The ALS Association says critical services are often denied
of ConsumerAffairsPatients increasingly complain that it is difficult to win approval from health insurance companies for certain types of treatment. Now, the ALS Association has introduced a new tool, the ALS Insurance Navigator, aimed at assisting individuals living with amyotrophic lateral sclerosis (ALS) and their families in navigating the often complex and challenging landscape of health insurance.
The app is free and the ALS Association describes it as a user-friendly resource is designed to address the significant issue of insurance denials, which affect nearly one-third of the ALS community, according to a recent ALS Focus survey.
The survey highlights the critical services often denied, including medications, power wheelchair modifications, and in-home care, which result in treatment delays, financial burdens, and increased stress for families.
Despite the daunting nature of these denials, research from the Kaiser Family Foundation shows that 80% of Medicare drug coverage denials are overturned upon appeal, yet only a small fraction -- 10% -- are ever contested.
Melanie Lendnal, senior vice president of Public Policy and Advocacy at the ALS Association, emphasized the growing frequency of these denials and their severe impact on patients' quality of life and survival, reporting that anecdotally, these challenges are becoming more common."
Guiding appeals
The ALS Insurance Navigator equips users with the knowledge to understand the reasons behind claim denials and offers guidance on interpreting the complex language found in denial letters. It provides a comprehensive, step-by-step approach to the appeals process, complete with letter templates, timelines, and strategic tips for building a robust case.
It also connects individuals with essential resources, such as the ALS Association's care services team and the Patient Advocate Foundation, which offers personalized case management assistance through The ALS Insurance and Benefits Resource Line.
The association said the ALS Insurance Navigator is designed to empower individuals, whether they are new to managing insurance or currently engaged in an appeal, by helping them advocate for the needed coverage and benefits.
Posted: 2025-02-21 11:55:17
