1. Do you help with insurance denials and appeals?
If your health plan refuses to pay a claim, you have the right to appeal the decision and have it reviewed. We can help guide you on the process of appealing. While we do not do the actual appeal for you, we can help you figure out what steps you need to take, assist you in crafting an appeal letter, gathering all the necessary documents, and decipher all that needs to be done within the timeframes needed. For reference, a health insurance denial happens when your health insurance company refuses to pay for something. An appeal is a request for your health insurance to review a decision that denies a benefit or payment.
If your health plan refuses to pay a claim, you have the right to appeal the decision and have it reviewed. We can help guide you on the process of appealing. While we do not do the actual appeal for you, we can help you figure out what steps you need to take, assist you in crafting an appeal letter, gathering all the necessary documents, and decipher all that needs to be done within the timeframes needed. For reference, a health insurance denial happens when your health insurance company refuses to pay for something. An appeal is a request for your health insurance to review a decision that denies a benefit or payment.
2. Can you help me choose an insurance plan?
We cannot recommend the best insurance plan for you and your family. However, we can assist you with finding services and organizations trained specifically in selecting health insurance plans. We can also help you understand the meaning of certain aspects of your insurance plan or proposed insurance plan.
We cannot recommend the best insurance plan for you and your family. However, we can assist you with finding services and organizations trained specifically in selecting health insurance plans. We can also help you understand the meaning of certain aspects of your insurance plan or proposed insurance plan.
3. When I ask for assistance, what is expected of me?
When you reach out to our program for assistance, we are excited to partner with you. You may find yourself working with more than one person, depending on your needs. We ask that you watch for emails, your spam folder and respond quickly so we can help you as much as possible. We also understand that BMD/DMD life can be time-consuming, so please let us if you have any specific time constraints. While you can apply without diagnosis confirmation, please be aware that we cannot move forward if we don't get it.
When you reach out to our program for assistance, we are excited to partner with you. You may find yourself working with more than one person, depending on your needs. We ask that you watch for emails, your spam folder and respond quickly so we can help you as much as possible. We also understand that BMD/DMD life can be time-consuming, so please let us if you have any specific time constraints. While you can apply without diagnosis confirmation, please be aware that we cannot move forward if we don't get it.
4. What Government programs will be available in my state?
Each state has different programs and opportunities, and we can do a personalized search for you based on your circumstances. To help you find the answer to this, we'll need to know specific information about the applicant. Additional medical diagnosis, level of current need, and other personal information can factor into eligibility.
Each state has different programs and opportunities, and we can do a personalized search for you based on your circumstances. To help you find the answer to this, we'll need to know specific information about the applicant. Additional medical diagnosis, level of current need, and other personal information can factor into eligibility.
5. What is a waiver, how does it work?
A Medicaid waiver, often called, a waiver, is a provision in Medicaid law that allows the federal government to waive rules that usually apply to the Medicaid program. The intention is to allow individual states to accomplish certain goals, such as reducing costs, expanding coverage, or improving care for certain target groups. Thanks to these waivers, states can provide services to their residents that wouldn't usually be covered by Medicaid. For instance, in-home care for people.
There are several different types of Medicaid waivers. Home and Community-Based Services, provide services and supports to people in need of long-term care in their own home and/or community. Those who are accepted into their state's waiver program will receive a range of medical and non-medical care, which can vary depending on the individual's needs and situation, as well as state guidelines. This may include:
-Personal care services and supervision
-A home health aide
-Nursing
-Medical supplies and medical equipment
-Chore and homemaking services, such as shopping, laundry, and cleaning
-Hot meal delivery services
-Respite care to relieve a primary caregiver
-Counseling services
-Home and/or vehicle modifications,
-Support and case management
-Transport to and from non-emergency medical appointments
-Non-medical transportation services
-Personal emergency response systems
Services provided may vary on a case-by-case basis and will be affected -by the state in which the beneficiary resides.
Each state determines what is offered and each state requires different criteria for enrollment. Often, parent income/resources are not a factor in determining eligibility for children. Usually, you do not have to have Medicaid to apply for home and community-based services if you/your child meets your state's criteria.
Many states have waiting lists for waiver services, so we recommend applying early, even before you think you may need the provided services.
We can help with navigating this often complex and confusing system.
A Medicaid waiver, often called, a waiver, is a provision in Medicaid law that allows the federal government to waive rules that usually apply to the Medicaid program. The intention is to allow individual states to accomplish certain goals, such as reducing costs, expanding coverage, or improving care for certain target groups. Thanks to these waivers, states can provide services to their residents that wouldn't usually be covered by Medicaid. For instance, in-home care for people.
There are several different types of Medicaid waivers. Home and Community-Based Services, provide services and supports to people in need of long-term care in their own home and/or community. Those who are accepted into their state's waiver program will receive a range of medical and non-medical care, which can vary depending on the individual's needs and situation, as well as state guidelines. This may include:
-Personal care services and supervision
-A home health aide
-Nursing
-Medical supplies and medical equipment
-Chore and homemaking services, such as shopping, laundry, and cleaning
-Hot meal delivery services
-Respite care to relieve a primary caregiver
-Counseling services
-Home and/or vehicle modifications,
-Support and case management
-Transport to and from non-emergency medical appointments
-Non-medical transportation services
-Personal emergency response systems
Services provided may vary on a case-by-case basis and will be affected -by the state in which the beneficiary resides.
Each state determines what is offered and each state requires different criteria for enrollment. Often, parent income/resources are not a factor in determining eligibility for children. Usually, you do not have to have Medicaid to apply for home and community-based services if you/your child meets your state's criteria.
Many states have waiting lists for waiver services, so we recommend applying early, even before you think you may need the provided services.
We can help with navigating this often complex and confusing system.
6. I am newly diagnosed; I don’t know where to start. Can you help me?
We want to welcome you and give you a gentle hug, as we know how difficult this new diagnosis can be. Take it one day at a time - many parents in this community will offer support, and numerous organizations can offer help. We can assist you as you start figuring out your DMD journey; we can help you find resources for what you may need at any stage of DMD. We can also connect you with other Duchenne organizations that offer amazing resources for newly diagnosed families.
We want to welcome you and give you a gentle hug, as we know how difficult this new diagnosis can be. Take it one day at a time - many parents in this community will offer support, and numerous organizations can offer help. We can assist you as you start figuring out your DMD journey; we can help you find resources for what you may need at any stage of DMD. We can also connect you with other Duchenne organizations that offer amazing resources for newly diagnosed families.
7. Does the program serve individuals who reside outside of the United States?
While our program is primarily focused on the United States, we may be able to help you with particular needs depending on the request. If we can't help you, we will do our best to connect you with some organizations that can.
While our program is primarily focused on the United States, we may be able to help you with particular needs depending on the request. If we can't help you, we will do our best to connect you with some organizations that can.
8. Is there anything DFAP does not provide financial assistance for?
There are limits to what we assist with, but we try to remain open to help with as many needs as possible. We encourage you to apply, and we commit to reviewing your request in its entirety. Here are a few examples of things that we don't provide financial assistance for: Insurance co-pays and deductibles, tuition to private schools, trade schools, higher education, pools, hot tubs, vacations, and veterinary care for service animals. We will, however, try to assist you in locating resources that may help.
There are limits to what we assist with, but we try to remain open to help with as many needs as possible. We encourage you to apply, and we commit to reviewing your request in its entirety. Here are a few examples of things that we don't provide financial assistance for: Insurance co-pays and deductibles, tuition to private schools, trade schools, higher education, pools, hot tubs, vacations, and veterinary care for service animals. We will, however, try to assist you in locating resources that may help.
9. Do you provide assistance with locating other financial resources, services, and supports?
Yes, we can help you find local, state, and national support programs. We also provide free access to our Resource Finder, located on our website: www.duchennefap.org, which offers immediate access to a wide array of resources that may fit your needs. To use the Resource Finder, put your zip code or a keyword into the search box to pull up a wide range of organizations that can help, from local transportation services to local food banks and much more.
We can also work with you directly to help locate services and supports available in your community or state through government programs or other organizations based on your family's individual and unique needs.
Yes, we can help you find local, state, and national support programs. We also provide free access to our Resource Finder, located on our website: www.duchennefap.org, which offers immediate access to a wide array of resources that may fit your needs. To use the Resource Finder, put your zip code or a keyword into the search box to pull up a wide range of organizations that can help, from local transportation services to local food banks and much more.
We can also work with you directly to help locate services and supports available in your community or state through government programs or other organizations based on your family's individual and unique needs.
10. Do you provide financial assistance in emergency situations?
Yes, our program can provide financial assistance to families in crisis or emergencies. We can help to support you with temporary rent or mortgage payments, utilities, short-term vehicle rental, or food due to hospitalizations, house fires, natural disasters, job loss, etc. Please apply for help, check the "Emergency support" box, and add additional information about your situation so we can see how we can best help you.
Yes, our program can provide financial assistance to families in crisis or emergencies. We can help to support you with temporary rent or mortgage payments, utilities, short-term vehicle rental, or food due to hospitalizations, house fires, natural disasters, job loss, etc. Please apply for help, check the "Emergency support" box, and add additional information about your situation so we can see how we can best help you.
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Resources
Duchenne can be a long and complex journey. Caregivers find themselves wearing multiple hats – parent, advocate, educator, scientist, fundraiser, and therapist - just to name a few. Here, we provide you a tool to search for national, state, regional, private and public programs that can help you with whatever you need. Start your search by entering your zip code. |
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