Category Archives: Tools & Resources for Families

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.

Important! We need your input!

Your Voice Counts!
Family Caregivers of Colorado – we need YOU!
Limited time to complete the Colorado Caregiver Survey – survey deadline has been extended and ends Friday, April 20!
Please share this vital survey information with your network.

 

The Colorado Respite Coalition and Easterseals Colorado are sharing a survey to learn more about the experiences of caregivers who provide primary and frequent support to individuals of any age with special needs.
Findings from the survey will be used to better understand: 
  1. The impact of the respite services on the health and quality of life of caregiver and care recipient
  2. The respite care needs of individuals in Colorado
  3. The availability, accessibility, and quality of respite care providers in Colorado
Survey participants may be caregivers of individuals with ANY special health care needs, including disabilities, chronic conditions, behavioral needs, and needs associated to aging. The survey is being conducted by Health Management Associates and will be open until April 20, 2018.
Ten participants will be randomly selected to win $100 gift certificates.
To learn more about the survey, visit:
HELP SPREAD THE WORD: SHARE INFORMATION REGARDING THIS CRUCIAL SURVEY WITH CAREGIVERS YOU KNOW! Your story will help us advocate for Colorado families.
Questions? Contact Robyn Odendahl, Health Management Associates at rodendahl@healthmanagement.com or 720.638.6710.

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.