Extended Insurance Benefit Campaign

Transcription

1 Extended Insurance Benefit Campaign If occupational therapy services are not covered by your insurance provider, Ask for it! Nicole Raftis Canadian Association of Occupational Therapists CTTC Building, Colonel By Drive, Ottawa, ON K1S 5R1 (800)

2 Extended Insurance Benefit Campaign What is it about? Not all Canadians have insurance coverage for all the health services that support their well-being and good health. One of the most significant gaps in coverage is the lack of access to the occupational therapists even though certain services most appropriately provided by occupational therapists are insured. To increase access by all Canadians to occupational therapy services, occupational therapists are looking first to employers and insurance providers to modify extended health benefit or flex health benefit plans to include coverage for critical occupational therapy services provided to clients by occupational therapists. While CAOT has been informed by some insurance companies that although they offer access to occupational therapy services as part of their service offerings, their clients may choose not to include them in the packages they select to purchase. Secondly, occupational therapists must talk about the lack of coverage for their profession to the general public and to their clients who must pay out of their pocket for occupational therapy services provided by the regulated professional or do without critical services impacting their wellbeing. Value of Occupational Therapy for the Workplace The Canadian economy is negatively impacted by the increased costs associated with workplace health and injury prevention issues. Occupational therapists services can reduce the $19.8 billion dollar cost associated with workplace injuries (PHAC, 2004) and the $51 billion cost of workplace mental health issues (Picard, 2008). Occupational therapists play an important role in dealing with ergonomic challenges, injury prevention, and workplace rehabilitation such as ensuring successful return to work following major injury, debilitating disease or surgery. Occupational therapists are engaged by insurance companies to reduce disability pay-out periods. The oil industry engages occupational therapists to reduce injuries and to promote better production outputs. Occupational therapists approach workplace issues with a unique perspective that considers the occupation, the needs of the individual worker, work group and the organization. They offer solutions to common workplace issues through programs and activities that can include ergonomics, nutrition and wellness, pain management, stress management, counseling, workplace safety equipment, health and safety policies, and life skills training. Third, professors, researchers and students of occupational therapy programs need to target the universities, offering these programs to include access to their profession as part of the insurance benefit packages provided by the university. If occupational therapy were more broadly covered by private health insurance plans, then more Canadians would be able to receive a range of unique health and support services for clients who have acute, chronic, palliative or rehabilitative health needs provided by professional health providers. However, without insurance payments for occupational therapy services, a large portion of Canadians are losing out on services important for their health and well-being. Access to occupational therapists should be a fundamental element of health benefit plans and should be an option permitted for those using flex plan approaches. Ask for it! 1

3 Insurance companies Insurance companies may or may not offer access to occupational therapists as part of their benefit plan offerings. In some cases, they may offer access but their clients choose not to include the profession in the packages they purchase for their employees. Many insurance companies will however cover services that fall within the scope of practice of occupational therapists. In fact the lack of use of occupational therapists for practice areas that cross over with psychologists, physiotherapists and social workers limits the options for their customers and may result in higher benefit costs being paid out than otherwise may exist. Insurance companies are prime employers of occupational therapists as part of their management of disability insurance payouts. Insurance companies will offer access to occupational therapists if customers ask for it. For example, Desjardins added access to occupational therapists as part of their health benefit offering for Newfoundland and Labrador provincial workers. The Canadian Association of Occupational Therapists also asked their provider to include access to the profession. It is important to note that while some insurance companies do offer the choice of access to occupational therapists, their clients (employers or other service providers) choose to exclude the profession from the package purchased. What they need to hear: Health care costs are rising because of the aging workforce, increased stress at work and home, increased use of prescription drugs and release of new drugs. Occupational therapists keep people working, to reduce stress and in some cases to decrease medication use. The incidence of depression is increasing; approximately 35 per cent of all long-term disabilities are related to mental health problems. Workplace modifications, assertiveness training and stress management techniques are just a few occupational therapy approaches that alleviate the negative effects of mental health problems on productivity. A global review of wellness studies by Dr. Ray Shephard for the federal government found that workplace wellness programs have a return on investment per dollar spent of $1.95 to $3.75 per employee. Health problems such as repetitive strain injuries and stress-related disorders can be prevented or their effects on productivity reduced through occupation-based educational programs regarding body mechanics, joint protection, energy conservation techniques, assertiveness training and stress management. Large companies are finding that a flexible benefits plan is advantageous not only for the employer but the employee as well. A flexible benefits plan allows for occupational therapy intervention in conjunction with other care and/or after an employee fails to get better through other services covered by the core plan. Action to be taken: Write to your insurance company/employer to ask them to include access to occupational therapists as part of their benefit plan and flex plan offerings. Insurance offerings Extended health insurance helps employees and their dependents pay for medical expenses that are not covered by the provincial health plan. Group health plans are customized to meet the needs of the employees of the particular company, therefore plans vary in the type of services covered and the amount the plan pays. Standard benefit plans or core plans usually include coverage for prescription drugs, emergency ambulance services, a semi-private or private hospital room, medical and nursing services, and equipment. Employers may add optional benefits to the core plan which may include paramedical services such as vision care, foot 2 Ask for it!

4 orthotics, and practitioners such as physiotherapy, massage therapy, naturopathy and podiatry. Typically, occupational therapy services are not included in standard or core extended health insurance packages. As a result, people may not be aware of the health benefits of occupational therapy because it is not available to them. Even if they are aware of occupational therapy, they may think that they are unable to receive compensation for occupational therapy services as it is only part of a list of optional services. Many insurance companies offer flexible benefit plans (flex plans) that provide employees the opportunity to choose the benefits they need. Employers determine the amount that they will contribute towards the plan; an employee chooses how they wish to use their benefits based on their needs. Flex plans provide an option for coverage of occupational therapy services and also allow employers to contain the costs of benefit plans. Approach your own employers and unions The best place for an individual occupational therapist to start is to approach your own employers and unions. Is occupational therapy covered in your group benefits package? If not: Write and/or meet with the people at your place of work who are in charge of arranging and/or negotiating the extended health benefit packages. These people may be your human resource personnel or union stewards. Insist that your own benefits package includes occupational therapy. Again, consider CAOT s promotional resources to support your efforts. With your client complete the joint letter to the insurance carrier/ service provider. Management consultants can also be allies. Some assist employers to negotiate coverage for their employees, requesting occupational therapy and explaining how it benefits the client or his/her family member. Universities Universities offering Occupational Therapy programs and who do not provide access to occupational therapists as part of the health benefits they offer faculty and students should be asked to provide access as part of the benefits they offer staff and students. What can you do about it? Write letters to HR administrators, university presidents, student union representatives, department heads, professors Write articles for student papers Draw up petitions, put up flyers, promote the campaign to engage other students to support access to occupational therapists through benefit plan (For sample letters see Appendix A) You can find the name of the insurance company by asking a medium to large employer; for example, bank, logging/pulp mill company or government agency. Small companies often don t have these types of benefits. The employer (usually the Human Resources Department) will provide you with a contact name in the insurance company (for sample letters see Appendix A). Ask for it! 3

5 APPENDIX A Date Attn: Name of contact Name of Insurance Company/Service Provider Address RE: Inclusion of occupational therapy services in health benefits plan Dear X (If do not have a name, address as Dear Sir or Madam ): I understand that your company does not offer occupational therapy services as part of the extended health benefits plan. Occupational therapy provides the solution to many health related issues and can stop problems before they start. Occupational therapy services can also assist in developing better practices in occupation that will lead to an improved level of health, wellness and productivity in the workforce. Occupational therapy is an essential component to any comprehensive benefits package and is proven to reduce disability claims through the promotion of function, independence in daily activities and the prevention of illness. Occupational therapy considers the medical, social, psychological and occupational factors that contribute to function and is an integral part of a health management strategy. I would like to arrange an in-person meeting with you, at your convenience, to discuss the added benefits occupational therapy services can offer your health benefits plan. I look forward to meeting you and will be in contact with you within the near future to schedule a meeting time. Therapist name

6 Date Attn: Name of HR person in charge of benefits Name of Company Address RE: Inclusion of occupational therapy services in health benefits plan Dear X (If do not have a name, address as Dear Sir or Madam ): I understand that your extended health benefits plan does not offer occupational therapy services to your employees. Occupational therapy provides the solution to many health related issues and can stop problems before they start. Occupational therapy services can also assist in developing better practices in occupation that will lead to an improved level of health, wellness and productivity in the workforce. Occupational therapy is an essential component to any comprehensive benefits package and is proven to reduce disability claims through the promotion of function, independence in daily activities and the prevention of illness. Occupational therapy considers the medical, social, psychological and occupational factors that contribute to function and is an integral part of a health management strategy. I would like to arrange an in-person meeting with you, at your convenience, to discuss the added benefits occupational therapy services can offer your health benefits plan. I look forward to meeting you and will be in contact with you within the near future to schedule a meeting time. Name Address Contact information

7 Client s address Date To Whom It May Concern, I recently required the services of an occupational therapist and, to my dismay I learned that my extended health benefits plan does not cover these services. I am requesting coverage of occupational therapy services in my plan. Occupational therapy benefits both you (the employer) and me (the employee) through early intervention, promotion of function in every-day work and home activities, and prevention of illness. As part of extended health benefits, occupational therapy services often reduce disability claims. Occupational therapists are important members of health teams that include medicine, psychology, speech pathology and physiotherapy and no comprehensive benefits package should be considered complete without them. Occupational therapy services would be of great benefit to me because (insert benefit to you) Please let me know how soon occupational therapy services will be covered by my extended health benefit plan. Client s name & insurance number

8 Client s address Date To Whom It May Concern: I recently required the services of an occupational therapist and, to my dismay I learned that I my extended health benefits plan through your company do not cover these services. I am requesting coverage of occupational therapy services in my plan. Occupational therapy benefits both the employer and the employee through early intervention, promotion of function and independence in daily activities, and prevention of illness. As part of extended health benefits, occupational therapy services often reduce disability claims. Occupational therapists are important members of health teams that include medicine, psychology, speech pathology and physiotherapy and no comprehensive benefits package should be considered complete without them. As a policy holder with your company, I would appreciate a response indicating when occupational therapy services will be covered by your company and whether or not a flexible plan is being considered as an option for your clients. Client s name & insurance number

9 Date To University Administrators: Attn: Name of HR person in charge of benefits Name of University Address RE: Inclusion of occupational therapy services in health benefits plan Dear X (If do not have a name, address as Dear Sir or Madam ): I understand that your extended health benefits plan does not offer occupational therapy services to your faculty, staff and students. I find this somewhat surprising as the university offers an occupational therapy program as part of its Health Science curriculum. As a future occupational therapist (or as an academic) I believe that university should ensure access to this health profession for students and faculty alike. Occupational therapy provides the solution to many health related issues and can stop problems before they start. Occupational therapy services can also assist employees, and their family members, in developing better practices in occupation that will lead to an improved level of health, wellness and productivity in the workforce. Occupational therapy is an essential component to any comprehensive benefits package and is proven to reduce disability claims through the promotion of function, independence in daily activities and the prevention of illness. Occupational therapy considers the medical, social, psychological and occupational factors that contribute to function and is an integral part of a health management strategy. I would like to arrange an in-person meeting with you, at your convenience, to discuss the added benefits occupational therapy services can offer your health benefits plan. I look forward to meeting you and will be in contact with you within the near future to schedule a meeting time. Student/professor name