Appeal the Decision at the Facility Level

HOW TO

  • If your patient has been denied admission to a behavioral health facility due to their 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 patient’s 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 your patient.

    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 patient may have within the facility or network.

    These additional contacts can sometimes help resolve barriers more quickly and ensure your patient’s case receives appropriate attention.

  • “Hello, my name is [insert name], and I am [insert title] at [insert name of treatment center]. I’m calling today on behalf of my patient, [Patient’s Full Name], who was recently denied admission to your facility. I understand this decision may be related to their diagnosis of [e.g., hemophilia A or another bleeding disorder]. I’m calling to respectfully request that the facility reconsider.

    [Patient’s First Name] has a well-managed bleeding disorder with a clearly documented treatment plan. They [are able to self-administer their medication / will require limited assistance from staff to administer their medication during the stay].

    We have a comprehensive care plan available, including their medication schedule, emergency protocols, and contact information for their specialty team. With this plan in place, your staff will be fully equipped to support them safely. I’d be glad to share the plan and answer any questions your team may have.

    It is important that patients 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 for [Patient’s First Name].

    Could I speak with your medical or nursing director, or the appropriate decision-maker who can review this case further?

    Please know that we are committed to ongoing advocacy for this patient 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 [Patient’s First Name] receives the treatment they need.”

  • Subject: Request for Reconsideration of Admission Decision for [Patient’s Full Name]

    Dear [Recipient’s Name or “Admissions Team”],

    My name is [insert name], and I am [insert title] at [insert name of treatment center]. I am writing on behalf of my patient, [Patient’s Full Name], who was recently denied admission to your facility. I understand this decision may be related to their diagnosis of [e.g., hemophilia A or another bleeding disorder]. I respectfully request that the facility reconsider this decision.

    [Patient’s First Name] has a well-managed bleeding disorder with a clearly documented treatment plan. They [are able to self-administer their medication / will require limited assistance from staff to administer their medication during the stay].

    We have a comprehensive care plan available, including their medication schedule, emergency protocols, and contact information for their specialty team. With this plan in place, your staff will be fully equipped to support them safely. I would be glad to share the plan and answer any questions your team may have.

    It is important that patients 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 for [Patient’s First Name].

    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 we are committed to ongoing advocacy for this patient 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 [Patient’s First Name] receives the treatment they need.

    Sincerely,
    [Your Name]
    [Your Title]
    [Your Contact Information]