Conversations with insurance providers will vary based on the type of coverage, the state, and the individual circumstances of your patient, including their skills and available supports. 

Whenever possible, these conversations should be conducted as a joint call with the patient and the insurance provider to request assistance in advocating for access. There is no one-size-fits-all approach; strategies should be tailored to each situation.

To begin, first identify your patient’s insurance provider (commercial, medicaid, managed care provider)

• There may be a separate number for behavioral health facilities. 

• If the patient has a case manager through their insurance plan, consider reaching out to that contact. 

If the patient has an employee assistance program, encourage your patient to reach out to them if comfortable. They may have recommendations for facilities that are covered by the patient’s insurance.

(Once you get to a live representative.)

“Hello, my name is [insert name], and I am [insert title] at [insert name of treatment center]. I’m calling today [with/on behalf of] my patient, [insert patient name].

I am seeking assistance in securing access to behavioral health treatment for [patient name]. They have been denied admission to [list facilities] due to their stable, well-managed bleeding disorder, despite having a clearly documented and effective treatment plan.

With this plan in place, their condition should not prevent them from receiving the behavioral health care they need. It’s important that patients with chronic, manageable conditions are not excluded from essential behavioral health services.

Can you help us with this?

• Would you be willing to join me in a call with the facility to advocate for access?

• Do you have a list of other in-network treatment centers that may be appropriate for this patient’s needs?”

Subject: Assistance Needed – Behavioral Health Treatment Access for [Patient’s Name]

Dear [Recipient’s Name],

My name is [insert name], and I am [insert title] at [insert name of treatment center]. I am reaching out [with/on behalf of] my patient, [Patient’s Name].

I am seeking assistance in securing access to behavioral health treatment for [Patient’s Name]. They have been denied admission to [list facilities] due to their stable, well-managed bleeding disorder, despite having a clearly documented and effective treatment plan.

With this plan in place, their condition should not prevent them from receiving the behavioral health care they need. It is important that patients with chronic, manageable conditions are not excluded from essential behavioral health services.

Can you help us with this?

Would you be willing to join me in a call with the facility to advocate for access?

Do you have a list of other in-network treatment centers that may be appropriate for this patient’s needs?

Thank you for your time and support in helping ensure [Patient’s Name] receives the care they require.

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