Insurance

How does Insurance work?

Talking Keyboards devices are considered “Speech Generating Device” (SGD) and can qualify for medical insurance coverage, both private and Medicare under the guidelines described below.

Many insurance companies, and
Medicare, provides 80% to 100% coverage and can reimburse you for payments made to own a Talking Keyboards product. If you have private insurance, please contact your insurance provider. They will offer guidelines to help you understand how they can reimburse you for the costs you have paid.

Generally, insurance coverage for SGD requires a doctor’s prescription. In addition, most insurance companies will ask for the “HCPCS” qualifying medical device code when filing your claim.

What type of Medical Device is a TS-04 Keyboard?

Talking Keyboards TS-04 Series is a “Speech Generating Device” .The category of device is identified as:

HCPCS / CPT Code E-2508

E2508 – SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, REQUIRING MESSAGE FORMULATION BY SPELLING AND ACCESS BY PHYSICAL CONTACT WITH THE DEVICE

Medicare CoverageAn informative links on Medicare more info and

http://aac-rerc.psu.edu/index.php/pages/show/id/5

Details:
Medicare is the nation’s largest health insurance program, giving coverage to people aged 65 years or older, disabled people receiving Social Security Disability Insurance (SSDI), and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).

Medicare refers to AAC devices as “Speech Generating Devices”, or SGDs. Medicare classifies SGDs as “durable medical equipment”, and they are available to Medicare beneficiaries when the following four (4) criteria are met:

  1. The beneficiary is enrolled in Medicare Part B
  2. The beneficiary lives in his/her family home, or an assisted living facility (but not in a hospital, skilled nursing facility, or hospice)
  3. The beneficiary is determined, following an assessment by a speech-language pathologist, to require an SGD to meet daily functional communication needs
  4. The beneficiary’s physician prescribes the SGD378347623326005

A speech generating device (E2500, E2508 – E2511, E2502 – E2506) is covered when all of the following criteria (1-7) are met:

  1. Prior to the delivery of the SGD, the patient has had a formal evaluation of their cognitive and communication abilities by a speech-language pathologist (SLP). The formal, written evaluation must include, at a minimum, the following elements:
    • Current communication impairment, including the type, severity, language skills, cognitive ability, and anticipated course of the impairment;
    • An assessment of whether the individual’s daily communication needs could be met using other natural modes of communication;
    • A description of the functional communication goals expected to be achieved and treatment options;
    • Rationale for selection of a specific device and any accessories;
    • Demonstration that the patient possesses a treatment plan that includes a training schedule for the selected device;
    • The cognitive and physical abilities to effectively use the selected device and any accessories to communicate;
    • For a subsequent upgrade to a previously issued SGD, information regarding the functional benefit to the patient of the upgrade compared to the initially provided SGD; and,
  2. The patient’s medical condition is one resulting in a severe expressive speech impairment; and,
  3. The patient’s speaking needs cannot be met using natural communication methods; and,
  4. Other forms of treatment have been considered and ruled out; and,
  5. The patient’s speech impairment will benefit from the device ordered; and,
  6. A copy of the SLP’s written evaluation and recommendation have been forwarded to the patient’s treating physician prior to ordering the device; and,
  7. The SLP performing the patient evaluation may not be an employee of or have a financial relationship with the supplier of the SGD.

If one or more of the SGD coverage criteria 1-7 is not met, the SGD will be denied as not medically necessary.

Codes E2500, E2508 – E2511, and E2502 – E2506 perform the same essential function – speech generation. Therefore, claims for more than one SGD will be denied as not medically necessary.

View the Medicare RMRP and NCD web site for more details.

Medicare requires that a speech-language pathologist (SLP) conduct, write, and sign the recommendations for specific AAC equipment and forward it to your physician for the agreement of medical necessity.

There is a particular way SLPs should conduct the evaluation. Medicare created a SGD Assessment Protocol as a guide so that speech language pathologists will conduct complete assessments and prepare written reports that address all of the points identified in the RMRP.

Medicare utilizes one of four (4) Durable Medical Equipment Regional Carrier (DMERC) to process their claims.

Note: Many health insurance providers now cover 80% of the cost of this equipment too. Check with your insurance provider and ask if they cover… “Speech Generating Devices (HCPCS Code E2510KX)”
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