Insurance

Insurance is wonderful, especially when your policy covers medically necessary diagnostic and treatment options! But when it doesn't, it can complicate your life at a time when you are adjusting to a SADS diagnosis in your family.

Some insurance companies are good at covering SADS-related testing and treatment, but many are not. If yours is not, it is time to APPEAL, APPEAL, APPEAL! SADS can help make the appeal process easier. We can provide samples of actual successful appeals, with the identifying information removed. We hope to collect enough to have company (or carrier) specific samples. You can actually use the example of someone else that appealed, and won, a denial with your same company!

Some commonly appealed issues are:

• Paying out of network co-pays when there are no "in network" providers of that service (e.g. LQT specialists, or genetic testing).
• High co-pays
• Denied coverage for AEDs, ICDs, Genetic Testing, or a LQT Specialist

Many people don't realize that 2 or 3 appeals are just part of the approval process for some carriers. Most carriers also have the option to request an outside review company for your appeal. It is only when enough appeals are filed--and won--that policy is impacted, and carriers stop "automatically" denying coverage. For that reason we always encourage every family to begin the approval process with their company and appeal high co-pays or denials.

Check out our other great insurance information--including two very thorough information sheets titled "Health Insurance Tips and Resources" and "Resources for Genetic Testing Insurance Questions". 

Tips for working with your employer and health insurance.