Challenge: Denied Coverage for Sleep Studies

The Director of Seattle Children’s Pediatric Sleep Disorders Center requested reimbursement from an insurance provider for sleep studies for medically complex infants. The request was repeatedly denied by one insurance company claiming that they did not have sleep studies listed as a service option for infants and, therefore, they could not reimburse the study.

Action

An MLP lawyer contacted the insurance company and explained the legal rights of the patient. As a result, sleep studies for infants were added as an approved service by the insurer.

Impact

The cost of one infant sleep study is approximately $8,000, which would likely have come out of uncompensated care without this action. About 150 studies are completed each year.

I would not have even known how to begin to convince the insurance company that this service is absolutely essential for these kids. This change allows staff and medical providers to use their time more effectively and saves me hours spent on the phone trying to get these studies covered.

– Maida Chen, MD,Director, Pediatric Sleep Disorders Center, Seattle Children’s

Challenge: Therapy Not Covered by Insurance

Though accepted as a leading therapy for autism across the nation, Applied Behavioral Analysis (ABA) was not covered by insurance.

Action

MLP advocacy led to Medicaid covering ABA therapy for Washington families. This action opened access to a vital treatment for thousands of children.

Later, due in part to MLP’s continued advocacy, the Centers for Medicare and Medicaid Services issued a rule requiring all states to provide this service.

Impact

There is mounting evidence that intensive ABA therapy for children with autism improves outcomes in terms of severity—and the earlier and more intensive it is, the less severe the symptomology. MLP has been very effective at solving broader advocacy legal issues like this one and addressing personal issues important to the well-being of children and their families—and you need to do both. Medical providers need legal partners to help us solve these issues.

– Chuck Cowan, former Medical Director, Autism Center, Seattle Children’s

Challenge: Social Issues’ Impact on Health

Medical residents often lack experience and knowledge of social issues that impact the health of their patients and families

Action

MLP staff provide over 30 hours of advocacy training each year for 200 pediatric residents, medical providers, social workers and staff at Seattle Children’s Hospital and Odessa Brown Children’s clinic.

Impact

As a resident working at the public health clinic, I thought I understood and related well to my patients. I was wrong… I was missing food insecurity, homelessness, substandard housing conditions, utility access, immigration issues and domestic violence. By asking these tough questions and learning about the most pressing issues in their lives, I connected with the families of my patients for the first time. I undoubtedly provided better and more meaningful healthcare because of this and cannot imagine how I practiced pediatrics without including these fundamental aspects of my patients’ health.

– Abigail Grant, MD, pediatrician who received training from Washington MLP while a resident

“Our mission is to promote better health outcomes by addressing the legal and social needs of patients and families.”

Our Impact