These may include your service benefit plan, and a directory
\nof network providers. Many private health insurers send periodic newsletters and health promotion materials. These may help you better understand your benefits and your family\u2019s services.<\/p>\n
These statements generally include phrases about providing members with affordable, accessible care, forming working partnerships, and ensuring a member\u2019s peace of mind. These statements can be useful when you are discussing service coverage. Frame your needs using the words your insurer has provided.<\/p>\n
If your child has special health needs and requires ongoing services, ask your insurance if case manager or care coordinator services are available. This is a service that provides a single \u201cgo to\u201d person to help you understand your benefits and make the referral or pre approval process easier.<\/p>\n
Review every EOB you receive from your health insurer. Check for accuracy, the amounts paid, and any copayments you must pay. This is a good way to avoid billing mistakes.<\/p>\n
You may have a long-term partnership with your health insurance company, so it can be helpful to develop a trusting relationship that will benefit your child.<\/p>\n
If the customer service person or your case manager can\u2019t help you, ask to speak to the
\nperson who can, such as a supervisor or head of the department.<\/p>\n
All health care insurance reimburses services based on \u201cmedical necessity.\u201d Your health plan will have a definition for medical necessity in the service benefit plan. Frame your requests to reflect your insurance\u2019s description of \u201cmedical necessity.\u201d<\/p>\n
Write down the names and numbers of the people you speak with and a short summary of your discussion. If you have a problem getting a service covered, it is more effective to say, \u201cI spoke with Ms. Smith on February 1, 2025, and she approved \u2026.\u201d Rather than saying, \u201cThe last time I called I spoke with someone, she told me\u2026..\u201d<\/p>\n
If your insurance company refuses to authorize or pay for services after you have already submitted an internal appeal, you may be able to get help from the Office of Patient Protection (OPP). OPP may be able to conduct an external review, in which your health insurance\u2019s decision is reviewed by an independent doctor or other professional. Call (800) 436-7757 for more information.<\/p>\n
The Massachusetts Family-to-Family Health Information Center at the
\nFederation for Children with Special Needs is here to help.
\nCall 1-800-331-8688 or go to www.fcsn.org and complete an intake form.<\/p>\n
<\/p>\n
Massachusetts Family Voices is a project of Federation for Children with Special Needs.<\/p>\n
Funding provided by the U.S. Department of Health & Human Services, Health Resources & Services Administration, Maternal and Child Health Bureau, Division
\nof Services for Children with Special Health Needs, Grant #H84MC08005 to Massachusetts Family Voices @ the Federation for Children with Special Needs.<\/p>\n","protected":false},"author":51,"featured_media":1388577,"template":"","resources-categories":[237,303,305],"topics-filter":[314,266,270],"age_filters":[247,248,249,250,251],"language_filters":[308],"class_list":["post-1388913","resource","type-resource","status-publish","has-post-thumbnail","hentry","resources-categories-mass-family-voices","resources-categories-youth-young-adults","resources-categories-families","topics-filter-caregiver-support-wellbeing","topics-filter-health-insurance","topics-filter-medically-complex","age_filters-age-0-3","age_filters-age-3-5","age_filters-age-6-13","age_filters-age-14-22","age_filters-age-23","language_filters-english"],"translation":{"provider":"WPGlobus","version":"3.0.3","language":"es","enabled_languages":["en","es","pt","ar","zh","vi"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"es":{"title":false,"content":false,"excerpt":false},"pt":{"title":false,"content":false,"excerpt":false},"ar":{"title":false,"content":false,"excerpt":false},"zh":{"title":false,"content":false,"excerpt":false},"vi":{"title":false,"content":false,"excerpt":false}}},"acf":[],"yoast_head":"\n