Variability in Insurance Coverage for Adult Voice Therapy in The United States of America

Voice therapy is often the first-line treatment and an adjunct to medical or surgical management of dysphonia. However, a minority of patients with dysphonia utilize voice therapy. Insurance coverage can affect patients' decisions and ability to pursue voice therapy. The objective of this study was to investigate variability in insurance coverage of voice therapy for treatment of dysphonia in the United States of America.

A cross-sectional study was performed to review insurance policies from the top three commercial insurers and Medicaid in all 50 states and District of Columbia (DC). Top three commercial insurers were determined using 2021 enrollment data. Policies for commercial insurers and Medicaid in all 50 states and DC were then identified using internet search. Voice therapy coverage was categorized as covered, requiring prior authorization, determined on case-by-case basis, or not covered. Copay and visit limitations were also assessed.

Among 153 commercial insurers, 135 (88.2%) provided coverage for voice therapy. 39 (76.5%) state Medicaid plans provided coverage for voice therapy. There was no association between coverage status and insurance type (p = 0.06). Commercial insurers (34.09 ± 13.8) were associated with significantly higher annual visits limit than Medicaid (23.8 ± 10.1) (p = 0.02). There was a significant association between commercial insurers and documented copays (p = 0.01).

While most of the commercial plans and Medicaid provide voice therapy coverage, discrepancies still exist, and many insurance providers do not provide coverage. This variability may contribute to disparities in access and outcomes for individuals with dysphonia.

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