The Art of Patient Advocacy
By
Kathleen Anderson
PERSISTANCE is the most important skill
needed when negotiating patient advocacy issues. Whether it
be for yourself or a loved one suffering with RSD, persistence
will become a tool that must be utilized to ensure proper
treatment and enable RSD patients the ability to utilize the
services legally available to them.
Pain patients are a vulnerable population.
Insurance companies, government agencies and social services
are well aware of this. The response to your first claim or
request will usually be a denial. Be strong — they don't
expect you to be — so be strong and appeal! The squeaky
wheels gets what they want.
Insurance companies and HMOs will deny
claims for in-patient services, physical therapies, brand
name medications and services offered outside of the network.
The key is not to accept "NO"for an answer. Know
your rights.
1. If an HMO cannot provide appropriate
services within their network —they must pay for you
to go out of network.
2. A physician may require and prescribe
a name brand drug in lieu of a generic drug. The insurance
company must provide the name brand drug at the co-pay cost
regardless of the availability of the generic drug.
3. Social Security may deny your first
claim for benefits. APPEAL! New wording is being established
for RSD and hopefully claims will be approved more expeditiously
in the future. Until then — APPEAL!
4. Worker's Compensation requires the
same tenacity — APPEAL its denials.
5. Your local school system may tell
you they cannot provide modifications for your child, home
tutoring, or the combination of the two. This is discrimination
and you have rights. Read the pamphlet they provide. Get your
child referred to special education or 504 status. They must
provide an appropriate education to all children under the
age of 18 in a public school setting. Ask for assistive technology
testing, neurological testing, tutors, transportation, and
individual education plans. It is your child’s right
and you pay taxes to receive these services.
6. Do you or your loved one need special
services? Call on your state's Department of Social Services.
Make an appointment and find out what services are available.
7. Do you or your loved one want to
get back to work — even part time? Then call on your
state Department of Rehabilitation. Learn about vocational
rehabilitation.
If you are having a problem with one
the agencies, pick up your phone and call the Commissioners
Office. Go right to the top. They may direct you to another
person; but the directive has come from the Commissioners
Office and they don't like adversity.
If going to your Commissioner doesn't
seem to help — call your local newspaper, television
network or even go to the Office of Consumer Protection in
your particular state. Tell your story. You will be surprised
at how fast things will get rectified. Don't be afraid to
fight for your rights or the rights of your loved ones.
Reflex Sympathetic Dystrophy is a very
complex disorder. Assistance doesn't come easy. In short,
never accept "NO" for an answer. Awareness is a
key element in solving these dilemmas. Be verbal, be informed
and most important —"Be Persistent!" |
