Diagnosis Destinations Articulation Disorder Insurance Articulation Disorders are"Developmental". "Developmental delays" are not Covered

One of the most important things to do when applying for insurance coverage of speech and language-related therapy is to ensure that the evaluator (that is, the speech-language pathologist) does not use the word "developmental" in his or her report, as in "a developmental Articulation Disorder". While the word "developmental" is a common one in speech therapy literature, for many families the use of the word has been the sole cause of denials of insurance coverage. Insurance companies' claims evaluators see the word "developmental" and think, "developmental delay." Most insurance companies and HMOs do not see it as their responsibility to pay for speech therapy if speech is developmentally delayed, which they interpret to mean "will improve with time, with or without treatment". The person who is denying claims often does not know that the phrase "developmental Articulation Disorder" is not the same as "developmental delay," nor may he or she know that the word "developmental" is used within the academic literature primarily to distinguish the condition from one that is occurring in an adult.

The insurance company might also be confusing an "articulation disorder" with a "developmental disability". The United States government's definition of "developmental disability" requires that the disability be a mental and/or physical impairment, manifest before the individual is 22 years old, will likely continue indefinitely, results in substantial functional limitations in 3 or more major life activities, and will necessitate special services and supports of either lifelong or extended duration. An articulation disorder is not a "developmental disability," though it can co-occur, in some children, with a developmental disability. Regardless of whether or not a child is developmentally disabled, in addition to having an articulation disorder, the insurance company should not deny the claim on the basis of the developmental disability, if speech therapy would otherwise be covered.

Therapists and doctors use diagnostic codes for insurance purposes. Again, the provider should not code a diagnosis for a child with an articulation disorder as "developmental delay" (code 315.9) or "developmental speech or language" (code 315.31). Codes to use are: a neurological code (codes 340 - 349) or coordination disorder (code 315.4). It is worth your while to ask the therapist or doctor (depending on if you need your physician's referral) what diagnostic code they will use in the report or referral.

If you have already received a denial of insurance because of the "developmental" confusion, you will need to provide documentation to your insurance company or HMO demonstrating that the speech difficulty is of a severity that it will not "go away" without treatment. Sometimes describing the condition as a neurological disorder seems to help. Review the Pub Med literature for appropriate quotes.

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