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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 CRPS, persistence will become a tool that
must be utilized to ensure proper treatment and enable CRPS
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.
- If an HMO cannot provide appropriate services within their
network —they must pay for you to go out of network.
- 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.
- Social Security may deny your first claim for benefits.
APPEAL! New wording is being established for CRPS and hopefully
claims will be approved more expeditiously in the future.
Until then — APPEAL!
- Worker's Compensation requires the same tenacity — APPEAL
its denials.
- 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.
- 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.
- 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!"
February 2001 |
