How to work with appeals + denials

Got a denial? Fret not and keep going!

In this article, we will cover how to continue to advocate for your child's needs even after an insurance/Medicaid denial and how to get started with an appeal. At Cubby, we are still in your corner and are here to further guide you on how to move forward after a denial from insurance with resources.  We know it can be hard not to become discouraged when this happens. However, know that most families who appeal a denial find success with approval. Do not give up! 💪

The Durable Medical Equipment (DME) supplier will continue to play a crucial role in getting a Cubby Bed through insurance/Medicaid even if you wish to do an appeal. If a denial is met, please partner with the DME to ask for the next steps in getting started with an appeal or resubmission. They have their team who are experts in your specific state and local guidelines on this matter.

Things to know before getting started

• Many families gain approval in the appeal process
• You will still need a Durable Medical Equipment (DME) supplier to assist you with the appeal process so it is best to continue working with the same DME supplier.
• There is a team at Cubby Beds to continue guiding you on the appeal process as well as you will still have support from the team at the DME supplier.
• The team at the DME supplier are the experts when it comes to your specific state laws and how to best assist with appeals.
• Cubby has an in-house specialist available to review denial documentation and Letter of Medical Necessity (LMN) to assist with where to improve documentation. This is not a guarantee for approval — it is, however, a very helpful service offered to ensure each safety feature of the Cubby Bed is associated with your kiddos' unique behaviors.
• Most common denial reasons stem from not having a Letter of Medical Necessity (LMN) that is not detailed enough. It is highly recommended that the LMN that was submitted to your insurance/Medicaid be reviewed and possibly revised before being resubmitted in the appeal process. You may need to involve your medical provider in editing the LMN.
• The average time to process an appeal takes about 1 - 2 months. Do not get discouraged by this as the end results can be life-changing for you and your family!
• When resubmitting, the original documentation will need to be updated, or new documentation that supports the medical need of the Cubby Bed will need to be added.

Resources available

The first step in the appeal process is starting with reviewing all of the original documentation that was submitted. There are a couple of ways to do that:

Our Documentation Specialist at Cubby Beds

• How this helps: A thorough review of the LMN from an expert on all of Cubby Bed's safety, sleep, and sensory features can be incredibly insightful. They can help with connecting these features to your child's diagnosis and how they would benefit their unique behaviors.
• If you are interested in getting your LMN and/or denial documents reviewed, click here to fill out our form and attach the documentation for the specialist. It is best to include the following attachments to the form:
  
  • Insurance/Medicaid reason for denial document
  • Letter of Medical Necessity (LMN) that was submitted to Insurance/Medicaid

Please note: At this time, a completed reviewal takes 7 business days. A Cubby Care Advocate will reach out to you within this time frame regarding the findings from the review. 

Our LMN Checklist + Denial Reasons Guide

• How this helps: It is quicker if you decide to do a self-review of your denial documents and your LMN with this guide. After using the guide and reviewing the LMN and denial reason, you can then work directly with your DME supplier and doctor on any updates needed to your LMN. The guide also highlights the 5 common denial reasons, what they mean, and how to rebut less costly options. 
• To access the LMN Checklist + Denial Reasons Guide, please scroll to the bottom of this page to download.

Another option is to begin to look at other funding alternatives to insurance/Medicaid. Please click here to view our other funding options which include waivers, charities, financing options, and private pay.

 Please reach out to our Cubby Care Team for more questions at hello@cubbybeds.com

Download the LMN Checklist + Denial Reasons here 👇️