Category Archives: System Navigation

Family Voices Resource Blast

Resource eBlast July/August 2018
Sharing Resources for Families of Children with Special Healthcare Needs
 
Back to School Checklists for CYSHCN
Back to school time is around the corner!  These checklists can help guide your planning to ensure your child/youth with special health care needs (CYSHCN) has a seamless return:
Looking for ideas of adaptive back to school supplies or supplies to contribute to classrooms? Let this list of ideas get your creative juices flowing!
Online options to get started with your shopping:
Have a tween or teen entering middle school this year? How do you support your child through the tumultuous time? Check out these tips from the Family Voices IMPACT project.

Part of transitioning to a new school year is figuring out how to ease kids from the more relaxed summer days and nights into a new school routine while continuing to get good sleep. This Family Voices resource addresses the tricky intersection of adolescence, sleep, and mental health.

Writing a Letter of Medical Necessity

Writing a Letter of Medical Necessity

  1. Name of child, names of parents (parents and child may have different names)
  2. Date of birth of child
  3. Insurance plan name (there may be more than one plan)
  4. Relevant diagnoses (codes are helpful only if they are accurate!)
  5. Item/service requested
  6. Why item/service is medically necessary (refer to the plans’ definition)
  7. What positive/negative impacts the item/service will result on (include financial) scope and duration of treatment
  8. Supplemental documents (letters from other providers, research articles, product information, PAR)
  9. 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.

  1. 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

    1. pertinent benefits
    2. limitations and exclusions
    3. appeals process
    4. terms and their definitions
    5. distribute instructive materials to parents (empowerment)
    6. write perfect letters of medical necessity

Parent needs to

    1. become knowledgeable about the policy (a-d above)
    2. supply information to providers
    3. keep a paper trail of all communications
    4. confront conflicting information

Advocate’s role is to

  1. assist with the appeals process
  2. guide providers and parents to resources
  3. influence systems’ change

Health insurance plan’s staff member

    1. confuse the member as much as possible (i.e., change the rules often), and deny benefits to contain costs.

 

 

Need Help Filing For Disability?

From our Friends at Easterseals Disability Services,

Do you know someone who need help filing for disability?  We’re here to help!

Refer them to our six one-hour webinars covering the following topics

(1) The Basics of SSI and SSDI                         (4) The SSA Work History Report

(2) The SSA Forms 3368, 827 & 1696             (5) The SSA Adult Function Report

(3) The Medical Eligibility Criteria                 (6) Transition from Childhood to Adult Disability

Register and find out more at http://www.easterseals.com/co/our-programs/dbs/webinar-trainings.html or see attached flyer!  If you have any questions, please contact me at bkish@eastersealscolorado.org or 303-515-1653.