An efficient letter adheres to a couple key factors. “A very powerful factor is language. Insurance coverage firms reply to very particular phrasing,” says Kiara DeWitt, RN, a pediatric neurology nurse at Cook dinner Youngsters’s Medical Middle in Fort Price, Texas, whose affected person advocacy efforts embrace serving to them decode insurance coverage denials and navigate billing misfires.
“In case your supplier says, ‘affected person wants X,’ that may be a possibly. If they are saying, ‘documented failure on formulary various,’ the percentages go manner up,” she says. “In the event that they add ‘proof of escalation protocol failure’ or ‘danger of irreversible situation development,’ that kicks it up once more. These particulars matter. Get scientific. Get precise. Keep away from emotion. Communicate their language.”
Some insurance coverage enable formulary exceptions to be submitted on-line. Examine your well being plan’s web site to see for those who can file electronically. For those who’re denied approval, the Affected person Advocate Basis advises calling your well being plan concerning the denial. Each plan is required to have an appeals course of, so ask what your timeline is for submission. You may file the attraction by yourself, ask your physician for help, or search out a affected person advocate to assist.
