Working with Insurance Companies

Insurance providers often require prescriptions, preauthorizations, or letters of medical necessity to cover the costs of some medications, equipment, services, nutritional or other supplies, and procedures that children with chronic and complex conditions need. The medical item requirements, processes, time frames, and options for appeal vary by insurer. Who responds to these requirements and communicates/coordinates with the insurers, families, and service providers should be considered, along with the expectations for each step’s timeframe and what to do if a request is denied. Designating a care coordinator or another staff member to manage these requests and processes is recommended. Keeping records of what does and does not work, who at an insurer is or is not helpful, important phone numbers and URLs, copies of prescriptions, forms, and letters of medical necessity, and appeals can improve processing times and success rates. Periodically updating forms and personal insurer contacts’ information keeps this often changing information current.