Appeal the Decision at the Facility Level
HOW TO
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If you have been denied admission to a behavioral health facility due to your bleeding disorder, it is important to act quickly and strategically, ideally within 24–48 hours of learning about the denial.
Before taking next steps, verify that the denial was specifically due to your bleeding disorder. Document the exact language used by the facility.
When appealing a denial, start by gathering clarity and opening a pathway for reconsideration:
Confirm the process: What is the process for appealing this decision?
Identify the right contact: Who is the appropriate person for submitting or discussing an appeal?
Explore network options: If the facility is part of a larger system, ask whether other in-network facilities may be better positioned to accept you.
In addition to following the facility’s established appeals process, you may also consider reaching out to:
Medical Director – to review the clinical rationale for the denial.
General Counsel– if legal interpretation of admission criteria may be a factor, and to raise concerns about potential discrimination or violations of the Americans with Disabilities Act (ADA) or Section 504 of the Rehabilitation Act.
Chief Executive or Administrator – to elevate the issue to leadership.
Parent Company or Corporate Office – if the facility is part of a larger network with centralized oversight.
Personal Connections – any professional relationships you or your provider may have within the facility or network.
These additional contacts can sometimes help resolve barriers more quickly and ensure your case receives appropriate attention.
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“Hello, my name is [insert name], and I was recently denied admission to your facility. I understand this decision may be related to my diagnosis of [e.g., hemophilia A or another bleeding disorder]. I’m calling to respectfully request that the facility reconsider.
I have a well-managed bleeding disorder with a clearly documented treatment plan. I [am able to self-administer my medication / will require limited assistance from staff to administer my medication during the stay].
My provider and I have a comprehensive care plan available, including my medication schedule, emergency protocols, and contact information for my specialty team. With this plan in place, your staff will be fully equipped to support me safely. I’d be glad to share the plan and answer any questions your team may have.
It is important that patients like myself with chronic, manageable conditions are not excluded from essential behavioral health services. I believe we can work together to identify a safe and appropriate solution.
Could I speak with your medical or nursing director, or the appropriate decision-maker who can review this case further?
Please know that I am committed to ongoing advocacy and will also be contacting the payor, the state ombudsman, and other resources to support access to care. I hope we can collaborate to avoid unnecessary barriers and ensure that I receive the treatment I need.”
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Subject: Request for Reconsideration of Admission Decision
Dear [Recipient’s Name or “Admissions Team”],
My name is [insert name], and I was recently denied admission to your facility. I understand this decision may be related to my diagnosis of [e.g., hemophilia A or another bleeding disorder]. I respectfully request that the facility reconsider this decision.
I have a well-managed bleeding disorder with a clearly documented treatment plan. I [am able to self-administer my medication / will require limited assistance from staff to administer my medication during the stay].
My provider and I have a comprehensive care plan available, including my medication schedule, emergency protocols, and contact information for my specialty team. With this plan in place, your staff will be fully equipped to support me safely. I would be glad to share the plan and answer any questions your team may have.
It is important that patients like myself with chronic, manageable conditions are not excluded from essential behavioral health services. I believe we can work together to identify a safe and appropriate solution.
Could you please connect me with your medical or nursing director, or the appropriate decision-maker who can review this case further?
Please know that I am committed to ongoing advocacy and will also be contacting the payor, the state ombudsman, and other resources to support access to care. I hope we can collaborate to avoid unnecessary barriers and ensure that I receive the treatment I need.
Sincerely,
[Your Name]
[Your Contact Information]