Speech-Language Pathologist Members Of The American Speech-Language-Hearing Association Report

ASHA Poll: Inadequate Insurance Coverage Hinders the Public's Recovery From Traumatic Brain Injury

(Rockville, MD - June 19, 2007) According to most polled speech-language pathologists (SLPs) who belong to the American Speech-Language Hearing Association (ASHA) and work on rehabilitation care teams in hospitals and community health centers, inadequate health insurance coverage hinders optimal recovery from traumatic brain injury (TBI) by the patients they treat who are from the civilian U.S. population.

Surveyed last month in a poll that was commissioned by ASHA and conducted by Zogby International, the SLPs were asked what they are seeing with civilian cases of TBI, a condition where brain function has been disrupted by a blow or jolt to the head, or by a penetrating injury. Falls, car crashes, "struck by/against events," and assaults are leading causes of the injury.

SLPs are among the professionals who provide TBI patients with cognitive rehabilitation services, systematically applied medical and therapeutic care. The SLPs help restore patients' abilities with memory, orientation, speech production, language formulation, executive function, and organization.

"Our returning soldiers with TBI have been in the news lately," ASHA President Noma B. Anderson says. "They are most deserving of the attention they have received. They also deserve the best care available for their injuries." Yet, Anderson notes: "There is another story with TBI-the civilian story."

The leading cause of death and disability among children and young adults, among civilians, TBI has a much higher incidence rate than other, better-known conditions. Annually, approximately 1.4 million TBIs occur in the United States according to the CDC. By comparison, in 2003 there were about 185,000 new cases of breast cancer. Additionally, the agency reports that about 40,000 persons become infected with HIV every year.

The condition is very costly, too. In 2000, TBI related direct medical costs and indirect costs such as lost productivity totaled an estimated $60 billion in the United States.

"Sixty-five percent of our polled SLPs report that inadequate health insurance coverage hinders optimal recovery," ASHA's Anderson explains, adding that many insurance companies either provide no coverage of cognitive rehabilitation services, or they offer very limited coverage of the services. Specific problems can include plans which allow too few care visits.

"More than 40% of our polled members say that the amount of insurance coverage for TBI-related treatment has decreased. They also report a noteworthy increase in case severity, plus a 48% increase in mild TBI cases."

Anderson points out: "Mild TBI is a medical term that doesn't convey the seriousness of the condition. Those who have it can suffer devastating and long-term consequences made all the more difficult by the unavailability of adequate insurance coverage."

(A seven minute podcast with ASHA member and SLP Kathy Manning about what can be involved with recovery from mild TBI can be downloaded).

ASHA has been at the forefront of urging insurance companies to expand their coverage, collecting a significant amount of research evidence that clearly supports cognitive rehabilitation provided by speech-language pathologists. ASHA's treatment efficacy report on cognitive-communicative disorders resulting from TBI shows that patients who received early intervention services were discharged at higher levels of cognitive functioning.

Meanwhile, independent review organizations are overturning insurance company denials for the treatment. In addition, according to the Brain Injury Association of America, more than 700 published studies have discussed the benefits of the care, plus numerous scientific organizations and professional societies have adopted treatment guidelines acknowledging its value.

The poll of ASHA's SLP members focused on the cases of persons ages 18-64 with TBI. Among its findings:

• nearly one third of those polled report dissatisfaction with the level of TBI care they have been able to provide over the past five years
• a high percentage blame inadequate health insurance as limiting their ability to provide care that is consistent with recognized standards
• an equally high percentage say the lack of patient follow-through is a main barrier to treatment, in part reflecting lack of community-based supports
• nearly one-third report that as many as one half of the persons they see with TBI were denied coverage of some aspect of their services
• most of the polled say that, of those patients denied coverage; only 10% or less have successfully appealed
• nearly one third report an increase over the past five years in speech-language pathology services to adults with mild TBI
• nearly 70% report that as much as one-fourth of the patients they see with mild TBI were referred six months or more post-injury
• more than half say the delayed referrals reflect the failure of other health care providers to identify problems or refer to an SLP
• most of the polled SLPs' TBI patients are age 40 or younger and male, which is consistent with national epidemiological statistics
• nearly one-third of the SLPs polled report an increase in patients with TBI and these were predominantly in referrals of younger patients

ASHA hosted Civilian Traumatic Brain Injury: The Other Story today at the National Press Club, Washington, DC, using the occasion to release the poll results (visit www.asha.org for complete details). The event featured TBI experts and patients, including Carolyn McCormack, a former business owner from Montana who suffered TBI in a car accident.

Because of her experience, McCormack says "I lost the person I used to be." She appealed successfully after her insurance company denied her coverage for related rehabilitation services. "I decided to appeal," McCormack explains, "hoping that it would not only help me out, but also help other people" in the same situation.

ASHA's Anderson says insurance companies, the health care system, and the public all need to become far more informed and accepting about TBI so that it becomes much better known and understood, and treatment for optimal recovery becomes widely available.

Anderson adds that ASHA urges:

• the public to see a physician if they are experiencing any kind of problems following a TBI
• individuals to follow up on a TBI diagnosis by asking their physician to refer them to an SLP if they are having cognitive or communication problems that limit their recovery
• insurance companies to provide coverage of TBI related rehabilitation services that are conducive to optimal recovery
• individuals with TBI to demand that their insurance coverage includes TBI rehabilitation services that are conducive to optimal recovery
• the public to appeal if they are denied insurance coverage, noting the importance of good record-keeping and having someone who can help the injured by clearly explaining what has happened and assisting them with the appeal process
• family members and friends to become involved if they suspect a loved one is having difficulty recovering from a TBI
• the public to take precautions such as making sure young children ride in car seats, and wearing seat belts and safety helmets to protect themselves against brain injuries at work and play
• the federal government to invest more research dollars into finding out more about what works in treating TBI
• the public to visit the ASHA web site, www.asha.org for further information

ASHA is the national professional, scientific, and credentialing association for more than 127,000 speech-language pathologists and audiologists, and speech, language, and hearing scientists.

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