Appeal letter sample: Ostomy patient assistance
Template letter for patients requesting extensive or coverage for mental health benefits. Healthcare provider completes and patient submits request for coverage/extension of coverage to insurance provider.
SAMPLE LETTER BELOW
RE: Ostomy Supply Resources
(During our last conversation) or (During your last office visit) you mentioned that you were having difficulty paying for your ostomy supplies (or) co-payments.
Obtaining financial assistance to cover all health costs can be challenging for those who need it most. If you need help paying for supplies or co-payments, below are several resources to look into. Also, please be sure to contact your stoma therapist directly as that nurse may also have suggestions.
Ostomy supply assistance
For information on ostomy supply assistance you may contact the following organizations:
United Ostomy Associations of America, Inc (UOAA): W: www.uoaa.org, P: 800-826-0826
Convatec- Access Program: P: 800-979-8716
Hollister: www.hollister.com , P: 888-740-8999
In addition if you have insurance that requires co-pays that may be too costly, the Patient Access Network Foundation provides financial assistance to people diagnosed with Crohn’s disease who cannot afford the out-of-pocket expenses associated with their insurance coverage. For further information on the fund and the application process, their contact phone number is 1-866-316-PANF (7263). A similar program is offered through the Patient Advocate Foundation for Crohn’s and ulcerative colitis patients, www.copays.org, 1-866-512-3861.
Also the Modest Needs Foundation provides one-time emergency grants to financially needy families or individuals. For more information on this foundation you can visit: www.modestneeds.org
Speaking with others who have been through the surgery may be beneficial for you to understand how they are living with their ostomies, to share resources and find support as you adjust after surgery. Many IBD patients and their loved ones find support groups to be a valuable resource for both information and understanding. Listed below are a few ways to connect to others:
www.j-pouch.org Another excellent resource would be the United Ostomy Associations of America, Inc (UOAA). The contact information is listed below:
Phone #: 800-826-0826
CCFA local chapters organize support groups for patients and loved ones. For information on support groups in your area, you can contact your local chapter. Please follow the chapter locator link here.
http://www.j-pouch.org/ Another excellent resource would be the United Ostomy Associations of America, Inc (UOAA). The contact information is listed below:
Phone #: 800-826-0826
UOAA can also provide information about possible ostomy support groups in your area
There are also online communities and discussion boards that provide a way to connect with others if an in-person support is not available in your area.
CCFA has a community discussion board with several forums located here: www.ccfacommunity.org
UOAA also has a discussion board for patients and loved ones located here: http://www.uoaa.org/forum/index.php
C3Life provides a forum, photo gallery, video gallery, and blogs for patients, loved ones and clinicians. You can find these here: http://www.c3life.com/ostomy/community/default.aspx
To find support after Ileoanal Reservoir (J-Pouch) Surgery the J-Pouch group has a discussion board located here: http://j-pouch.org/groupee/forums and a live chat room located here: http://www.j-pouch.org/chat.html
If, after reviewing the information and you have further questions, you can contact the Crohn's & Colitis Foundation of America at 1.888.MY.GUT.PAIN (694-8872) or firstname.lastname@example.org to get more information on medication and health insurance resource information.
Disclaimer: The sample appeal letters available to prescribing physicians on this website may include use of agents for conditions other than their FDA indications. CCFA does not endorse the use of any pharmaceutical agent, including any use which is outside the labeled indication. CCFA provides this service for informational purposes only. CCFA, its agents, officers, employees and volunteers shall not be liable for any claims, damages or actions whatsoever which may arise for the use of this information. (Remove disclaimer prior to submission of recipient)
For further information, call CCFA at our Information Resource Center: 888.MY.GUT.PAIN (888.694.8872).
The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.
About this resource
Published: May 1, 2012
Ostomy Patient Assistance (.doc)
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