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

[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

[izm]

As somebody who spent a lot of time and energy helping acquire such a device for his father who suffered from ALS, I would like to highlight some important facts.

Many of the devices that the insurance companies cover are actually modified PC's. Before you say that people are better off buying a computer and having insurance foot the bill, look at the facts:

1. These PC's come modified with software and other interfaces which are specially designed based on years of research to meet the needs of the disabled for communication in the most intuitive way possible.

2. Often times the software is placed on an embedded windows system so that its harder to "break" with malware, and the like. Very few PC owners apart from the tech savy can say they've never gotten a computer virus or some form of malware. Even us techies slip up sometimes. Can you imagine if your lifeline were disabled by a virus? This is exactly what these devices are. Lifelines. People rely on them every day for the basic things we take for granted. Having the software embedded keeps the device functioning. Having functionality limited to...well....speaking...that makes the device far less daunting to those who might not be as computer savvy.

3. There are lots of different attachments available for these devices that let pretty much anyone with any level of disability use them. Each attachment is geared towards using the functionality a person has left. These are niche items that are pretty hard to come by at WalMart.

4. These computers are generally ruggedized (usually a toughbook, or something similar). The ruggedization is critical when the device goes everywhere with you.

The bottom line, really, is that these devices are designed to work any time anywhere for anyone. These are really custom solutions. Also, a whole lot of vendor support comes with the device, which is critical to making the most of it. This entire package, including the support, the level of customization in terms of input devices and software tools, and the level of quality and reliability seem to justify the high price in my eyes.

Your insurance company, believe it or not, has your best interest in mind as well as their own when they decide what is and isn't covered. These costly specialized devices are the best option for a whole lot of people. By only covering a solution like this, the insurance company knows you're getting what you need, which is tough to do if you're talking about building a system yourself.

I could have created a home-brew solution, but it would have been without the benefit of years of research into the progression of various diseases and the capabilities of somebody paralyzed from the neck down. Why should a patient have to deal with debugging a home-brew solution or trying to use a conventional mouse or keyboard when they can barely move their fingers? Being paralyzed is frustrating enough as it is...they don't need the extra stress.

On a side note, you can in fact work with the vendor and the insurance company to have an "add-on" placed in the computer-turned-medical device to allow you to use it as a computer as well. The expense is out of pocket, but is usually far less than the cost of a computer.

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.

Re:To be expected

[Wizard Drongo]

Yeah, they would. I mean, sure, they'll go for the medical device if it's better, but if a simple iPhone would work nicely, they'll get you an iPhone. Mainly 'cause in Scotland at least, that sort of decision is made by the local manager in the place you actually go to see the doctor/physio etc. The great thing about the NHS is that it divorces cost from medicine. Since it's all "free" to the patient and the doctor anyway, the doctor will go for the best medical option, regardless of if it costs less or more; admittedly there is some shilling still of GP's by big Pharma trying to get them to prescribe brand X drug, but it's mostly gone, and we see a lot more brand-x-generic now, and all gratuities from Big Pharma to the GP have to be declared. In the States, even if you get coverage, your insurance co. still get shafted by doctors that will order unnecessary tests etc. just to bump up the bill, because it's not his company the money's coming from. Here, it's all the same "company", so if you need a test, you get it. If not, you don't. On the bad side, whilst they'll never turn you down for treatment, depending on where you live, and what it is, you may be waiting a while for that hip-replacement/eye-operation etc.

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.