Question
May I bill patients or their families for ASL or foreign language interpreting services? If not, may I refuse to schedule an appointment with a potential patient because they speak ASL or a foreign language and I do not have interpreting services readily available at my office?
Answer
Under ADA, the family cannot be billed for interpreting services. It is quite clear in the law that the professional's office is responsible for securing the services of an interpreter and paying the bill. With very rare exception, insurances and HMOs will not cover the cost of interpreters. As I believe Deb mentioned, If you are affiliated with a hospital, they often have an office with a stable of interpreters just for this purpose. But if you are in a private practice setting, you would be on your own with regard to making arrangements and paying for the services. Use of a family member to interpret is highly discouraged because of the vested interest and emotional involvement - interpretation to the individual may be biased in one direction or the other. It is necessary to offer unbiased, effective communication to the patient and the patient's family. The entire goal is to ensure that deaf individuals can access the same services in the community as anyone else.
The answer to whether you can refuse to schedule an appointment with a potential patient with limited English proficiency (LEP) is 'no.' Under 45 C.F.R. Section80.3(b)(2) health care entities that receive payments from either Medicaid or Medicare will not discriminate against an individual because of that person's limited English proficiency. LEP individuals are entitled to an interpreter at no expense to them. Family members who desire to interpret for the individual may do so with the consent of the individual IF the individual is fully aware that an interpreter can be provided at no cost to him/her. In other words, LEP patients fall under similar provisions as Deaf and Hard of Hearing individuals with regard to the professional practice or provider arranging for an interpreter/translator at no cost to the patient. Again, the goal is equal access all services in the community regardless of communication mode or language.
Robert C. Fifer, Ph.D. is currently the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine. He received his B.S. degree from the University of Nebraska at Omaha in Speech-Language Pathology with a minor in Deaf Education. His M.A. degree is from Central Michigan University in Audiology. And his Ph.D. degree is from Baylor College of Medicine in Audiology and Bioacoustics. Dr. Fifer's clinical and research interests focus on the areas of auditory evoked potentials, central auditory processing, early detection of hearing loss in children, and auditory anatomy and physiology. He is the immediate Past-President of the Florida Association of Speech-Language Pathologists and Audiologists, a member of ASHA's Health Care Economics Committee, and the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee. Additional responsibilities at the state level include serving as a consultant to the Florida Department of Health's Children's Medical Services and the audiology representative to the Genetics and Newborn Screening Advisory Council.
