CKSN UPDATE for May 15, 2003			ABC for Health, Inc.

IN THIS ISSUE:

1. CASE TIP:  First Steps in Fighting Private Insurance Denials
2. CASE TIP:  Flat Feet and Orthotics
3. Health Disparities and People with Developmental Disabilities Web Site
4. Websites from the Northern Regional Center for Children with Special Health Care Needs
5. Public Interest Law Conference in June
6. HealthWatch Contacts




1. CASE TIP:  FIRST STEPS IN FIGHTING PRIVATE INSURANCE DENIALS

What do you do if your private insurance denies a claim?  You must first obtain a written denial and a copy of your Insurance Plan.  Pursuant to State and Federal law you have the right to an explanation of the denial with references to the language in your Plan.  Your Plan defines the coverage you are entitled to and is the basis for contesting denials.  What do you do if you cannot get a copy of your Plan or a written denial?  Write a letter to your insurance company requesting this information.  A copy of your Plan must be provided within 30 days of your request.  After 30 days a $110.00 per day penalty accrues against the Insurance Company.  (See the Health Insurance Guide Book at ABC's web site, www.abcforhealth.org regarding where to send your request and for other important information). 


2. CASE TIP:  FLAT FEET AND ORTHOTICS

Children with special health care needs may require orthotic devices to help with balance and walking.  These type of devices need to be characterized correctly in your provider's prior authorization (PA) request.   If your child has "flat feet" and is on Wisconsin Medicaid it is important to know that Wisconsin Medicaid does not cover this medical condition.  According to HFS 107.06(5) Wisconsin Administrative Code, "services directed toward the care and correction of 'flat feet'" are non-covered services.  In addition, "orthopedic shoes and supportive devices such as arch supports, shoe inlays and pads" are non-covered services.  

Therefore, if you take your child to the doctor because he/she needs an orthotic device and is also suffering from a condition that results from flat feet, it is important that your provider (doctor) write down the correct diagnosis as part of a PA.  If the provider only writes "flat feet" as the diagnosis on the claim, it will not be paid.  Mentioning this important fact to your provider will increase the chances of getting this claim paid by Medicaid.  

If your provider is billing you for claims that were denied by Medicaid because "flat feet" are not covered, and you believe that your provider may have written the wrong diagnosis on the claim, you can contact a Medicaid and BadgerCare Ombuds at 1-800-760-0001.



3. HEALTH DISPARITIES AND PEOPLE WITH DEVELOPMENTAL DISABILITIES WEB SITE

The Waisman Center at the University of Wisconsin - Madison recently launched a new website for its Health Disparities and Developmental Disabilities Initiative.  This website features the action plan, publications and trainings that are a part of this initiative, which is a statewide, collaborative effort that is facilitated by the Waisman Center - University Center for Excellence in Developmental Disabilities, Wisconsin Coalition for Advocacy, Wisconsin Council on Developmental Disabilities and the Wisconsin Department of Health and Family Services. The "Wisconsin Blueprint to Improve the Health of Individuals with Developmental Disabilities" and its 31 action steps serve as the overall plan for this health disparities initiative. The website is: 
http://www.waisman.wisc.edu.healthdisparities/index.html


4. WEBSITES FROM THE NORTHERN REGIONAL CENTER

Thanks to Robin Mathea and Diane Strong Allgood from the Family Resource Connection in Rhinelander for the following suggested websites that are helpful for families who have children with special health care needs. 

Genetics:
http://ghr.nlm.nih.gov

For Parents & Teachers:
http://www.do2learn.org/

Health Care in Schools:
http://www.healthinschools.org/home.asp

Tips for preventing medical errors:
http://www.aap.org/visit/02-P034-20Tips.pdf

Center for Effective Collaboration and Practice: http://cecp.air.org/

Health Information tips:
http://www.askme3.org/

Fact sheets on recreation/games/resources & accessibility:
http://www.ncpad.org/Factshthtml/default.htm

Special Education Law and Advocacy (printable articles):
http://www.reedmartin.com/addarticles.htm

Facts for families: http://www.aacap.org/publications/factsfam/index.htm


5. PUBLIC INTEREST LAW CONFERENCE IN JUNE

The second annual Public Interest Law Conference will be held in Madison on June 10 at the American Family Insurance Headquarters.  This year's conference will focus on "Advocacy, Representation and Referral of the Low-Income Client."   The full day seminar will feature an experienced panel of experts from various areas of practice who will provide practical advice on navigating legal forums that commonly affect a low-income client. For further information, visit the State Bar's website at www.wisbar.org or phone 1.800.728.7788 or 1.608.257.3838.  


6. HealthWatch Contacts

If you are interested in joining your regional HealthWatch committee, or want more information about their work, please contact the following people:

Southern Region:  Barbara Katz, ABC for Health, Inc., 608.261.6939 ext 207, barbk@safetyweb.org
Southeastern Region:  Brad Holman, Children's Hospital of Wisconsin, 414.266.3189,
bholman@chw.org
Northern Region:  Deb Blackstone, Family Resource Connection, 715.365.8030,
dblacks@shsmh.org
Northeastern Region:  Steve Gerczak, St. Vincent Hospital, 920.433.8154,
sgerczak@stvgb.org
Western Region:  Rose Marsh, Chippewa County Dept of Public Health, 1-800-400-3678, rmarsh@co.chippewa.wi.us


The CKSN Update is a bi-weekly electronic newsletter of the Covering Kids with Special Needs project that ABC for Health, Inc. is implementing with its partners, the Title V Children with Special Needs Regional Centers and Family Voices - Wisconsin.  If you would like to submit news and information in future CKSN Updates, please send it to the attention of Barbara Katz.  All submissions should be limited to 150 words.

Barbara Katz, moderator
Parent Consultant
ABC for Health, Inc.
152 West Johnson Street, Suite 206
Madison, WI  53703-2213
608-261-6939, ext. 207
barbk@safetyweb.org