Writing a Letter of Medical Necessity
- Name of child, names of parents (parents and child may have different names)
- Date of birth of child
- Insurance plan name (there may be more than one plan)
- Relevant diagnoses (codes are helpful only if they are accurate!)
- Item/service requested
- Why item/service is medically necessary (refer to the plans’ definition)
- What positive/negative impacts the item/service will result on (include financial) scope and duration of treatment
- Supplemental documents (letters from other providers, research articles, product information, PAR)
- Include funding streams NOT able to help (denial letters help)
Terms to use; medically necessary, clinically based, promoting independence, preventing secondary disability, cost-effective, safety.
Terms to avoid; custodial, rehabilitate, developmental delay/disability, speech delay (without a diagnosis such as aphasia), Caregiver convenience.
- Ask if your Letter of Medical Necessity answers the following:
- Is there a licensed provider stating in writing the item/service is medically necessary?
- Is this item/service not for care giver convenience?
- Is this item/service costs effective and if so have you explained how?
- Is this item/service considered standard medical practice?
- Have you explained how long and how often the item/service will be used.
- Is this item/service right for the need of individual?
The Responsibilities of Each Role
Care provider needs to know the process if the parent is not yet skilled
- pertinent benefits
- limitations and exclusions
- appeals process
- terms and their definitions
- distribute instructive materials to parents (empowerment)
- write perfect letters of medical necessity
Parent needs to
- become knowledgeable about the policy (a-d above)
- supply information to providers
- keep a paper trail of all communications
- confront conflicting information
Advocate’s role is to
- assist with the appeals process
- guide providers and parents to resources
- influence systems’ change
Health insurance plan’s staff member
- confuse the member as much as possible (i.e., change the rules often), and deny benefits to contain costs.
Position Title: Health Information Center Coordinator and Family Navigator
Family Voices Colorado (FVC) is seeking a Family Navigator and coordinator of the Colorado Family to Family Health Information Center (F2FHIC). The position may be combined as one full-time position or two part-time positions depending on the candidate(s). The position is based at CBR YouthConnect’s (CBRYC) Lakewood Colorado office since FVC recently became a program of CBRYC.
The Family Navigator and F2FHIC Coordinator provides resources and system navigation for families experiencing barriers to care for a child with special health care needs. The Health Information Center is funded by a Federal grant recently renewed for four years. In partnership with families, hospitals, providers, and community based agencies, the Family Navigator will actively engage in system navigation and advocacy on behalf of families. In addition, the Family Navigator coordinates the information center and works with partners to continuously develop and update resources for families, and provide information and training for families throughout Colorado.
Qualified candidates will have a deep commitment and passion for making Colorado a better place for children with special health care needs and must possess highly-developed communication skills both verbally and written and in English and Spanish. Applicants should be able to handle multiple tasks and work in a fast paced environment. Additional qualifications include:
- Family experience with a person with a disability (child, parent, sibling, and grandparent) preferred.
- Bilingual/Bicultural Spanish and English required including writing proficiency (Test required).
- Clinical and/or non-clinical education and/or experience with systems encountered by families who have a child with a special health care need preferred.
- Applicants must have strong interpersonal skills and career interest in working effectively with diverse communities.
- Applicant should be self-motivated, but also effective at working as part of a team.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook) required.
- Proficiency with social media platforms (Facebook, and Twitter) required.
- Reliable transportation, good driving record and motor vehicle insurance required.
- College degree and/or equivalent work experience preferred.
Salary is commensurate with experience and qualifications. Additional benefits include health and dental insurance, company paid training, generous paid time off and holidays.
About CBR YouthConnect (CBRYC)
CBR YouthConnect’s mission is to achieve excellence in providing troubled youth with the means to become hopeful and productive citizens. This is accomplished by serving at-risk children through person-centered, trauma-informed social work and clinical practice, with an emphasis on social-emotional learning and civic responsibility. CBRYC has a long history in the Colorado community. The organization was established in 1959 and was previously known as the Colorado Boys’ Ranch, a nationally recognized, award-winning residential treatment and education center
How to Apply
Candidates may submit a cover letter, electronic resume, and salary requirements to email@example.com
No Phone Calls Please