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Why Insurers Won’t Pay for Speech-Disability Devices

September 15 2009 | by

Dynavox's VMax series is a speech-generating device and computer.

The New York Times has an excellent, if not disturbing, piece on insurance companies that refuse to reimburse people with speech disabilities for devices that help them speak. This isn’t a new topic: Insurers argue that many of today’s speech-generating devices, which cost upwards of $5,000, can perform other non-speech functions like Web browsing and e-mail — making it more of a “fun and games” device but not a “dedicated” piece of equipment that they normally cover for reimbursement.

This principle has led scores of people with speech disabilities, including those with autism or neuromuscular diseases, to try to find cheaper products on the mainstream market. Many have had success with Apple’s $300 iPhone 3G, which has a downloadable app called Proloqu2go that performs text-to-speech functions. Others choose to buy the specialty speech device with all the “fun and games” removed, which meets the insurers’ requirements for reimbursement.

But is it really fair? The disabled say they’d rather have an all-in-one device that lets them speak while doing computer work and web browsing. But they can’t simply walk into a Best Buy or Circuit City to get what they need, unless they pay for it out of pocket.

According to the article: “We would not cover the iPhones and netbooks with speech-generating software capabilities because they are useful in the absence of an illness or injury,” said Peter Ashkenaz, a spokesman for the federal Centers for Medicare and Medicaid Service.

Assistive technology vendors say their products are so highly customized that their costs are warranted, which is very true. These proprietary devices are sturdier than typical computers and have better speakers and links to support services. One example is Dynavox’s VMax series, which has been lauded as a top device for speech generation. It uses the powerful AT&T Natural Voices speech engine, has a proprietary word-and-phrase builder program called Boardmaker, and can be controlled by eye gaze or other methods.

But based on components alone, the cost may not be justified, according to the article. “One $5,000 DynaVox product is essentially the speech software bundled with a two-pound keyboard that has a six-inch screen. And the manufacturers mark up standard accessories by as much as 2,000 percent. Prentke Romich, for example, charges $250 for a Bluetooth wireless adapter similar to those that cost $20 in stores.”

With technology changing so rapidly, more and more companies, like Proloquo2go’s AssistiveWare, are creating cheaper, very functional and even cooler versions for devices like the iPhone. Another company, Gus Communications, creates a similar version for the BlackBerry Curve, Bold and Storm called Mobile TTS.

In the future, insurance companies will have a harder time justifying the costs of “dedicated” speech machines, especially if anyone in the world can use a $300 iPhone with speech capabilities that fits in their back pocket. And in many cases, an iPhone or BlackBerry may be all a person who cannot communicate really wants or needs; they shouldn’t be punished just because the device is so devastatingly cool.

  • Mike A.

    Such a timely article. Someone should send this to Obama.

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  • Susan Shaw

    Ironically I was at a Dynavox training class with my son’s speech therapist. She told me of Proloquo2Go. I had mentioned I wish there was “an app for that” and that is how it started. My son is 9 and the Dynavox weighs him down. He won’t use it anywhere but at school because it isn’t portable enough for him. The good Lord knows my iPhone is though. He snags that every chance he gets to play the Sesame Street Podcasts. He does this so much I was considering buying him an iTouch to get him to leave my phone alone.

    As far as insurance coverage, our copay for the new Dynavox V would cost us about $1,600. The alternative would be to spend $200 + $190 + $40 = $430 (iTouch/app/speaker case). Hmmm, cheaper and more portable versus a high dollar anchor.

    I have contacted a Resource Center to hopefully try the app out and regardless, my little one will get an iTouch for both our sakes!

  • helen holmes

    These same insurers – and Medicare and Medicaid – do not insure the deaf for the very high cost of digital hearing aids. Mine run in the area of $4500 per pair and the industry itself states that the average life span of aids is all of 4.5 years. That means that those of us who tend to have small incomes must sock away $100 or so a month to prepare for the day when our current aids fail. And of course we need a steady stream of specialty batteries that are far from in expensive.

    To this. companies like Verizon Wireless insist on charging deaf people at the high voice rates even though the deaf used to receive appropriately the lower data rates to compensate for our typing speeds being so much slower than the speed of speech.

    To be disabled (often through genetics) in America is becoming the fastest way to skid row. The technology is here or al most here and yet we who need it the most are priced out of it. And yet politician after politican refers to us as “burdens” to society – the society that won’t give us any help at all.

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