covered service. BCBSM further claimed that the child was being treated for stuttering and for articulation errors, both of which they argued were developmental.

An Independent Review Organization (IRO) appointed by the insurance commissioner stated that speech disorders in children are often both developmental and organic and one does not automatically exclude the other. The IRO found that although the child's speech issues were longstanding, developmental, and possibly congenital, the impairment was also neurological, thus organic. The review body also stated that the child's apraxia of speech and stuttering may have neuropathological correlates. Finally, the IRO noted that the child's speech treatment had benefited him and that the services were effective in the remediation of disorders that were both organic and developmental in nature. The commissioner then ruled that the child's condition was not strictly developmental in nature and therefore the speech therapy was a covered service.

Analysis and Implications

The ruling may be helpful in relation to insurance reimbursement for speech services for some children. While the decision was not rendered in a court of law and thus may not be controlling, it could be relevant and could potentially influence a judiciary decision. Additionally, the case could be referenced in other appeals of denials of speech treatment coverage. According to the Michigan ruling, BCBSM had 60 days from the date of the Insurance Commissions Order to seek judicial review. The date of the order was Jan. 31, 2003. As of June 1, 2003, per telephone inquiries to the Insurance Bureau, Department of Consumer & Industry Services in Michigan, no appeal had been filed and thus it is presumed that the ruling stands.

The term "developmental apraxia of speech" is misleading in that developmental implies to insurers that children will outgrow a speech impairment. However, according to David Hammer, coordinator of speech-language services at Children's Hospital of Pittsburgh, "the word 'developmental,' when used with apraxia, signifies a childhood disorder to differentiate it from adult acquired apraxia."

Visit the Apraxia-KIDS Web site to read the ruling from the Michigan Insurance Commission. 

Sharon Gretz, is the founder and a board member of the Childhood Apraxia of Speech Association of North America (CASANA). She is also the parent of a child diagnosed with apraxia of speech and will begin a doctoral program this fall at the University of Pittsburgh's department of communication disorders and sciences.

Kathy Bauer, is an original officer and a board member of the Childhood Apraxia of Speech Association of North America (CASANA). She currently administrates the Apraxia-Kids Information Helpline, a program of The Hendrix Foundation and CASANA. Kathy is the parent of two children with apraxia of speech.

cite as: Gretz, S.  & Bauer, K. (2004, May 25). Michigan Insurer Rules on Childhood Apraxia of Speech. The ASHA Leader.

Committee Will Develop Documents on Childhood Apraxia of Speech

In 2003 ASHA formed an Ad Hoc Committee on Apraxia of Speech in Children, with a charge of examining practice related to apraxia in children and to determine and develop appropriate practice policy documents. Committee members are Lawrence Shriberg, chair; Christina Gildersleeve-Neumann; David Hammer; Rebecca McCauley; and Shelley Velleman. Celia Hooper is monitoring vice president. The committee, which will meet in May at the National Office, is completing a review of the literature related to CAS and is drafting a technical report and position paper for examination by a diverse group of reviewers. Members will explore professional issues, genetic and other neurodevelopmental frameworks, multicultural content, as well as assessment and treatment approaches. The committee hopes to have documents prepared for peer review by late fall.

What You Can Do

Clinicians seeking reimbursement for childhood apraxia of speech should:

  • Provide clear, initial information regarding apraxia of speech in children in written reports, progress notes, and informational letters to insurance companies. Be cognizant of the impact of your words-for example, use "childhood" instead of "developmental." Share information with families who are appealing denials.
  • Insurance companies are interested in both treatment outcomes and efficacy. Clinicians will need to document outcomes of their interventions carefully. For a practical overview of treatment outcomes data from one facility, read "Functional Treatment Outcomes in Young Children with Motor Speech Disorders," by Thomas Campbell in Clinical Management of Motor Speech Disorders in Children, edited by Anthony Caruso and Edythe Strand. However, stopping at outcome data will not be enough. Campbell states that, "We need to move beyond outcomes data and start documenting treatment efficacy by carefully thinking through research design and experimental control questions in order to obtain interpretable clinical data to be collected and presented in a scientific way to the insurance industry." Clinicians will need to turn to researchers for these data.
  • Stay current on the prevailing expert literature on the diagnosis and treatment of CAS and other severe speech production disorders. See the Apraxia-KIDS Web site, produced for The Childhood Apraxia of Speech Association by the Hendrix Foundation, as one source of comprehensive, current, and easily accessible information. The two nonprofit groups have just recently released the print proceedings of the 2002 Childhood Apraxia of Speech Research Symposium, which is available for order through the Web site. Although research related to apraxia is relatively sparse, the past 30 years have seen constant refinement and changes in the understanding of apraxia of speech in children and there appears to be increased interest in research and its clinical applications. 


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