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These letters are intended for use when your patient is denied coverage and a utilization management company is involved.  APTA is here to help! If you aren’t sure where to start in addressing an issue, or when you notice an reoccurring issue, please contact staff at advocacy@apta.org.

For Physical Therapists and Physical Therapist Assistants

 

  • Letter to Legislator Re: Subcontracted Company Causing Issue – Outpatient Services
    Use these letter when your patient is enrolled in any type of health insurance plan that subcontracts with a utilization management company. This letter should be sent to your legislator to inform them of the issues your patients (their constituents) are having in accessing their healthcare, as well as the challenges your business faces in dealing with this company.
  • Letter to Legislator Re: Medicaid Issues with Managed Care Organization/Medicaid
    This letter should be used when your patient is a Medicaid beneficiary and they are enrolled in a Medicaid plan administered by a Managed care organization. This letter should be sent to your legislator so they are aware that the company the state contracted with to provide Medicaid services is creating barriers to care.
  • Letter to State Medicaid Office RE: Issue Managed Care Organization
    This letter should be used when your patient is a Medicaid beneficiary and they are enrolled in a Medicaid plan administered by a Managed care organization. This letter should be sent to the Medicaid Office in your state so they are aware that the company they contracted with to provide Medicaid services is creating barriers to care.

Help Your Patients Be Their Own Advocate

Insurance companies are legally required to respond to consumer complaints. These letters should be shared with your patients as a way to communicate with their representatives and officials. When a patient raises a concern, attention is paid.

  • Patients Be Your Own Advocate (Know Your Rights)
    This document is intended to educate your patients on their rights to health care coverage. If they have been denied services, you should provide this document as an education tool for them to appeal any denials. You should complete as much of the form as possible and indicate to your patient what they need to complete and can serve as a way to help them in writing to their representative or official.
  • APTA Template: Consumer Letter to Legislator – Basic 
    This letter is for your patient to use in sending their complaint to their legislator. They should explain the type of plan they have as well as the difficulties they are having in receiving care.

Letters for Medicaid Beneficiaries

  • Letter to Legislator Re: Medicaid Benefits Issues with Managed Care Organization
    This letter is for your patients who are Medicaid beneficiaries and they are enrolled in a Medicaid plan administered by a Managed care organization. This letter should be sent to their legislator so they are aware that the company the state contracted with to provide Medicaid services is creating barriers to care.
  • Letter to State Medicaid Office (Medicaid beneficiary)
    This letter is for your patients to use when they are a Medicaid beneficiary. This letter should be sent to the Medicaid Office in your state so they are aware that the company they contracted with to provide Medicaid services is creating barriers to care.

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