How to Use the Insurer & Health Plan SGD Approvals Database

Instructions

The Insurer & Health Plan SGD Approvals Database is easy to use.  It contains 2 items of information: 

·                    the names of insurers and health plans, and

·                    the number of times each was reported to have approved an SGD. 

To enable easy searching, the insurers and health plans are listed in alphabetical order.

Identifying Whether an Insurer or Health Benefits Plan Previously Approved an SGD

Use the database to identify whether an insurer or health benefits plan previously approved an SGD.  The names of all insurers and health plans reported to the ATLC by the manufacturers are listed alphabetically. 

NOTE 1:  Because the data base lists the names as reported by the manufacturers, some insurers have multiple listings.  However, it is fairly certain these policies or plans were issued by the same parent company.  It is recommended, therefore, that all the earlier approvals from all the distinct listings for a single company can be totaled. 

Example:  Aetna has 19 distinct listings, but it is reasonable to assume all those listings represent policies issued by or plans administered by the same parent company.  Thus, the total number of earlier approvals for Aetna (214) will represent the sum of all 19 listings. (The same procedure should be used for other insurers with multiple listings.) 

NOTE 2:  The database is admittedly incomplete.  The database reports information only from the mid-to-late 1990s to 2003 for 5 companies.  Current information is being supplied only by Assistive Technology and Prentke Romich.  There are more than 5 SGD manufacturers, and insurance funding for SGDs dates back to the late 1970’s, an extends to the present.  In short, the database significantly under-counts the total number of insurers and health plans that have approved SGDs and the total number of devices approved. 

NOTE 3:  The presence of an insurer or health plan on the database list means this source has approved an SGD in the past.  However, if an insurer or health plan is not listed, it is not correct to conclude it has never previously approved an SGD.  To the contrary, the absence of an insurer’s or health plan’s name from the database list only supports the conclusion its name wasn’t reported to the ATLC.

Inserting Database Information in Funding Documentation

If the current client’s insurer or health plan is listed, insert this fact into the documentation supporting a funding request or appeal.  The sample letters stated in the overview section provide an example of what can be said and how the data base information can be used.