ADVOCATING FOR CHILDREN Muhammed WITH SPECIAL HEALTHCARE NEEDS - PowerPoint PPT Presentation

3/6/2014 ADVOCATING FOR CHILDREN Muhammed WITH SPECIAL HEALTHCARE NEEDS Feda Almaliti LLE M a r c h 6 , 2 0 1 4 We all wear many hats… A Positive Message � Parent of a child with special health care needs � Appointee to the State Council on Developmental Disabilities � Appointee to Advisory Commission on Special Education � Parent of a TEENAGER! � Advocate 1

3/6/2014 What is an Advocate? Real World Definition: Merriam-Webster Dictionary 1. One who pleads another ’ s cause advocate (n.) 2. One who argues or pleads for a cause or proposal American Heritage Dictionary 2000 advocate (v.) 1. The Art of pleading or arguing in favor of something, such as a cause, idea or policy; active support. What is the biggest change in this country in the Why should you be an Advocate? last 50 years… � It is every healthcare providers duty � It’s a very natural part of your job and you do it all the time i.e. in the form of treatment decision � You bring credibility to the issues � No one else may be advocating � Everyone needs an advocate 2

3/6/2014 Patient Protection & Affordable The Exchange Care Act � Ambulatory patient services � Emergency services � Hospitalization � 50% coverage of DME � Maternity and newborn care � Mental health and substance use disorder services, including behavioral health treatment � Prescription drugs � Rehabilitative and habilitative services and devices � Laboratory services � Preventive and wellness services and chronic disease management � Pediatric services, including oral and vision care “ A ROSE BY ANY OTHER NAME ” Common Denials � The word “habilitative” has been at the heart of health insurance coverage denials for children Not medically necessary � Health insurers typically claim to cover Experimental “rehabilitative” and not cover “habilitative” � Habilitative definition - Health care services that Not a covered benefit help a person keep, learn or improve skills and functioning for daily living 3

3/6/2014 Continued Barriers to Care Leading the country Parents of CSHCN’s are under extreme pressure. � Therapies/treatments for CSHCN is a financial hot potato. � Insurance companies have traditionally refused to pay for it. � Social services agencies play hide-the-pea with confused parents until their children age out of � eligibility. School districts expertly pick up where the agencies leave off, � The “system” is not fair. � The “system” is confusing. � Parents of CSHCN are exhausted (mentally, financially and emotionally) � Getting treatment for CSHCN will always be a challenge. � It is and will never be easy to get coverage for expensive treatments/therapies � Primum non nocere Cue the sappy music… � Everyone is entitled to medical care. � DD patients are entitled to have their quality of life maximized. � Families are your partners. � Do NOT be shamed into giving up. � Only 10% of denials appeal. � Do not take NO for an answer. 4

3/6/2014 Q & A Fragen? Fragen? des questions? ேகளவிக domande ள ? ? câu hỏi? सवाल ? ? תולאש Tanong? ؟شسرپةلئسأ 问题 ？ 질문 ? Preguntas? 5