Appeals and Exceptions to Policy

APPEALS: A person eligible for services and benefits from a public program or health insurance policy generally has a right to appeal the decisions made by the agency or program. Some agencies refer to this as "due process" rights, or the right to a fair hearing.

If you receive notification of a denial of coverage:

Check the written material for the time deadlines. An appeal of the decision may have to be made within a certain number of days of the notification - ten, thirty, sixty, or longer.
Check the written materials for the address and phone number of the individual or department to contact within the agency for appeals information. Write down any information you receive over the phone, including the name and position of the person you speak with, and the time and date of the phone call.
Contact InfoTech as soon as possible to receive free advocacy and legal assistance. Delays may lead to losing your appeal rights.

In some instances, such as an IEP staffing, you will receive the information about which services and devices will be provided in person. Information about your right to appeal a decision is on the back of the IEP form that you sign. Be sure to read the information carefully.

EXCEPTIONS TO POLICY: Some private insurance programs and the Medicaid program will at times make an "exception to policy." This means that the policy or program does not normally cover a particular service or device, but, because there is an exceptional case, coverage will be provided. The problem with asking immediately for an exception to policy is that you area, in a sense, admitting that the policy does not cover the particular service or device. If the exception to policy is denied, there is no appeal from it. Going through the appeal process is a better strategy in many cases. Contact Iowa COMPASS for referral for free advocacy and legal advice before making this decision.

CONTACT US

Funding Services Coordinator
Iowa COMPASS
Center for Disabilities and Development
100 Hawkins Drive, Room S295
Iowa City, IA 52242-1011

800-779-2001 (voice toll-free)
877-686-0032 (TTY toll-free)
319-353-8502 (local-voice)

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