The following is excerpted from the article "Aphasia Therapy When Insurance Runs Out," Stroke Connection Magazine, May/June 2009.

Recovery from aphasia is a process that may continue for many years. Unfortunately, most people with aphasia find that their insurance coverage runs out before they are done with therapy. It is often frustrating for the patient and their family as they try to continue the recovery process with very limited professional support.

Some insurance plans allow you to renew services periodically (e.g., 20 therapy sessions per calendar year) while other programs will cover an assessment and/or therapy following a change (positive or negative) in communication skills. Given that insurance companies may change their policies, you should stay in contact with your insurance company after you stop direct speech-language pathology intervention. Review your written policy and contact the company directly for clarification. Ask about what needs to happen for you to qualify for additional therapy (e.g., improvement or decline in communication skills, new medical diagnosis and time since therapy) and what specific written information you need to provide.

Even with insurance policies that allow for a lot of therapy, it is almost inevitable that at some point you will spend time without direct treatment. Although your communication needs are unique, the following list of low-cost options may help you continue your progress.

1. Ask your speech-language pathologist (SLP) for information about low-cost or free therapy services in your community. Universities offering speech-language pathology training programs may have clinics that provide individual or group therapy performed by graduate students supervised by SLPs who are certified by the American Speech-Language-Hearing Association (ASHA). The quality of treatment is typically excellent, but cost is generally low given that services are provided in an educational setting.
   
   
2. Some communities have research programs that provide free or low-cost therapy for individuals with aphasia who qualify for participation in treatment studies. Universities, private clinics and government agencies such as the Department of Veterans Affairs and the National Institutes of Health can be great sources for these types of programs. The National Aphasia Association has links for several research programs that may currently be looking for participants. You may also find studies recruiting participants by visiting www.clinicaltrials.gov.
   
   
3. You may benefit from continued speech-language practice with a friend or family member. Before you stop therapy, ask your SLP if this may be an appropriate option for you. If so, your therapist may be able to develop a home therapy program for you and help one or more assistants learn to work effectively to help you improve your communication skills. If you have already been discharged from direct intervention, your insurance company may pay for the development of a home therapy program.
   
   
4. Because working on speech and language can be emotional and sometimes frustrating, not everyone can work with family members at home. It is sometimes helpful for a volunteer who is new to you and your family to help you practice. Your community may have volunteer organizations, churches, colleges or senior centers that could assist you in finding a volunteer who may be interested in helping you improve your communication skills. 
   
   
5. Some people find computer-based software programs helpful for ongoing, independent speech-language practice. Ask your SLP to help you explore programs that may be appropriate for your individual needs. Many companies offer free trial software with no obligation to purchase materials. If you have already been discharged from therapy, try a variety of free computer programs to find one that is challenging but not too frustrating. If you find one that fits your needs you may want to consider purchasing the software and/or equipment.
   
   
6. Being read aloud to may help improve communication skills. Also, depending on how much your reading skills are affected, you may benefit from reading single words out loud or may find it most helpful to read newspapers or books. Ask your SLP if this might help you. If so, have your SLP direct you to reading materials that might be appropriate given your particular strengths and challenges.
   
   
7. The use of books paired with matching audiotapes, CDs, DVDs, etc., may help some people. You can read along (silently or out loud) while listening to the words, poems or stories. It may be helpful to start with simple books, moving to more complicated poems or stories as your reading and/or understanding skills improve. 
   
   
8. Aphasia or stroke support groups are another possible resource. See if there is a support group in your area and get involved (check for aphasia-specific groups already established in your state/province, or general stroke support groups). If there is not a support group in your area, consider starting one. Support groups are a great resource for sharing practical strategies with one another.

Even when you aren’t receiving direct therapy from an SLP, remember that every time you speak, read, write or listen you are improving your ability to communicate with others. Some people get discouraged after leaving therapy and isolate themselves from their community. Although it may still be hard to communicate, try to participate in new activities as well as familiar ones. Put yourself in situations that you enjoyed before you had aphasia and challenge your skills. Above all, remember that your communication abilities can gradually and steadily improve over many years. If your insurance is no longer covering professional speech-language intervention, there are many options available to continue to challenge you and maximize your communication recovery.