Insurance bureaucracies slow to catch up on new AAC devices

15 Sep

For Speech-Impaired, Insurance Fights Remedy. So goes the title of a New York Times story about people trying to get around some antiquated rules on speech devices.

If you are like me, when it comes to speech (or augmentative and alternative communication) devices, the image that comes to mind is often a big, dedicated device like a dynavox.

Times have changed, even for dynavox, who has a smaller device that includes wireless web browsing.

Even more, text-to-speech and icon based programs are available for laptops and, get this, the iPhone/iPod-touch.

Imagine a device that not only helps with communication, but can be surf the web and play games and videos and music and do even more. Imagine a device that has a “cool factor”. Imagine a device that fits in your pocket.

Can you imagine it? Well, it seems insurance companies can’t.

You see, if it can do something in addition to speech, it isn’t covered. If it hasn’t been approved yet, it isn’t isn’t covered. And, let’s face it, insurance companies aren’t that fast at approving new technology.

The funny thing is, this could save them money.

“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 Services. Private insurers tend to follow the government’s lead in matters of coverage. Two years ago, iPhones and netbooks barely existed, so it may not be surprising that the industry has yet to consider their role as medical devices.

A dynavox system costs about $8,000. An system based on an iPod touch can be under $400 plus external speakers (I don’t think the speakers on the iPod touch would be loud enough if there is any background noise. But I could be wrong.)

One software product is Proloquo2Go, which works on the iPhone and iPod . I first heard about Proloquo2Go from a blog post on by Dora Raymaker.

But, remember, insurance companies aren’t paying for the iPod becuase it isn’t tested yet. That and they don’t like devices that do more than one thing. They dislike devices that do more than one task so much that they pay a lot extra ($8,000 vs. $500) and, get this, they turn off the extra features.

DynaVox, a leading maker of devices for the speech-impaired, has computers that start at $8,000 and run Windows, just like 90 percent of all PCs. To meet insurance rules, DynaVox disables the general computing tools. After the insurer pays, customers can pay $50 to DynaVox to reactivate the full functions.

This strikes me as bureaucracy getting in the way. Other devices, which would save the insurance company money, should be easy to test and get approved.

I just don’t get what the hold up is.

Thanks to a very cool reader who pointed me at this story.


This story is being picked up by a few other bloggers as well:

Disability Scoop, Insurers Balk At Modern, Low-Cost Assistive Technology

I4U, Medicare Denies Useful $150 App in Lieu of $8000 Machine, Medicare Would Rather Buy $8000 Computer than $150 iPhone App.

4 Responses to “Insurance bureaucracies slow to catch up on new AAC devices”

  1. Dawn September 15, 2009 at 14:11 #

    As an employee of the dark side of the force (and you are right, unless CMS covers something, usually other insurance companies won’t), I have a few questions, Sullivan (based on curiosity and lack of knowledge, not antagonism!) How effective are the TTS versions of these programs? I have a cousin who tried to use speech-to-text software, and found it very frustrating. Is a generic TTS program better? I know a GPS, programmed to give locations, can do that much. But I know very little about computer programs that use TTS technology. If they are very accurate (you type in the word(s) and the program speaks for you), users might be able to appeal to the insurance companies to get them covered.

    The other cost issue is this: how long do the dynavox systems work? Overall, items like a cell phone seem to have a planned obsolescence, and only last 2-4 years. If the lifetime overall cost turns out to be lower, could the dynavox be a better deal ($8000 for a lifetime vs $500 every 2-4 years).

    These are issues that many insurance companies look at. Personally, I think a cheap form would be great, if it lasts as long as a dynavox. But the cost issue is a factor.

  2. Sullivan September 15, 2009 at 16:01 #


    an iPod is not the most durable thing in the world. Neither is it the most fragile.

    If you take a look at the picture on the NY Times website, you will see that the kid has a case around his iPod. Good move, in my opinion.

    Dora Raymaker gives a good account of the iPod/Proloquo2Go solution in her blog piece. I’ve seen it and it is pretty darned good in my opinion. But, I don’t have much experience with the alternative.

    One big issue for an iPod is battery life. This is especially true for the speakers. I don’t know about battery life for a Dynavox.

  3. Dawn September 15, 2009 at 16:28 #

    thanks, Sullivan. I’ll check out Dora’s post when I get home; she’s blocked from here.

    iPods vary on life. I have one that’s currently 4 years old. The battery life is only about 4 hours. I don’t know about the iTouch and the iPhones. I would guess that like most cell phones, it would depend on how much they are used (active vs standby), volume, etc.

    I don’t know about the Dynavox either. The internet site says their battery life ranges from (depending on the item) 4-8 hours.

  4. Jean-Michel Reghem September 29, 2009 at 21:00 #

    Hello Dawn

    For a demonstration of the TTS program embed into Proloquo2Go, give a try to

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