- Delaware Insurance Department
- Individual Health Plans
Private insurance is often overlooked when efforts are made to obtain AT for persons with disabilities. If one has private insurance, Medicare and Medicaid consider that insurance to be the “payor of first resort” and will not consider funding requests until an individual’s private insurance carrier has denied all or part of the claim. It is in your interest, therefore, to be knowledgeable about your private insurance coverage and rights.
There are a number of informative online publications concerning private health insurance. A good, practical two-part article on private insurance and AT was published by the National Assistive Technology Advocacy Project’s AT Advocate newsletter. The first article entitled “Will the Insurance Policy Pay for AT?” appeared in the February/March 1998 issue. The second installment of the article entitled “Is the Assistive Technology Device in Question Covered by the Policy?” was published in the April/May 1998 issue.
The Henry J. Kaiser Family Foundation published an article entitled “How Private Insurance Works: A Primer” in April 2002. This article provides more technical information regarding private insurance and AT.
The Delaware Insurance Department produces a number of guides and publications for consumers on many topics. This Department regulates insurance companies licensed in Delaware and its Consumer Services Division has programs to resolve disputes with insurance companies. Their action kit “Resolving Health Care Insurance Disputes”, an online complaint form, as well as a printable complaint form are excellent facilitators for resolving private insurance issues. The Department may assist in cases where there are slow payments or where a consumer believes a claim was unfairly denied. However, the Department’s arbitration program exempts cases where there is a dispute over “medical necessity”. The Department’s website contains a long list of their publications on health insurance.
Aetna U.S. Healthcare has begun covering speech generating devices (SGD) in a manner identical to Medicare's coverage. However, unlike Medicare, which considers SGDs as a form of DME, Aetna defines them as prosthetics. Aetna's policy requires that the member have a formal evaluation of cognitive and language abilities by an American Speech and Hearing Association (ASHA) certified speech-language pathologist (SLP). A copy of the SLP's written evaluation and recommendation must be forwarded to the patient's treating physician.
Aetna will cover SGDs even if the plan excludes "communication aids" because SGDs are considered a true prosthetic replacing speech. Voice prosthetics, including voice amplifiers, are covered under a separate benefit.