Appeals

The Healthcare Access and Financing, Medical Home and Education and Dissemination work groups of the NEGC developed resources for families and providers on how to appeal health care insurance claims denials. Links to external resources are also provided.

• Navigating the Health Insurance Appeals Process for Children with Genetic Conditions
  • ​3 Hints to Help You Navigate the Appeals Process
    1 page infographic for your office or waiting area, stressing the value of families and providers working collaboratively for the best outcomes.
  • Parent Guide
  • Contact list for New England
  • ​​Age Group:Child, Teen/Young Adult

Helpful links:

• Appeals: Appealing Funding Denials​
  From the Medical Home Portal, University of Utah
  Age Group:Child, Teen/Young Adult
   
• Catalyst Center: Improving Financing of Care for Children and Youth
  National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs (CYSHCN). Includes State Data, Heatlh Care Transformation; Financing Strategies; Info for Families, and more. 
  Age Group: Child, Teen/Young Adult
   
• Complaints and Appeal Processes
  ​HealthyChildren.org
  Age Group: Child
   
• Consumer Complaints Toolkit: Health Insurance Resources for Health Advocates, Health Providers and Enrollment Assisters
  ​From Community Catalyst, Boston (June 2016).
  Age Group: Child, Adult
   
• Customizable Medical Home Brochure for Families
  ​From the American Academy of Pediatics & National Center for Medical Home Implementation
  Age Group: Child, Teen/Young Adult
   
• Family-to-Family Health Information Centers
  Looking for the Family-to-Family Health Information Center (F2F) in your state?  Visit the Family Voices National Center for Family/Professional Partnerships website to find your F2F and learn more about how these centers provide free service to families of children/youth with special health care needs and the professionals that serve them.
  Age Group: Child, Teen/Young Adult
   
• Family Voices
  Family Voices is a national, nonprofit, family-led organization promoting quality health care for all children and youth, particularly those with special health care needs. 
  Age Group: Child, Teen/Young Adult
   
• Family Voices: Helping Families & Professionals Maneuver the Maze of Complex Conditions
  Part of a six-part webinar series: It's All About Teamwork: Incorporating Genetics and Family History into the work of the Patient Centered Medical Home (PCMH)
  Age Group: Child, Teen/Young Adult
   
• Health Care Financing for Your Child with Special Needs: Six Ways to Access Medicaid and other Health Care Benefits
  (see page 33) Vermont Family Network
  Age Group: Child
   
• How Families of Children with Special Needs Can File Insurance Complaints
  Family Voices (July 2016) ​(Also go to your state’s Family Voices organization, found through the national website)
  Age Group: Child
   
• Pathways to Reimbursement Success
  Cambrooke Therapeutics (includes several LMN for medical food, seizure disorder, PKU and other metabolic conditions)
  Age Group: All
   
• Rare Toolkit: Navigating Health Insurance
  From Global Genes,  one of the leading rare disease patient advocacy organizations in the world
  Age Group: Child, Teen /  young adult, adult