Diagnosis Destinations Articulation Disorder Insurance Articulation Disorders are not covered

Reason for Denial: "Articulation Disorders are not Covered"

If you've received an insurance denial because "articulation disorders" are not covered, the first thing to do is to review your insurance contract (also sometimes referred to as the "member handbook"). There will be a section that discusses your coverage for therapies, often referred to as "physical therapies" or under the header of "physical, occupational, and speech therapy".

If there is no explicit exclusion of coverage for "articulation disorders," appeal the denial based on the lack of specifity in the contract. An attorney from an Internet discussion group encouraged the following, with regard to apraxia of speech, which applies to other speech-language disorders, as well:

"...Review the language in your insurance policies. Break down the language and syntax of each provision of the policy, looking to see if the language is subject to a reasonable interpretation that is beneficial to you and your family. Since the insurance company is responsible for the language of the policy, any ambiguity is construed against exclusion and for coverage. The fact that the insurance company maintains there is no coverage for treatment of apraxia of speech does not make it so."

"...Excluding 'articulation disorders' was noted to be perplexing because articulation disorders refer to many types of speech impairments that otherwise would be covered under the policy, such as cleft palate related speech impairments and dysarthria. ASHA observed the 'policy language was akin to saying it provided treatment for broken bones, except for breaks of the arm or leg...'"

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Another option, If articulation disorders are excluded, is to discuss this with your child's speech therapist. Many children have multiple issues affecting their speech difficulties. If your child also has a diagnosis that falls into another category that would be covered, such as apraxia or a phonological disorder, ask the speech therapist to resubmit for therapy in order to treat the co-morbid (ie concurrently occurring) speech disorder.

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