We know that understanding insurance benefit coverage can be confusing. If you want to learn more and get a better understanding, click to watch Health Insurance 101 - Learning and Navigating the System.
The MAGIC Foundation, although involved only in the External Appeal Stage of a denial, realizes people may have difficulty understanding and navigating the entire appeal process when your child's medication has been denied by your insurance company. The Juvenile Diabetes Research Foundation (JDRF) has included a very good article explaining denials and appeal levels on their website This information can be applied to any medical condition and is not specific to diabetes. We hope this resource will provide you with a better understanding of an often difficult process.
In addition to the above information on general health insurance processes, we wanted to include some specific information for families who have a child either on GH therapy or will be starting GH injections. This information does not guarantee insurance approval but is meant to provide information that may be helpful when considering your benefit coverage.
The MAGIC Foundation realizes that families are often left without resources when trying to file appeals, especially so at the external appeal stage. An insurance company must provide you with the opportunity to file an external appeal after all of your internal appeals are exhausted. The external appeal is considered the last appeal available to a member and the determination is final.
In an effort to provide support for our families, MAGIC provides assistance with external appeals via our appeals department or with online external appeal templates.
In order to help you understand the usual external appeal process, we have included some considerations you may want to think about when choosing an insurance company. Even though you, hopefully, will never need to do an external appeal, it is good to do your homework beforehand so you are well prepared if an external appeal becomes necessary.
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