What's New In Health Care

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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.

 

The Realizing Health Reform’s Potential issue brief series at http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2010/A-New-Series-of-Briefs-on-the-Affordable-Care-Act.aspxexamines how the ACA will benefit different groups, improve health insurance coverage, and change the way care is delivered.

 

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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