NAVIGATING HEALTH INSURANCE,
MEDICAID AND CHP+
After diagnosis, parents of children who have a hearing loss are inundated with information. Who pays for hearing aids? What is the difference between occupational and physical therapy? Does my child qualify for a cochlear implant? What services does my health insurance policy, or Medicaid, or CHP+ cover? The answers to these questions are unique for every family. By increasing consumer knowledge about your rights and responsibilities concerning health care, you can more effectively advocate for your child's health care needs.
Denials from insurance companies, Medicaid and CHP+ occur. Most parents don't realize that a denial of coverage doesn't necessarily mean no. Persistent parents have gone through the appeals process and obtained hearing aids, therapy or other services for their child.
Whether health insurance or Medicaid covers your child, it is important to read and understand your health benefit plan. Is the requested treatment an exclusion or a covered benefit? The language in the policy may not be clear and limitations may apply. It is also important to carefully read the section of your benefit plan that describes the appeals process.
Developing positive relationships with key individuals, such as your providers and insurance company, is important. You need to work closely with someone in the billing department. The physician provides an ICD-9, or principle diagnosis code. A CPT-4 (Current Procedural Terminology) code is a systematic listing and coding of procedures and services performed by physicians and service providers. Any inconsistency found in these codes can result in denial of service.
Keep a list of names of those individuals who are helpful. If you have not been assigned an insurance case manager, request one. It is helpful if the contact person is the same each time you call your insurance company. Knowing the individual that has closest access to a physician or a therapist can expedite the process. Don't hesitate to draft or even revise a letter of medical necessity for a professional; the wording needs to be very specific and this will help give the professional an idea of what needs to be stated in the letter.
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