Policy Track

Knowledge and Skills Building Workshops

PO01 - Supporting Your Patient in Appealing an Insurance Denial

Presenter(s)

• 

  Gaines Blasdel

  Medical Case Manager
  Callen-Lorde Community Health Center

  Nothing to disclose

Co-Presenter(s)

• 

  JM Jaffe

  Pronouns: they/them
  Trans Health Consulting, LLC (Founder) & Lyon-Martin Health Services (Consultant)

  Nothing to disclose

Overturning an insurance denial of a gender affirming surgery can have far-reaching effects, creating access not only for that one client, but also setting precedent for many others to be able to access that particular surgery. This workshop is designed for anyone assisting with the insurance authorization process, including professionals in surgical, primary care, and behavioral health fields. Attendees will be introduced to an overview of the insurance authorization and appeals process, recommended language, and suggested medical and legal citations to be used to create a strong case for medical necessity and overturn unlawful denials for their clients. The workshop will then split into "think tanks" on common cases, generating resources that can be shared with the workshop and larger summit.

 

Learning Objectives:

• Write an effective appeal letter to support clients who have been denied coverage by their insurance provider
• Cite primary literature, organizational statements, and local regulation in appeal letters to advocate for medical necessity
• Navigate the structure of an appeals process confidently and direct patients towards legal resources when provider-driven options have been exhausted

1. Write an effective appeal letter to support clients who have been denied coverage by their insurance provider
2. Cite primary literature, organizational statements, and local regulation in appeal letters to advocate for medical necessity
3. Navigate the structure of an appeals process confidently and direct patients towards legal resources when provider-driven options have been exhausted