[DYSPHAGIA] Ins co pay for formulas?

[drjeff6@juno.com (Jeffrey I Lewis)]

Dear Julia:

What a "horror story"!  Unfortunately, that does happen.

I brief, the remedies available depend on the kind of insurance you are
talking about.  If the child is on a federal form of funding or a state
funded insurance, the remedy mechanism is a part of the law creating the
program.  If it is a private insurance, most have appeal procedures that
they are mandated to have.  A letter should be written to this type of
company and sent registered.  If it came from a lawyer's office, that
would be "a nice touch".  In the letter, they should put the company on
notice that there is a disagreement with their interpretation and request
a fair hearing or any parallel system in place for appeal.  The next
steps are obvious.

If the insurance is through an HMO, there are legally required appeal
procedures that are a part of what the company had to have available in
order to be approved as an HMO.  They will likely respond to a phone call
requesting the information.  To expedite matters, I have found it best to
start in the Administrator's office to get the information rather than
get "jerked around" by a bunch of well-intentioned but under-informed
helpers.

Hope this helps and that things resolve favorably to get that little one
all that s/he needs.

Sincerely,
Jeff Lewis
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