Exclusive Preferred Provider Arrangements
Preferred provider arrangements are agreements between insurance companies or other third party funding agents and manufacturers or suppliers of durable medical equipment (DME). AAC devices are classified as DME. The advantage of such arrangements to funding agents is that they can negotiate a lower price for providing AAC devices. The incentive to participate in these arrangements for manufacturers and suppliers is that their products will be covered and they may be given an exclusive providership. When this exclusive providership happens, AAC consumers can be hurt.
The way things work from the consumer and service provider perspective is this. A comprehensive assessment is completed. A recommendation is made for an AAC system (device, language application program, peripherals, etc.) that will result in the highest communication performance and best life experience. The request is made for funding. When preferred provider arrangements are in place, the funding agent may reply with a denial for the selected the AAC system OR replies with the intention of providing an AAC system other than the one selected in the AAC assessment.
The appropriate response from both the AAC team and the family is to advocate for the selected system. This means that the funding agent must be contacted immediately with the message that the selected system cannot be changed. This may mean following through with an appeal process. However, the funding agent can be directed to components of the comprehensive assessment report that support the selected system. The following points may be helpful:
- Point out that professionals follow a Code of Ethics and basing AAC recommendations on funding policies violates professional obligations.
- Point out the a comprehensive AAC assessment must present the full range of AAC options, that the principles of evidence-based practice were followed, and that the client/family was fully informed when making a decisions on the specific AAC system selected for funding.
- Point out features that are distinctive with the selected system.
- Point out the performance (clinical data) that was achieved during the trial of the selected system and used to determine the intervention that would most likely result in optimized communication.
- Point out the user and family preferences and satisfaction with the selected system.
- Point out that the AAC system from this preferred provided was specifically rejected give the reasons.
The experience of AAC teams and families who have challenged exclusive or preferred provider arrangements has been positive. The goal of AAC as expressed by the American Speech-Language-Hearing Association (ASHA) is to optimize communication. Anything less is not acceptable to individuals who rely on AAC and families. Anything less should not be acceptable to AAC team members holding paramount the interests of individuals who cannot speak.
Contact AAC Institute (email@example.com) if you need help with this process. If you have experience with this funding problem, please consider sharing your testimonial with us as we build evidence to stop this practice. Do not allow funding agents to override comprehensive AAC assessments and in the process reduce the communication performance and life experience of individuals who use AAC.