Comprehensive Speech & Therapy Center

Help Advocate: Blue Cross Consumers

SAMPLE GRIEVANCE LETTER

Daniel Loepp
President
Blue Cross Blue Shield of Michigan
600 Lafayette East
Detroit, MI  48223
 
To Whom It May Concern:
I am writing this letter to request that you fund the project to add a provider group for independent speech-language pathologists (SLP) and occupational therapists (OT). 
It is important for you to know that SLPs and OTs in private practice have the same certification and credentials as those practicing in the hospital settings.   Additionally, it is important that you understand that this decision is not consistent with other insurance carriers in the state of Michigan or Medicare, which allow independent speech pathologists to bill for their services.   Also, I feel that this decision by BCBSM  is inconsistent with your standards as other medical condition I am allowed to choose my provider and obtain services from a specialist when necessary.  This decision is limiting my choices for healthcare and reducing the standards of our healthcare. 
Personally, changing therapists for my child will be detrimental and cause a lapse in services for my child and subsequently a reduction in progress.  When I discovered my child needed speech therapy services, my pediatrician encouraged me to contact __________, due to their knowledge and expertise in ________________  (i.e., autism, apraxia, language disorders, etc.).   The only other facility in the area has not had a consistent therapist for the past several years and the therapist there although credentialed had no experience working with children like mine.   When my child started therapy he was non-verbal, behavior was a challenge and I was unable to understand his wants and needs.  His therapist (insert facility if you want) has established a rapport with my child (which is not easy to do), provided consistency (which is very necessary for people with communication impairments and helped teach me how to help my child communicate.   My child went from one who could not communicate to one who can.  He still has a long way to go to be able to have a conversation or defend himself but he can now tell me when he wants a drink, a toy or a hug.  Without the referral from my physician, knowledge of the therapist, rapport and consistency, my child would not have made progress.  There isn’t anywhere in driving distance from my home that offers these same services.   Without being able to go to my current provider of choice, I will not be able to obtain appropriate specialty services for my son and he will not learn the ability to communicate for himself. 
Thank you for your consideration,

____________________________ 

SAMPLE LETTER – Please feel free to personalize and modify this letter prior to sending

Daniel Loepp
President
Blue Cross Blue Shield of Michigan
600 Lafayette East
Detroit, MI  48223

Dear Mr. Loepp,
I am aware that BCBSM has not yet updated its policy to add independent occupational therapists (IOT) and independent speech and language pathologists (ISLP) as providers.  We support this project and request adding these groups as providers.
We are asking that there be equality among the allied health professionals:  physical therapy, occupational therapy, and speech and language pathology.  In 1996, BCBSM added Physical Therapy as a provider group (IPT) without adding the other two groups within the rehabilitation triad. 

This inconsistency in policy by BCBSM has resulted in:

  • Restricted access to rehabilitation specialists.
  • Increased out of pocket expenses. BCBSM subscribers are paying to access specialists who most appropriately fit their needs.  Additionally, these specialists may be the local access to subscribers in areas where therapists are few in number.
  • Inconsistency between states. BCBSM is not aligned with other BCBS state plans which allow all three independent therapists (OT/PT/SLP) to bill.
  • Inconsistency between majority of other insurance carriers. BCBSM is not aligned with other insurance carriers in the state which allow Occupational Therapists and Speech Language Pathologists as independent providers (i.e., Medicare, Workers Compensation, Priority Health, Aetna, Cigna, United Health Care, Beech Street, Cofinity, Tricare, Health Plan of Michigan).
  • Negative impact on small business and economic development. IOT and ISLP leave the state to practice since these businesses cannot survive without being BCBSM providers.

 

We believe our health care is impacted by this current policy.  We are asking for this change to support continued excellence in health care in Michigan.  Please make this change today. 

 

Respectfully,

 

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Signed                                                                                    Printed name