MP3 and Materials on September 23rd Health Care Reform
Provisions Available
SPAN’s
Family to Family Health Information Center can help you understand the new
health care reform law and how it impacts children. On September 22, SPAN
presented a teleconference on the new provisions that kicked in on September
23. Listen to the recorded teleconference (MP3), along with the presentation
materials, an implementation timeline and fact sheets from Families USA and
other health advocacy organizations at: http://spannj.org/healthcarematerials.htm.
Health Organizations Launch New
On-Line Health Care Reform Resources
The
Kaiser Family Foundation, http://healthreform.kff.org,
offers explanations of the law, analysis of policy issues in implementation,
and quick and easy access to data, studies and developments and a short movie,
“Health Reform Hits Main Street,” is an animated short movie that clearly
explains the health reform law. You’ll also find a customizable Implementation
Timeline for the major provisions that can be viewed by year of implementation
or topic.
Check
out the interactive state-by-state map with pop-ups of key state-specific
information on health coverage and the health law, statehealthfacts.org.
The
Commonwealth Fund’s Health Reform Resource Center, http://www.commonwealthfund.org/Health-Reform/Health-Reform-Resources.aspx,
offers a comprehensive tool for understanding the provisions of the ACA.
Visitors can view a timeline of the law's major provisions and use the
"Find Health Reform Provisions" tool to search for summaries of
specific provisions by year, category, and/or stakeholder group.
FamiliesUSA’s
Health Road Central: The Road to Implementation, http://www.familiesusa.org/health-reform-central/
features the Patients’ Bill of Rights and other Consumer Protections; a quick
overview of the health reform law and its timetable; fact sheets and issue
briefs on specific aspects of the law; information that states will need to
implement the law; an interactive state map that shows how many people in each
state will gain health coverage and other state-specific material; and advocacy
tools.
Great Resources
For Families With Children With Health Challenges
Family Voices www.familyvoices.org/TakeActionHCR.php
Catalyst Center http://hdwg.org/catalyst/news/2010-01-08/2
Community Catalyst
www.communitycatalyst.org/projects/implementing_reform
Families USA www.familiesusa.org/health-reform-central
HealthCare for America Now http://healthcareforamericanow.org
What to Do When Your
Health Insurance Company Won’t Pay
FACT: Insurance
companies depend upon consumers not appealing decisions. Only one-third of
consumers file appeals. 50% of the time, the decision is reversed on the
first appeal. Here is how to appeal step-by-step (may not need to do all
steps):
1. Call your insurance company to appeal. Be prepared to
follow-up in 2-3 weeks if you don’t get a new explanation of benefits. (*If
the denied claim has a deadline, skip to step 2 instead of waiting)
If that doesn’t
work…
2. Write an appeal letter. Include a copy
of the claim and denial. Send it certified mail, return receipt requested.
If that doesn’t
work…
3. Many times, your employee benefits
department will assist you with a difficult claim.
If that doesn’t work…
4. Send an additional appeal, including
documentation of why it is “medically needed” (for example doctor’s note). This time, copy
the NJ Commissioner of Insurance, PO Box
325, Trenton, NJ 08625 Although many “self-funded or self-insured” plans
aren’t subject to state regulations (due to the Employee Retirement Income Security
Act), these same insurance companies that compete for the Medicaid managed care
and other state contracts, and they don’t want to look bad to the
Commissioner.
If that doesn’t
work…
5. Contact an advocacy organization such as the Family
to Family Health Information & Resource Center/Family Voices-NJ @ SPAN
(800-654-SPAN), the Community Health Law Project at (973) 275-1175, or Disability
Rights NJ at (800)
922-7233.
NOTE: for Medicaid-see Family Voices-NJ @ SPAN
Medicaid factsheet #4 at
www.spannj.org/familywrap/fact_sheet4.htm
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