Does Medicare Pay For This??? and... What Are YOU Willing To Pay For?

In my twenty years of practicing as a speech-language pathologist in Florida, the first question usually posed to me by prospective patients is the Medicare question. Hence, it has led me to include a few comments about the Medicare payment system in my Voice Aerobics seminars. I provide a few definitions of what Medicare considers as “medically necessary” treatment, and than I caution participants to not make health care decisions based solely on whether private insurance or Medicare will pay.

Now, don’t misunderstand, as a self-employed and self-insured person, I am as concerned as you are about health care costs. But, I also know that I am willing to pay for certain non covered services, like my bi-annual dental exam, my vision exam, my monthly massage, and others, because I have witnessed the benefit of prevention and self-care. Blindly accepting a physician’s prescription for any sort of therapy, just because you are told Medicare or insurance will pay, is not likely to yield a result you hope for.

Last week I saw a woman for voice treatment for a functional voice disorder. That is, a voice problem that has come about mostly from misuse of her vocal mechanism, and not because of something anatomically wrong. She spent the first 20 minutes of the visit, telling me how stressed she was because she was about to lose some health care benefits associated with her deceased husband’s employment with Chrysler. I reminded her that voice treatment was likely to be short term (6-8 visits) and self-directed ( voice exercises that she would need to perform on her own outside of treatment). In response, she elaborated further telling me, that because she was “so busy”, and “so stressed,” she did not find time to perform any of her home voice exercises, practice recommended vocal hygiene techniques, or various other suggestions provided to her the previous week.

This example is layered with many of the challenges associated with successful outcomes from voice treatment, including: Is the patient ready? Do they understand the nature of their problem, and are they sufficiently motivated to independently perform a home program? And, will they continue to self-monitor their vocal behavior once formal treatment has ended?

Whether Medicare is paying for treatment, or a patient is taking their check book out at the end of a session, my obligation is the same: to educate you about your disease/symptoms and best treatment; to instruct you in exercises, strategies, and techniques that reduce your symptoms or improve function; and to establish a home program that you can independently and safely perform on your own or with assistance from a caregiver. So, as you consider any type of medical therapy or treatment, I would encourage you to do a self-check, and answer the question: what am I willing to pay for?

 

Articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .
(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.