A new tool in advocating for your patients
In the past year, UOA has been collaborating with an organization called "Advocacy for Patients with Chronic Illness" - see a link to their site below. They provide a variety of advocacy services AT NO CHARGE - initially for people with IBD and now branching out to those with other chronic situations. Their founder, Jennifer Jaff, is a lawyer with experience in disability law who herself suffers from serious Crohn's Disease. She works part time when she can, and devotes considerable time and energy to this donation-supported effort.
Jennifer informed me today that she has successfully helped convince an insurance company to cover the cost of a complicated situation for someone who needed an stoma relocation. Before the stoma relocation could be done, a significant amount of fat and extra tissue needed to be removed. The insurance company denied it initially, and on the first appeal, because this essentially is a tummy tuck, and there was an exclusion for 'cosmetic surgery'.
Jennifer and APCI provided legal analysis, photographs, etc., and yesterday heard that the insurer had reversed its decision and is going to pay for the surgery.
Since this kind of exclusion and denial may occur with other insurers as well, we thought you would all be happy to hear that we have one in the WIN column (a nice precedent to be able to point to), WITHOUT resorting to a costly legal suit. Many of you have probably had clients who needed this kind of advocacy... sometimes your clinical evidence will be enough to win the coverage, and sometime it needs to be taken up a notch - which is where Jennifer and her organization would be glad to help. You can find her contact information at www.advocacyforpatients.org. Remember, her service is free, and she works very hard to avoid actual lawsuits.
