Insurance Won't Cover Smartphones, When Pricey Alternatives Exist

consonant writes "The NY Times has an article on insurers refusing to cover cheaper devices such as iPhones and netbooks which may be used by the speech-impaired, and instead requires them to acquire devices that cost from 10 to 20 times as much. The reason? 'Insurance is supposed to cover medical devices, and smartphones or PCs can be used for nonmedical purposes, like playing video games or Web browsing.' From the article: 'For the millions of Americans with A.L.S., Down syndrome, autism, strokes and other speech-impairing conditions, the insurance industry's aversion to covering mainstream devices adds to the challenges they face. Advocates say using an everyday device to communicate can ease the stigma and fear of making the adjustment. At the same time, current policies mean that the government and private insurers may be spending unnecessary dollars on specialty machines.'"

Comments

Fraud-bait... tort-bait

[EmagGeek]

It'll be amazing how many people suddenly come down with "disabilities" once insurance companies start paying for fancy PDAs and SmartPhones...

Also, once a PDA or SmartPhone is declared a "medical device," it will be subject to the same approvals and liabilities as medical devices, and will therefore cost 10 to 20 times as much as they do today...

Re:Fraud-bait... tort-bait

[Lord Lode]

Indeed... And why would these devices have to be insured if they're cheap anyway?

Re:Fraud-bait... tort-bait

[corbettw]

Guess the Republican mods are out in force because this is utter rubbish.

Seriously? Have you never known someone who got a handicap placard from an agreeable doctor, even though they didn't need one? Or what about the ease of getting a prescription for marijuana in California? There are clinics in LA where you just have to tell the doc you have "occasional headaches" and they'll write a script for pot. Are you trying to claim there won't be ANY doctors who would write a script for an iPhone for some reason or other?

Re:Fraud-bait... tort-bait

[99BottlesOfBeerInMyF]

You can tell I grew up in a country with universal healthcare.

No, but I can tell that you threw in a useless addendum to an otherwise insightful post.

It's not exactly useless. In truth the procurement of items for medical treatment in countries with socialized healthcare is often quite different. Not always, mind you, but often. Without a financial motivation for whether or not patient obtains a device to help them, most people tend to be both compassionate and pragmatic. That is to say, rarely would a person be denied a cane as a medical expense because it is cheap and someone needs help walking. Rarely would someone be granted a power exoskeleton because it is expensive and excessive.

With a profit motive in the US healthcare system insurance companies make more money erecting artificial barriers that prevent people from getting any assistive device. They're in a position to impose arbitrary rules to make providing such devices harder so their issuance is rarer. At the same time medical suppliers an make money by specializing in jumping through the hoops and getting certified products which make them artificially scarce allowing said companies to charge a lot of money. Even with the few expensive payouts, the insurance companies save money so they keep the policies.

Of course you see what is missing from the above scenario. That is the compassion and the pragmatism. A normal person working in healthcare would say, "an iPhone with apps for the blind, yeah that makes sense to help a blind person and is a lot cheaper than a specialty device". Then they approve it. It is the system standing in the way, a system motivated by rules designed to maximize profits. This type of rule is a great deal rarer in socialized medicine

This isn't to say that other healthcare systems are better in this way, just different. Profit is not the only motive that can result in arbitrary rules detrimental to individuals who need healthcare. Government bureaucrats can be just as bad implementing rules to punish groups at the expense of the masses or implement policies to mollify their special interest group in order to get re-elected. For example, rules to make abortion practically unavailable in order to appease a religious lobby or rules to refuse healthcare to overeating overweight people who are actually saving society money overall by their condition, but who much of society wants to punish for their sin.

Re:Fraud-bait... tort-bait

[mrisaacs]

Actually the ideal would be to cover the purchase of the device and the software, but not additional services - there would be no need to pay for internet or cell access- although you could probably make a case for services in the case of some conditions.

The issue is that the accounting rules require that the funds be used for a device for medical purposes only, so a multipurpose devices is deemed to include items that can't be paid for with those funds.

The "specialized" devices in many cases are consumer gear whose general purpose software (OS) has been crippled and a specific app loaded. A netbook, iPhone or PDA with the same app would do the job just as well (possibly better), but includes non-medical apps and features.

The insurance companies/medicare/medicaid think they're paying for additional functionality (even though the consumer product is usually much cheaper) and will force a client to buy the more expensive, more limited item.

It is one of the more stupid aspects of a law that was originally designed to limit waste, by making sure that only the features needed by a patient would be present on the device. There are numerous other laws and regulations on the books that work the same way and have the same effect. The rules have not kept up with technology and now work to the opposite of their intent.

Re:Fraud-bait... tort-bait

[maxume]

I wouldn't be terribly astonished to see an insurance company going through the hoops to get something like an iPhone approved as a medical device, if they actually thought it would save them money (that second part is the kicker though).

Re:Fraud-bait... tort-bait

[sjames]

You can tell I grew up in a country with universal healthcare.

No, but I can tell that you threw in a useless addendum to an otherwise insightful post.

Actually, no. When it comes to avoiding actually providing services, nothing is as Kafkaesque as a for-profit corporation. Not even silly government rules can rise to that level.

Re:Fraud-bait... tort-bait

[drinkypoo]

Their goal isn't serving the disabled, it's making maximum profits. They get a bigger piece of the claim that buys a two thousand dollar machine than a four hundred dollar machine. That is all.

I didn't say it was a laudable goal, I just said that's what their goal is. It's a natural consequence of allowing them to be publicly traded corporations, and requiring that corporations serve their stockholders first. I don't like it any more than you do, or think it makes any kind of sense for the long-term survival of the species. That, however, is quite irrelevant in the context of the current conversation. Again, you could have come to the same [correct] answer by simply following the money. You don't have to follow it far.

I do not mind recontextualizing, and discussing how we round up all the insurance company moguls and feed them to the lions. I suspect we could put it on pay-per-view, and pay for a lot of medical care.

Ah, American insurers ...

[aeschenkarnos]

... is there anything stupid, evil or simply wrong that they will not do?

Missing the other half...

[R2.0]

What TFS leaves out is that the reason "medical devices" cost so much is FDA regulations and the higher standards to which they are held. There is no possible way an iPhone could be certified as a "medical device". If Apple were to apply for certification, they would need to make a lot of changes, such as...wait for it...eliminating the ability to run 3rd party code.

Yes, insurance companies can be stupid when applying rules against paying for certain devises or "experimental" procedures. But ask the women whose lives were cut short by Congress forcing them to cover bone marrow transplants for breast cancer.

Now wait for it to be a government agency.

[FooAtWFU]

Now wait for it to be a government agency denying you instead of an insurance agency. We can replace one insensitive bureaucracy with another, equally insensitive one! Hope and... change?

It reminds me of transit benefits, and how you're only allowed to use them for getting to and from work - God forbid that we take public transit for personal trips - it would be a tragedy... also, it reminds me how the Aptera is ineligible for auto-industry loans because it only has three wheels and the law says an auto has four wheels.... at least Congress is thinking about changing that one (well, at the "this is eligible for loans" level, not the "cars have four wheels" level. . .)

-- still wondering why my health insurance can't be more like my auto insurance, where I get to pick someone who has their act together...

Re:Fraud or stupidity

[bcmm]

They're not talking about that sort of insurance (which you can already get). The article is from the USA, where "insurer" means medical insurance.

To be expected

[FreeUser]

Customers: I've paid my insurance premiums all my life. Now that I've had this terrible accident I need you to cover some modest expenses required for me to maintain the semblence of the life I once had.

Insurers: We thank you for your custom. Your call is important to us. However, you fail to understand even the most basic aspects of our business model. We're here to fuck you, not help you. Coverage denied. Thank you for playing.

(Applicable to most forms of health-related insurance it seems)

In the context of things like this, it amazes me (as an American, no less) that the US still finds itself embroiled in the health-care debate the rest of the industrialized world successfully resolved more than 60 years ago (in some places, as long as 80-90 years ago). Even with neanderthals like the Republicans around, you'd have thought the moderate and progressive populations of the country would have dragged that country out of the stone age by now ... but I digress.

Re:To be expected

[FooAtWFU]

Have you tried getting the Canadian | British | French | $EUROPEAN_NATION's government to cover an iPhone for a speech impediment or other similar communications-related disability? Please, try it and let us know exactly how much better socialized medicine is in this regard.

Re:To be expected

[Rich0]

From what I've heard cost-cutting has a big impact. I know a guy who had some breathing problems in the UK, and the problem was handled with tiny little escalations until it became untreated Pneumonia and he was out of work for a month. It took a week before they gave him an x-ray, and it took a week to get the x-ray interpreted. Then it took about a week before they prescribed him an antibiotic.

I had a friend with similar symptoms in the US. They went to the ER at 10PM with difficulty breathing. They were x-rayed within about 15 minutes, and despite it being late at night the test was interpreted within an hour. Antibiotics and steroid nebulizer were immediately administered, and by about 1-2AM they were headed home with a prescription in hand. They still had a few symptoms the next day, but within 48 hours all symptoms were gone and they finished their prescription over the next week. No work/etc was missed aside from sleeping in a little the next morning.

In this case the UK actually shot itself in the foot since the patient in question missed a month of work - which was a huge net cost - just so they could try to save a few dollars on treatments that have been around for 50+ years. However, sick pay/etc doesn't come out of the NHS budget...

Somewhere there is a balance. The US is a mess, but so are most health care systems - they're just messy in different ways, and by different metrics.

Re:To be expected

[mikael]

But did the antibiotics cure the problem or did the steriod nebulizer. Did the doctors attempt to diagnose what the illness was or just take the shotgun approach? Shooting off antibiotics all over the place is just leading to more antibiotic resistant strains of bacteria.

Re:nope, they follow government guidelines

[MartinSchou]

Considering what you're describing, I'd have to think that the US is by far the most corrupt industrialised country in the western world.

When private companies (looking to make a profit) can provide cheaper health care than the government (who isn't looking to make a profit), something is very wrong, and the answer to that is usually corruption.

While we tend to complain about our hospitals (usually because of staffing issues), at least we don't face interesting questions such as "would I rather lose the house or the leg. The leg costs 100 grand, isn't covered by insurance, and I'd have to sell the house. And if I sell the house, where will we live? Maybe the wife'll leave me, or maybe child services will take the kids away."

And we don't have to worry about our doctor finding out that we have some kind of underlying but undiscovered illness. Or if we get one that takes forever to fight, to the extent that we lose our job over it and have to go on welfare for a while, at least we won't be fucked when we finally get back on our feet, just because we have a pre-existing condition that requires expensive medicine to cure.

Sure, if you can afford the insurance and weather a few years of really bad luck, I don't doubt that the US can provide some of the very best health service in the world. But I'm yet to hear of anyone in Denmark or Sweden who had to declare bankruptcy because they couldn't pay hospital costs.

As an example, I spent four days in a mental institution (checked myself in). That did cost me. A staggering 320 Swedish Kronar or 46 US$. Sure, that's more than it'd cost to feed myself for four days, but not by much. And considering I have a suicide attempt in my medical history, I think I'd be excluded over a pre-existing mental condition by most US HMOs if not all of them.

So again, if the private for profit companies can do a better job than your non-profit government, you have a massive problem with corruption. Not just in government, but also in the companies that provides these bribes and get away with it. But I don't think I've ever seen any mention of this in the mainstream US media, but considering none of them seem to be providing any kind of critical thinking and instead settle for either being cheerleaders or hecklers, I can't say I'm surprised.

Um, what?

[ZekoMal]

Okay, so if I coded some software that had some sort of medical use on my computer, would everyone also get all up in arms if insurance companies wouldn't cover my PC that I use almost entirely for entertainment purposes?

The ONLY way that an insurance company should be able to insure a phone is if the phone has everything stripped of it except for the ability to dial 911 and use the medical software. Why the hell is anyone assuming that slapping an iBandaid program on something means that if your dumb ass drops the iPhone in the toilet someone else should pay to replace it?

Re:nope, they follow government guidelines

[mcgrew]

why do people think health insurance is prohibitively expensive when bought outside an employer

Because it is.

It will get vastly worse when the government takes total control.

That's not been the case in the countries that do in fact have total government control of health care spending.

Re:nope, they follow government guidelines

[radtea]

But I don't think I've ever seen any mention of this in the mainstream US media

You have, you just don't understand the code-words. When the American media talks about "the free market" and "free market capitalism" they mean "our utterly corrupt system where corporate and Party interests have completely captured the organs of the State and use them to futher their own interests."

Americans call this system of plutocratic oligarchy a "free" market for historical reasons, although arguably "free" could also mean, "free of economic rationality, ethics and democratic oversight."

Cripple Ware

[goombah99]

If there ever was a good excuse for crippled software then this might be it. Allow the application to lock out all the other functions of the iphone the insurance companies fear. That way you get the cost savings of a commondity device as the platform, but avoid the temptation of people to try to get phony perscriptions. I sort of doubt this temptation logic but the insurance companies probably know better than I do about how that goes. There are tonnes of shady companies pushing home health devices that can be justified under medicare but don't really work or soon break (e.g. scooters whose batteries quickly die). They can just imagine how an easy to sell iphone would become.

Moreover you can imagine that while this test to speech is a compelling use case, there are tonnes of other marginal justifications. for example, a timer application might be sold as a reminder for diabetics to check their glucose. A web based local pollen count application for asthmatics. all of these justifying that the insurance companies buy someone an iphone.

(by the way getting diagnosed as an asthmatic is apparently easy since all the pro bike riders have prescriptions for inhalers for brochial passage enlargers)

making the app cripple the device would sort of fix the dillema but still allow genuine need cases to get what they need.

Re:Cripple Ware

[RKThoadan]

The problem is that crippling it will cost more than just using it as-is. Why in the world should it matter if the device has non-medical uses if a medical-use only device costs more?

Re:Cripple Ware

[level_headed_midwest]

Insurance payment is determined by a bunch of bean counters sitting in a basement somewhere. They don't care about spite, they only care about their actuarial tables and the balance sheet. The insurance companies are willing to pay more for a device without any non-medical functions because it will end up costing them less in the long run. If they start to cover stuff like iPhones, then people who want an iPhone will lie to and badger a doctor into diagnosing them with an illness they don't really have just so they can get a "free" iPhone from their insurer.

Or, if you want me make a scenario:

1. There are 1000 patients that actually need the device. The insurance company decides to only approve the $20k medical device, so they spend $20M.

2. There are 1000 patients that actually need the device. The insurance company decides to approve $500 iPhones. They spend $500K on iPhones for the legitimate patients. Word gets out that the insurance company pays for iPhones, so 100,000 people now "need" this device. The insurance company is now out $50.5M to treat the 1000 people who actually needed the device instead of the previous $20M.

Spite has nothing to do with it; it's all about minimizing risk.

Re:Cripple Ware

[sjames]

It's not as if they are somehow helpless to prevent fraud. Based on a $600 cost for the phone, I figure if they can keep fraud below 97%, they save money. Considering that insurance fraud is a serious crime, it takes a great deal of contempt and/or spite to believe that after their best efforts to prevent fraud and given the severe penalties if fraud is discovered that over 97% of all claims of serious disability requiring an assistive device will be frauds.

Re:American Healthcare...

[Red Flayer]

Not sure why this was modded flamebait, other than it probably touched a nerve.

Sometimes something inflammatory makes a good point, and one worthy of consideration. A lot of the rest of the "civilized" world DOES think the American health care system is abominable, due to the way that it accumulates cash at the top while failing to treat the poor.

But I know that opinions that offend blind patriotism are often disregarded, so I'm not really surprised by the moderation. I just wish people could react a little less instinctively when their beliefs are challenged...

Re:It's government's fault

[Qzukk]

It's easy to hold bullshit opinions and remain ignorant when you hold the belief that if others don't do all the research for you then your opinion can't possibly be wrong, isn't it?

It's easy to claim that the government imposes some maximum limit of care by law and if anyone dares to provide more value then the FBI will come and arrest everyone.

Next up, OP will be claiming the EPA demands that companies pour a liter of benzene into the water supply every year.

Re:Fraud or stupidity

[plague3106]

And why does she need the insurance to pay for it? Because that's they're job.

Since when is it medical insurance's job to pay for someone's iPhone? Sorry, they are not medically necessary. Health insurance is supposed to pay for health problems that come up unexpectedly... but it quickly doesn't work if everyone is expected to get back more than they pay in.

Re:It's government's fault

[Svartalf]

It's also easy to provide bullshit remarks to try to avoid answering a legitimate question.

It's a legit request- either answer the poster or spare us.

Re:Fraud or stupidity

[RKThoadan]

But does it make sense to pay for a device 10-20 times more expensive that is also more cumbersome and has less capabilities? Look at the big picture. Is it so terrible that a device might have a potential non-medical use?

Weird Mod Abuse

[99BottlesOfBeerInMyF]

So what's up with the modding for this thread. Someone makes an assertion about US law and when people post asking for a citation they are modded down as offtopic or flamebait? Are there astroturfers from political lobbies or healthcare companies active here or is it just a bunch of opinionated people who are trying to abuse the mod system to shout down people who disagree with their party? I find the modding here as interesting as the article.

As the kids on Wikipedia say...

[sean.peters]

[citation needed]

Re:Fraud or stupidity

[level_headed_midwest]

"Medical insurance" in the United States isn't really insurance so much as it is a third-party payer for the vast majority of your medical bills.

Re:Fraud or stupidity

[WCguru42]

And why does she need the insurance to pay for it? Because that's they're job.

Since when is it medical insurance's job to pay for someone's iPhone? Sorry, they are not medically necessary. Health insurance is supposed to pay for health problems that come up unexpectedly... but it quickly doesn't work if everyone is expected to get back more than they pay in.

The whole point of the article is to state that insurance currently pays for items that cost up to ten times as much as an iPhone. By replacing the more expensive item with an iPhone multiple goals are achieved. The cost is lower. The person with the disability can now communicate in a less conspicuous way. Everybody is happy, except for the people who don't understand how having a debilitating disease could be made worse by having an awkward and somewhat off putting speech device.

Re:Health Insurance: Broken Incentives Abound

[mcgrew]

Here's another misguided incentive -- drug coverage. I had a vitrectomy last year (I've been asked to warn people that the link supplied can be upsetting) and was prescribed some antibiotic eyedrops afterward. Wanting to hold costs down, I called around for the best price. The tiny bottle of drops retail price varied from sixty dollars to eighty dollars. The sixty dollar option was 20 miles away, the eighty dollar option was less than a mile.

But the co-pay was $26 regardless of where I bought the drug (which retails for $24 in Canada). Ultimately I went to the close pharmacy, which happened to have the most expensive retail price. With gasoline at almost $4.50 per gallon it was an easy choice.

Re:Fraud or stupidity

[dissy]

The article is about Medical Insurance (HMO's, etc) paying for consumer devices such as iPhones and software to run medical uses,

Exactly. iPhones are not medical devices. "Medical Device" has special meaning, and an iPhone with some medical apps on it does not a medical device make.

Either these people are choosing the wrong type of insurance (The correct type, or at least the only type you are going to find in existence) is that which I pointed out, or they are choosing the wrong type of device for their health. This claim however is ludicrous.

Medical insurance is to cover actual medical devices. There is a very good reason these things cost more than a smartphone ever would. They need to be safety tested with live humans, and that is not cheap.

If Apple does not wish to pay all of that money to have the iPhone certified as a medical device (and there is no reason they should), then you can't claim it a medical device, and medical insurance doesn't come into the picture.

If Apple DID want to pay for that testing, the cost of said testing will be added to the price for the end-user, and the iPhone wouldn't be $400 but $8000 instead, and these people would be having the exact same complaint.

did this need to be included??

[nimbius]

"For the millions of Americans with A.L.S., Down syndrome, autism, strokes and other speech-impairing conditions"

down syndrome...wait...what?

the kids retarded, not mute. im pretty sure i heard him say "i can count to potato!" the last forty or fifty times. no iphone required.

Autistic people granted are broad, but are either completely incapable of conversation, or theyre found annoying when they attempt it through mirroring an entire episode of sesame street in a bank or church. nothing requiring an iphone there.

New category needed

[Lonewolf666]

Medical insurance is to cover actual medical devices. There is a very good reason these things cost more than a smartphone ever would. They need to be safety tested with live humans, and that is not cheap.

True for things that can kill you if they fail. Imagine an implanted pacemaker blowing up like an iPhone ;-)

But if you use a smartphone (with special software) in a way similar to how able-bodied people use it, special safety testing may be unnecessary.
Hence I propose a new category "medical assistance device (non-hazardous)" that can be used without expensive special certification. It could cover things like general purpose computers that are loaded with special software, limited to applications where errors pose no significant health hazard.

typical

[speedtux]

Do you really think that insurance companies would have much power or money if healthcare became really cheap and successful? For companies passing money along, their own profits usually end up being a percentage of what flows through them. That's why insurance companies actually don't mind the cost explosion in the health care system; they don't pay for it, you do, they just take a cut.