The DOI (State Departments of Insurance) Templates, created by the Center for Health Law and Policy Innovation, is intended to support the development of grievance letters from advocates/providers to state’s DOI regulators. They can be used to address a variety of complaints, including:
- Insurers aren’t covering important HIV medications
- Insurers are changing coverage after the end of open enrollment
- Insurers are practicing adverse tiering (i.e., placing HIV medications in formulary tiers with high cost sharing)
- Insurers are requiring onerous prior authorization or other kinds of medical management requirements for HIV medications
- Insurers are requiring use of mail-order pharmacies for HIV medication (note: federal regulations going into effect in 2016 will help alleviate this issue)
The consumer DOI Template is a simplified version of the letter intended for consumer use. It is intended for use by individuals who may not feel as comfortable with some of the scientific and legal language of the DOI template.
The Consumer DOI Template:
- Is shorter (three v. seven pages)
- Has minimal citations
- Has an extremely abbreviated standard of care section
- Has a shortened anti-discrimination mandates section
The DOI Templates can also be modified to send to insurers. CHLPI suggests cc’ing relevant insurers on the letter to regulators to give them notice.
Most importantly, always download a fresh copy of the DOI Templates. These templates may be subject to changes, especially if new federal regulations are issued. If you or your clients need help modifying the templates, please contact Carmel Shachar at 617-390-2588 or firstname.lastname@example.org.