Insurance Appeal: Don't Give Up

Insurance Appeal: Don't Give Up

Insurance Appeal: Don't Give Up

by Vicki Deskins

Reprinted from Newsline, newsletter of Dakota LINK. The

article was adapted from the Augmentatively Speaking

Newsletter, Vol. 7, No. 1.

When a parent has a child with disabilities, submitting

requests for insurance funding for therapy services, AAC

devices, and other technology needs becomes a part of the

parenting role. The denial by insurance companies for funding

may often discourage parents and put them at a loss. As an

advocate for my daughter, I have learned some techniques which

can help others get positive results with insurance appeals.

Here they are:

1. Obtain a copy from your insurer of the proper grievance

procedure to follow.

2. Provide all information requested by the insurer by

certified mail. When the doctors and/or therapists must

provide records, have them mailed directly to you, copy them,

then mail them certified mail or fax them if it is not too

cost prohibitive. This will eliminate the step of a medical

release form, and also provide you with your own copy of the

records.

3. Retain all correspondence from the insurer concerning the

appeal, and when phone calls become necessary, you will have

names of specific individuals to contact.

4. In the information provided by yourself, the doctor, and/or

therapists to the insurer, be sure to use appropriate

terminology. For example:

a. a prescription should be written for all services and/or

equipment and signed by your physician;

b. all services and/or equipment should be described as a

medical necessity;

c. use the term prosthesis when appropriate; and

d. avoid reference to any service and/or equipment as being

"educational."

5. Contact all agencies which may help your cause. These are:

a. your employer's union;

b. HRS;

c. Department of Insurance/Insurance Commissioner; and

d. County Commissioner.

Following the above suggestions can greatly reduce the

time factor in your appeal. My prior lack of knowledge

resulted in ten months of appeal for me, which finally did

result in approval of physical and occupational therapy for my

daughter. I am continuing to appeal for speech therapy and

have found that the above tactics plus perseverance are

extremely important. Just remember, don't give up!

(Vicki Deskins is a parent of a first grader who is

included in a mainstream first grade class at Hickory Tree

Elementary School in St. Cloud, Florida. Vicki and her husband

Robert are the parents of three daughters.)