Assistive Technology Program
Augmentative/Alternative Communication (AAC)
The term “Augmentative/Alternative Communication” (AAC) refers to any mode of communication other than speech. This includes systems such as sign language, symbol or picture boards, electronic devices and/or computers that feature synthesized speech. Although the same systems can be used for either augmentative communication or alternative communication, there is a difference between the two. Augmentative systems are used by people who already have some speech but are either unintelligible or have limited abilities to use their speech. In such case, other modes of communication are used to support, or supplement what the person is able to say verbally. Alternative communication is the term used when a person has no speech. These people must completely rely on another method to make all of their ideas, wants, or needs known.
To begin the process of obtaining an AAC device, the individual must receive a communication assessment. Since communication devices come in so many different shapes and sizes and offer so many functions, receiving a proper evaluation is essential prior to selecting a device. Licensed Speech Language Pathologists, Assistive Technology Specialists, or Rehabilitation Engineers that are experienced in AAC perform these assessments. During the assessment, the therapist will try different communication devices with a patient to determine which device is the most appropriate for the patient as well as other important factors such as hearing, eyesight, and motor function. The goal is to match a device to the person’s wants, needs, and capabilities. A professional who understands the progression of ALS should be consulted for this assessment. The nature of ALS requires that professionals choose electronic devices that will adapt as the disease changes. The cost of an evaluation is usually covered under medical insurance.
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Electronic Communication Devices
Many different electronic communication systems are available. The therapist that performs the AAC assessment helps the patient try out several communication systems at the evaluation center. Some communication systems are custom designed for a specific user or can only be used in specific situations. For example, a communication system that works through a desktop computer cannot travel with the patient to doctor visits, but a laptop or notebook computer is more portable and will allow the patient to travel with the system. In selecting an electronic system, the individual must understand the features offered by the system and determine if those features best meet his or her needs.
Electronic communication devices can be broken down into two categories: dedicated and undedicated systems. A dedicated device is strictly a communication device—the only thing it does is speak. Undedicated devices, which are computer based, not only speak, but also feature all the functions of a regular PC or laptop—word processing, e-mail, web surfing, etc… Voice output on a device is either digitized or synthesized. A digitized voice utilizes recorded human speech. Synthesized speech devices use computer-generated speech. There are pros and cons to both types of devices. Digitized devices, although more “normal” sounding, are limiting because they can only say the words or phrases programmed on the device. They do not allow for free-thinking thoughts and sentences to be typed into the machine and said via the synthesizer. Only phrases that have been pre-programmed can be said with a digitized device. Synthesized devices (computer voices) allow the user to have pre-programmed phrases or words and also have the ability to spell out novel thoughts.
Communication devices can be accessed several ways. The term access refers to the way the individual will operate the communication system. For example, one individual may use fingers for typing, with another moving the eyes to point at letters, thereby spelling words. An access method for an individual will often change as the disease progressively leads to weakening of different areas of the body. This means that a patient who at one point uses hands for communication may lose this ability and eventually have to use another access method. It is important for each individual to know that communication does not have to stop simply because hands become weak and typing is no longer possible.
Most private and public insurance companies will now cover the cost of a communication device. If you are interested in obtaining a communication device through insurance, the average time span from assessment to when you receive your device averages four months. Start the process early!
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Medicare Coverage of Speech Generating Devices (SGD)
*Medicare will cover the cost of a SGD if you have Medicare Part B services.
- You must live in your family home or an assisted living facility.
- Medicare will not cover the cost of a SGD if you are in a hospital, skilled nursing facility, or on hospice.
*Medicare will only cover 80% of the “allowable” cost of the device. Secondary insurance should pay the remaining 20% but that is not always the case. If you do not have secondary insurance, you will be responsible for the 20% co-pay. If funding is an issue, please contact Alisa Brownlee at the Chapter—215-631-1877.
*Medicare classifies SGD’s as “durable medical equipment” (DME) and will cover the device under this classification.
*An assessment by a speech-language pathologist is required to document that this device is needed to meet your daily functional communication needs.
*Once the assessment has been completed, appropriate paperwork will be submitted to the vendor of the device. This process usually takes approximately four months. *If the vendor feels all the paperwork is in order, they will ship the device directly to you. Once you receive your device, please contact Alisa Brownlee at the ALS Association—215-631-1877.
*Training on your device can be provided by: Vendor—many vendors offer initial training sessions at no cost. Facility—the facility where you received your device can provide training. The cost of the training session is covered by Medicare. Chapter—the ALS Association can arrange for a specialist to train you at Pennsylvania Hospital in Philadelphia. Home visits can be arranged for those individuals that are not able to leave their home. (limited service area)
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Private Insurance Coverage of Speech Generating Devices (SGD)
Most private insurance companies will cover some cost of a communication device. On average, the covered cost is 80%. This is because AAC devices are “out of network” expenses since most vendors of AAC devices do not belong in the insurance network’s list of approved providers. Most vendors have made the decision not to participate in the major insurance company’s provider network and because they are not part of the network, insurance companies will only pay their “out of network” DME rate which is 80%. However, some insurance policies have NO “out of network” coverage. This would mean the insurance company would pay nothing toward the cost of the device. Some major insurance companies will offer coverage special coverage since communication devices can not be found in the mainstream DME market. This special coverage recognizes that the AAC vendor is the only company in the country that provides this particular device. Since the vendor is the only company that provides this device and the insurance company can deal with no one else, a special “out of network” allowance is given and the device can be covered around 80%. Getting this special coverage is usually done through a case manager.
It is recommended that you obtain a case manager from your insurance company!! Case managers will handle all your claims, answer your questions about coverage, and intervene on your behalf to help you get the medical equipment you need. You can either call and ask for a case manager or some insurances (mainly the HMO companies) ask the doctor's office to call. Having a case manager may mean the difference in getting a communication device or getting a denial.
Things you need to know before authorizing a therapist to order a device for you:
- The DME coverage available under your current insurance. Since SGD’s are covered under the DME policy of your insurance, make sure you have DME coverage and find out how much your insurance will cover for a particular piece of DME. Make sure you have out-of-network benefits.
- What your deductible is. Most insurance policies will have yearly deductibles that have to be met. After you reach your deductible, your insurance company may then pick up full coverage of a piece of DME.
- Find out if your insurance company participates in an “out of network” allowance as mentioned above.
- If you have a case manager, speak with them to find out this information. If you do not have a current case manager, get one!
Training on your device can be provided by:
Vendor—many vendors offer training sessions at no cost.
Facility—the facility where you received your device can provide training. The cost of the training session is covered by Medicare.
Chapter—the ALS Association can arrange for a specialist to train you at Pennsylvania Hospital in Philadelphia. Home visits can be arranged for those individuals that are not able to leave their home. (limited service area)
Funding options are available should you have a co-pay. Please contact Alisa Brownlee at 215-631-1877 to discuss available options.
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Alternatives if Insurance does not cover a Communication Device
For those patients that do not have insurance, have insurance with no DME coverage, or are on hospice or living in a nursing home, there are several choices to obtain a device.
- Borrow a device from the Chapter. A refundable deposit of 5% is required to borrow a device from the Chapter. The borrow option may have a waiting list. Prior to borrowing a piece of equipment from the ALS Association, a proper AAC evaluation must be performed. A copy of the SLP AAC report must be forwarded to the Chapter’s Assistive Technology prior to receiving a loaner device.
- Purchase a system outright.--The device would solely belong to you.
- Rent a device from the Manufacturer.
Training sessions are provided for all equipment from the Chapter’s loaner closet. Training sessions can be arranged with the Chapter’s Assistive Technology Specialist on Thursdays at the Pennsylvania Hospital ALS facility or may be done in your home (limited area and certain restrictions apply).
If you are unsure a device is right for you and want to “test” a device, you may want to consider borrowing a device from your State Assistive Technology Project. Every state, as part of a federal mandate, must have an Assistive Technology Project. Each state differs in the services offered, so check your local blue pages for the telephone number of your State AT Project. Pennsylvania has an Assistive Technology Loan Closet and lets families borrow both low-tech and high-tech equipment. Pennsylvania’s AT Project (PIAT) can be reached at (215) 204-1356. New Jersey’s Tech Act Project (TARP) can be reached at (800) 554-2626. Delaware’s Project (DATI) can be reached at 800-870-DATI.
Also, most major manufacturers of communication equipment have some form of rental program. You can rent by the week or month. Contact the manufacturer of the device for more details.
There are many myths about communication devices. There is no perfect device and no matter how sophisticated the device, it is still more time-consuming than speaking. Having a communication device does not mean you must stop speaking. In fact, you should begin thinking about communication devices well before you lose the ability to speak, because getting the initial assessment, securing the appropriate device, and learning how to use it may take several months. Continue speaking and utilizing AAC equipment when faced with an unfamiliar situation such as a restaurant setting or family gathering. However, it is important to recognize when your device must become a full time partner. When your caregiver and family members cannot understand your speech, a device must be utilized to convey wants, thoughts, and needs.
If you have questions about AAC or the Chapter’s program, please contact Alisa Brownlee at (215) 631-1877.
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Examples of Non-Electronic Communication Systems:
Non-electronic communication systems are tailor-made for each individual user and are not electronically operated. An example is a written letterboard containing letters, words, and phrases. Non-electronic communication systems have the advantage of being inexpensive, readily available, highly portable, and resistant to breakage. They are excellent backup systems for those when an electronic system is not functioning or for those that are not interested in an electronic system.
Some samples of non-electronic systems are:
- Double plexiglass (sandwich) board fastened with velcro or sealed with tape makes a good communication board. There are various sizes, ranging from approximately 9”X9” for small board, all the way up to a lap board designed for wheelchair usage.
- Portable waterproof communication boards are often needed during transfers from house to car or in the bathroom area. A plastic envelope can be purchased at any office supply store and will help keep the board dry, or laminate the board with clear contact paper or lamination paper.
- A children’s “magic slate” is excellent for those who can still write. It is portable, lightweight, and easy to use. If holding the pen is difficult, wrap some foam around the pen for easier gripping.
- A communication notebook can be created for the person with different categories along with an alphabet page.
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Copyright: Alisa Brownlee, ATP
Assistive Technology Specialist
The ALS Association, Greater Philadelphia Chapter