Students with developmental speech issues have been  labeled with a special education condition. Now that’s going to change, and will be classified as a medical condition under a new federal mandate.

Hyde Park speech pathologist, Arnell A. Brady Jr. said this new requirement is significant to speech pathologists.

“Now insurance companies must pay us to teach children how to talk and not just to rehabilitate their talking through some disease or accident where they lost that ability,” he said.

As of Jan. 1, insurance carriers that provide health coverage under the Federal Employee Health Benefits Program will be required to cover habilitative, speech development services. Previously insurance carriers only covered rehabilitative services, if someone had the skill to speak and lost it. This policy will ensure carriers will reimburse pathologists who treat children with communication disorders, according to the American Speech-Language-Hearing Association, based in Washington D.C..

FEHBP provides health insurance coverage to approximately 8 million federal employees, retirees and their families. The U.S. Office of Personnel Management will require carriers to meet coverage requirements. Health insurance carriers who want to participate in the program must comply with the federal rule, to provide insurance when medically necessary.

This mandate is a great opportunity for speech pathologists. However, Ingrida Lusis, the director of federal and political advocacy for ASHA, said she’s concerned insurance providers would put a cap on the amount of therapy.

Lusis said carriers could make exceptions if the pathologist can prove the treatment is effective and necessary, “In the past, pediatric coverage has been limited.” She added that insurance companies erroneously labeled developmental delays or educational in nature. The result, children were left untreated until they see a school speech pathologist at age seven.

“We need to make interventions before seven,” said Brady, “The longer we wait, the worse the problem is.”  

He thinks the most important years in a child’s development, the formative years, occur between infancy and six years of age. He encourages pediatricians to seek treatment early.

Brady looks forward to the new rules because his biggest challenge in his profession has been insurance access.

Patients had to pay for services and wait for reimbursement, even with insurance. In a cash-strapped economy, speech treatment is not always a high priority.  However, this concerned speech pathologist manages to see 10 clients a day. Brady makes an individualized plan with each patient by evaluates their strengths and weaknesses. He said the best chance for success is continuous treatment and works on a “good-faith” system.

“When patients come in, we start work,” he said.