A significant success was achieved through an external review board’s reversal of Blue Cross and Blue Shield of Mississippi’s denial of cognitive rehabilitation benefits for James Butler following his stroke. Mr. Butler suffered a series of strokes which left him with a residual right hemiparesis, speech and cognitive deficits which impaired his ability to function independently and compromised his safety. Mr. Butler’s wife, Mary Hawkins Butler, the mayor of Madison, Mississippi realized that her husband needed continuing rehabilitation following his initial inpatient and outpatient care. The Butler case began in 2006 with a letter from American Speech and Hearing Association, a long time advocate of cognitive rehabilitation, to Blue Cross Blue Shield Association which provided data from the ASHA National Outcomes Measurement System and other supports for cognitive rehabilitation.
This case paves the way for other in a similar situation. Blue Cross covers cognitive therapy for traumatic brain injury but has denied cognitive therapy following a stroke or aneurysm. The external review board ruled that “cognitive therapy is not experimental or investigational in nature”. Blue Cross has removed its 2008 report from its website which called cognitive therapy “investigational”.
Its been a long battle with insurers to recognize that cognitive therapy is part of medical rehabilitation. Mr. Butler’s successful appeal is part of a well-deserved victory.
Click here to read the story from The ASHA Leader