Special Needs Resource Directory

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Health Insurance Issues

General Resources

American Academy of Child & Adolescent Psychiatry provides information about understanding mental health insurance.
Catalyst Center provides information on improving health care insurance coverage for children and youth with special health care needs.
Centers for Medicare and Medicaid Services provides comprehensive information on eligibility and coverage.
Children and Youth with Special Health Care Needs are supported in each state through Title V government funding. A directory of local contact information and services is available.
Cincinnati Children's Financial and Medical Assistance Programs for Families has counselors who can help arrange for payment plans, discounts and financial assistance for eligible patients and families. The Hamilton County Tax Levy provides medical coverage for indigent care through the University of Cincinnati Hospital and Cincinnati Children's. For further information and an application, please contact Patient Financial Services at Cincinnati Children's, 513-636-4427.
CoverCincy provides information on health insurance coverage, paying hospital bills, help with prescription medication and local community health centers.
Cover the Uninsured provides guides for finding health insurance coverage in each state.
Families USA has information on public and private sources of health insurance.
Georgetown University Health Policy Institute offers a consumer guide to getting and maintaining health insurance. Guides summarize consumer protection by state, including Ohio, Indiana and Kentucky.
Kaiser Family Foundation publishes A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan.
National Health Law Program provides publications, notices of current and upcoming legislation, information on advocacy all related to health care issues.
National Institutes of Health provides comprehensive information about health insurance.
Ohio Department of Insurance provides information on Health Mainenance Organizations (HMO) as an alternative to traditional insurance. An HMO will accept individuals during their Open Enrollment Period regardless of any pre-existing health conditions. They also provide a Health Insurance Guide that explains different types of coverage.
State Children's Health Insurance Program (SCHIP) is federally funded health insurance designed to provide support to families and children up to the age of 19.
United Healthcare Children's Foundation offers assistance grants for children's medical services not fully covered by health insurance.
University of Washington School of Public Health has compiled a glossary of health care management terms for consumers.

Find additional information on health insurance programs under Financial Assistance.

Glossaries of Insurance Terms

Health Insurance Finders provides information about a variety of health insurance issues, including understanding health insurance terms.
Medical Economics offers a series of handouts for patients and families, including "Translating Insurance Speak."
Ohio Department of Insurance provides a health insurance guide that explains different types of coverage.
Patient Advocacy Foundation published "The Managed Care Answer Guide" with information about understanding managed care terminology, a consumer guide to selecting an insurance plan, and understanding the provisions of a health care plan.
Robert Wood Johnson Foundation has a glossary of health care quality terms.
University of Washington School of Public Health has compiled a glossary of health care management terms for consumers.

BCMH

Bureau for Children with Medical Handicaps (BCMH) is a tax-supported, state-administered program through the Ohio Department of Health. The mission of BCMH is to assure that children under age 21, with special health care needs, obtain comprehensive medical care and services that are family centered and community based and culturally sensitive:

Information for families on enrollment, eligibility and services
Core programs and special services covered
BCMH-approved health care providers for equipment, facilities, pharmacies, and medical practitioners in Ohio are arranged by county
BCMH medical application can be downloaded
You can download a copy of their comprehensive guide, A Handbook for Families of Children with Special Health Care Needs in Ohio: Programs and Services

Medicaid / Medicare

Medicaid is a publicly funded health insurance program that provides health coverage to families with low incomes, children, pregnant women and people who are aged, blind or who have disabilities. Individuals must first apply for Social Security benefits (SSI / SSDI) prior to applying for Medicaid. Ohio Department of Job and Family Services provides information about income eligibility requirements and the application process including:

Medicaid Fact Sheet on services for the aged, blind or disabled
Medicaid Consumer Guide
Medicaid Managed Care Weekly newsletter

Find the Medicaid agency in your state.

Medicaid Buy-In for Workers with Disabilities (MBIWD) begins in Ohio on April 1, 2008. MBIWD is an Ohio Medicaid program that provides health care coverage to working individuals with disabilities. Historically, people with disabilities were often discouraged from working because their earnings made them ineligible for Medicaid coverage. MBIWD was created to enable Ohioans with disabilities to work and still keep their health care coverage. The program has eligibility and financial requirements. Applications are available from your local county office of Ohio Department of Job and Family Services.

Medicare provides qualified adults with disabilities with publicly funded health insurance. This site provides general information about the Medicare program and has an online "eligibility tool."

Pre-Existing Conditions

The Health Insurance Portability and Accountability Act (HIPAA), effective July 1, 1997, provides certain protections for people who have pre-existing medical conditions. A pre-existing condition is any medical condition that a person has before being enrolled in an insurance plan. This law helps protect your health insurance benefits by:

Limiting exclusion periods for pre-existing conditions.
Lowering your chances of losing your existing coverage or of being discriminated against because of your health.
Providing protections for you when you change jobs.

The length of time coverage can be denied for a pre-existing condition under HIPAA is limited to no longer than 12 months (18 months if you are a late enrollee). This time can be reduced or eliminated if you were covered by previous health insurance (which qualifies under HIPAA as creditable coverage) and if there was not a break in coverage between the plans of 63 days or more.

Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, has information on health insurance and pre-existing conditions.
Consumer Guide for Getting and Keeping Health Insurance, written by the Georgetown University Health Policy Institute, provides information for each state.
Health Insurance Portability and Accountability Act Fact Sheet provides a summary of protections.

Appeals / Writing Letters of Medical Necessity / Prior Authorization

Many families depend on their insurance company to pay for expensive treatments, assistive technology and adaptive devices. Insurance denials can be appealed since decisions are sometimes made by an individual who may not be an expert on the condition or recommended treatment. It is important to know the fine details of your insurance policy.

A strong letter of medical necessity or appeal can often make the difference in what an insurance company will cover. The physician or health care specialist writes the letter emphasizing how the individual's life will be affected by permitting or denying treatment. There are also rare situations when an attorney is needed. Alternative sources of funding may be available if the insurance coverage is inadequate or denied. These web sites provide sample letters, checklists, strategies and appeals process information.

DoctorBach.com provides a variety of sample letters of medical necessity for treatment, equipment and training needs. The user can create a letter by filling in the blanks of a worksheet.
Rifton Equipment offers a checklist for writing an effective letter of medical necessity, sample letters, and strategies on how to deal with the appeals process.
Utah Collaborative Medical Home Project details the important components of an effective letter of medical necessity. You can find a helpful form that can be used as a guide to assist you in the letter writing process. Important information is also provided on how to appeal an insurance decision when a request for funding is denied. .