What this article is about: This article provides a brief overview of how to appeal an insurance denial and links to a resource where you can find more information and support.
If you have a child with special needs, chances are you will deal with insurance denials from time to time. This article from Complex Child magazine is an excellent place to start and even includes a sample letter for your appeal.
Community Catalyst Consumer Complaints Toolkit: http://www.communitycatalyst.org/resources/tools/consumer-complaints-toolkit
National Disability Navigator Resource Collaborative Mental Health Parity Factsheet: http://www.nationaldisabilitynavigator.org/wp-content/uploads/Materials/Fact-Sheet-7-Mental-Health-and-Substance-Abuse-Parity.pdf
National Disability Navigator Resource Collaborative Civil Rights and Disability Discrimination Factsheet: http://www.nationaldisabilitynavigator.org/wp-content/uploads/Materials/Fact-Sheet-11-ADA_504.pdf
Healthcare.gov: Consumer Rights and Protections: https://www.healthcare.gov/health-care-law-protections/rights-and-protections/
Centers for Medicare and Medicaid The Mental Health Parity and Addiction Equity Act: https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html
SAMHSA (Substance Abuse and Mental Health Services Administration) Health Financing: http://www.samhsa.gov/health-financing
Help for consumers – appeals
- https://www.paritytrack.org/get-support (for mental health claims)
ERISA (Employee Retirement Income Security Act – private plans)
- http://www.dol.gov/ebsa/publications/filingbenefitsclaim.html (how to)
- https://www.askebsa.dol.gov/WebIntake/Home.aspx (form)
CMS (Centers for Medicaid/Medicare Services) – public plans
- (877)267-2323, ex. 6-1565 or email [email protected]
OCR (federal Department of Health and Human Services Office on Civil Rights) – discrimination