Voice Disorders and Reimbursement

By: Samantha Graffius, Hannah Roy, Christian Boles, & Elaine King

​What are Voice Disorders?
 
For most of us, our voice is a tool we use each and every day; we chat with the ones we love, speak to the clerk at the supermarket, and sing with our friends. For others, it’s an essential part of their career. Teachers, singers, actors, and the like all use their voices constantly. Voice disorders are a problem throughout professions, but the aforementioned few are particularly vulnerable to voice disorders due to their prolonged use of their voice. If a teacher loses his or her voice after a long week, they are unable to perform their job; likewise, a singer who cannot sing due to vocal nodules is ineffective.
 
But what is a voice disorder?
 
A voice disorder is when a person’s voice is different than the expected age, gender, cultural background, or geographic location. Voice disorders can occur in any individual but are more prevalent in adult females, elderly adults, and occupational groups such as teachers, manufacturing/factory workers, salespersons, and singers (ASHA, n.d). Studies have shown that voice treatment provided by speech-language pathologists can improve the quality of life of people with voice disorders. The following list of examples demonstrates the effectiveness of voice therapy as seen in the research literature:

Following voice rehabilitation, patients with laryngeal cancer reported positive effects on overall psychological well-being as well as lower ratings of anxiety and depression (Bergstrom, Ward, & Finizia, 2016). “Voice therapy has been demonstrated to be effective for hoarseness across the lifespan from children to older adults” (ASHA, 2018; Ramig & Verdolini, 1998; Thomas & Stemple, 2007). Therapeutic techniques used during voice therapy have shown positive results for individuals diagnosed with muscle tension dysphonia (da Cunha Pereira et al., 2018)

What we are asking?

If Kim has a stroke that severely debilitates her, the insurance company (in this example, Medicare) will provide, at maximum, $3,000 of annual coverage. This amount is static and will not change. If Kim needs additional therapy, Medicare will not allow for reimbursement once that amount is met.

This presents a problem. Kim may begin to show improvement early and have no need for additional therapy. However, in the likely event that additional therapy is required, Kim will be ineligible to receive more until the next year. A break in therapy this large could impact her recovery. Research shows that the amount of therapy given impacts the recovery time of individuals with voice disorders (Fu, Theodoros, & Ward, 2016).
 
So, what can we do about this?
 
Insurance companies need to be educated that patients should be covered for the entire time it takes them to improve. It’s important that the insurance companies hear from a large amount of us; they respond to the requests of the many, not the few. Without your help, this limitation forced by insurance companies will continue to affect the lives of those with voice disorders - from stroke and Parkinson’s victims to those with vocal trauma. Speech therapy for those with voice disorders is a necessity by increasing their quality of life.

References
ASHA, (n.d). Voice Disorders. Retrieved from https://www.asha.org/practice-portal/clinical-topics/voice-disorders/
Bergström, L., Ward, E., & Finizia, C. (2017). Voice rehabilitation after laryngeal cancer: Associated effects on psychological well-being. Supportive Care in Cancer, 25(9), 2683–2690. https://doi-org.marshall.idm.oclc.org/10.1007/s00520-017-3676-x
da Cunha Pereira, G., de Oliveira Lemos, I., Dalbosco Gadenz, C., & Cassol, M. (2018). Effects of Voice Therapy on Muscle Tension Dysphonia: A Systematic Literature Review. Journal of Voice, 32(5), 546–552. https://doi-org.marshall.idm.oclc.org/10.1016/j.jvoice.2017.06.015
Fu, S., Theodoros, D., & Ward, E. C. (2016). Long-term effects of an intensive voice treatment for vocal fold nodules. International Journal of Speech-Language Pathology, 18(1), 77-88. doi:10.3109/17549507.2015.1081286