how to get diastasis recti surgery covered by insurance

9+ Tips: Diastasis Recti Surgery & Insurance Coverage

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9+ Tips: Diastasis Recti Surgery & Insurance Coverage

Diastasis recti repair aims to correct the separation of the rectus abdominis muscles, commonly known as the “abdominal muscles” or “six-pack muscles.” This condition often occurs during pregnancy or with significant weight fluctuations. Surgical intervention becomes a consideration when conservative treatments, such as physical therapy and targeted exercises, fail to alleviate symptoms. A significant factor in pursuing this option is the potential for insurance coverage.

Securing financial assistance for this procedure offers considerable advantages. It can alleviate the financial burden associated with surgery, allowing individuals to address the condition without significant economic strain. Historically, insurance companies have often viewed diastasis recti repair as a cosmetic procedure; however, mounting evidence suggests that in certain cases, it constitutes a medically necessary intervention. This shift in perspective is paramount in the pursuit of coverage.

The subsequent sections will provide an overview of navigating the insurance landscape, including demonstrating medical necessity, understanding policy nuances, and documenting symptoms comprehensively to maximize the likelihood of claim approval for abdominal muscle repair.

1. Medical Necessity Documentation

Comprehensive medical necessity documentation is paramount in securing insurance coverage for diastasis recti repair. The success of a claim hinges on the ability to demonstrate that the procedure is not solely for cosmetic enhancement but rather a necessary intervention to alleviate significant functional impairments and health concerns.

  • Detailed Symptom Log

    A meticulously maintained record of symptoms, including their frequency, severity, and impact on daily activities, provides tangible evidence of the condition’s disruptive nature. Examples include chronic back pain unresponsive to conservative treatments, difficulty performing basic movements like lifting or bending, and gastrointestinal issues attributed to impaired core support. Specificity in documentation strengthens the claim’s foundation.

  • Physician’s Assessment and Recommendation

    A thorough evaluation by a qualified physician, including a physical examination and potentially diagnostic imaging, is essential. The physician’s documented assessment should clearly articulate the extent of the diastasis recti, its impact on the patient’s health, and the rationale for recommending surgical intervention as the most appropriate course of treatment. A statement explicitly stating the medical necessity is crucial.

  • Failed Conservative Treatment History

    Insurance providers often require evidence that non-surgical options have been exhausted before approving surgery. Documenting a history of physical therapy, exercise programs, and other conservative treatments that have proven ineffective is a critical component of the medical necessity argument. This demonstrates that surgery is not a first-line choice but a last resort after other avenues have been explored.

  • Impact on Quality of Life

    Beyond specific symptoms, documentation should address the overall impact of diastasis recti on the individual’s quality of life. This includes limitations in physical activity, emotional distress, reduced self-esteem, and any other ways the condition negatively affects daily functioning. Illustrating the broader consequences of the condition strengthens the justification for surgical intervention.

The compilation of these documented elements serves as a compelling case for the medical necessity of diastasis recti repair. When presented effectively, this comprehensive documentation significantly increases the likelihood of insurance claim approval, ensuring that individuals can access the necessary treatment to improve their health and well-being.

2. Policy Coverage Specifics

Understanding the specifics of an insurance policy is crucial for securing coverage for diastasis recti repair. The intricacies of the policy dictate the extent to which the procedure is covered, if at all, and any prerequisites that must be met before approval. A thorough review of policy documentation is therefore a necessary step in pursuing coverage.

  • Exclusions and Limitations

    Insurance policies often contain specific exclusions or limitations regarding cosmetic procedures. Determining whether diastasis recti repair is classified as cosmetic, or if it falls under an exception for medically necessary procedures, is paramount. Some policies may explicitly exclude abdominal muscle repair, while others might cover it only under specific circumstances, such as severe functional impairment.

  • Pre-authorization Requirements

    Many insurance plans mandate pre-authorization, or prior approval, before undergoing surgery. Failure to obtain pre-authorization can result in denial of coverage, even if the procedure is otherwise covered under the policy. The pre-authorization process typically involves submitting documentation of medical necessity, physician’s recommendations, and details of the proposed surgical procedure for review by the insurance company.

  • Deductibles, Co-pays, and Coinsurance

    Even with policy coverage, individuals are typically responsible for certain out-of-pocket expenses, such as deductibles, co-pays, and coinsurance. The deductible is the amount the insured must pay before the insurance company begins to cover expenses. A co-pay is a fixed amount paid for specific services, while coinsurance is a percentage of the cost the insured is responsible for after the deductible has been met. Understanding these costs is essential for financial planning.

  • In-Network vs. Out-of-Network Providers

    Insurance policies often have preferred provider networks, and utilizing in-network providers typically results in lower out-of-pocket costs. Choosing an out-of-network surgeon can lead to significantly higher expenses, and in some cases, the insurance company may not cover any portion of the bill. Verifying the surgeon’s network status and understanding the policy’s out-of-network benefits is crucial for cost management.

A detailed understanding of policy coverage specifics empowers individuals to navigate the insurance landscape effectively and maximize their chances of obtaining coverage for diastasis recti repair. By carefully reviewing policy documentation, adhering to pre-authorization requirements, and considering cost-sharing arrangements, individuals can make informed decisions and advocate for their healthcare needs.

3. Symptom severity evidence

Symptom severity evidence represents a cornerstone in the process of securing insurance coverage for diastasis recti repair. The degree to which symptoms demonstrably impair an individual’s functionality directly influences the insurance provider’s assessment of medical necessity. A direct causal link exists: more severe, well-documented symptoms translate into a stronger justification for surgical intervention from a medical perspective. A claim lacking substantive evidence of significant functional limitations is likely to be viewed as elective or cosmetic, leading to denial.

For instance, consider two hypothetical cases. In the first, an individual reports a minor abdominal bulge with minimal discomfort and no functional limitations. In the second, an individual presents with a pronounced diastasis recti, accompanied by debilitating back pain, compromised core stability impacting daily activities like lifting or walking, and documented digestive issues. The latter case, substantiated with medical records, physical therapy reports, and physician assessments, provides compelling evidence of symptom severity. This evidence establishes that the condition is not merely an aesthetic concern but a source of significant medical impairment warranting surgical correction. The evidence should include objective measures, such as the width of the diastasis, alongside subjective reports of pain and functional limitations.

In summary, thorough and compelling evidence of symptom severity is not merely an ancillary component; it is an essential prerequisite for achieving insurance coverage for diastasis recti repair. Challenges in obtaining such evidence may arise from subjective reporting of symptoms or difficulties in quantifying functional limitations. Overcoming these challenges requires meticulous documentation, objective assessments, and clear articulation of the condition’s impact on the individual’s overall health and quality of life, all reinforcing the validity of the surgical intervention.

4. Conservative Treatment Failure

Conservative treatment failure is a pivotal factor in the context of securing insurance coverage for diastasis recti surgery. It serves as a key determinant in establishing the medical necessity of the procedure, differentiating it from purely cosmetic interventions. Demonstrating that non-surgical methods have been exhausted without achieving satisfactory results is often a prerequisite for insurance approval.

  • Documented Physical Therapy

    Insurance providers typically require documented participation in a structured physical therapy program designed to address diastasis recti. The therapy should focus on strengthening core muscles and improving abdominal wall stability. Failure to improve or a worsening of symptoms despite consistent adherence to the program, supported by progress reports from the physical therapist, strengthens the argument for surgical intervention.

  • Exercise Regimen Adherence

    Beyond physical therapy, individuals are often advised to follow a specific exercise regimen at home. Documenting consistent adherence to this regimen, along with a detailed record of exercises performed and any challenges encountered, provides further evidence of conservative treatment efforts. A log of exercise sessions, including frequency, duration, and any modifications made, demonstrates a commitment to non-surgical solutions.

  • Symptom Persistence Despite Intervention

    Even with physical therapy and exercise, symptoms such as back pain, abdominal weakness, and postural instability may persist. Documenting the continued presence of these symptoms, despite diligent efforts to address them through conservative methods, is crucial. The documentation should include specific examples of how these symptoms impact daily activities and overall quality of life.

  • Physician’s Recommendation

    A physician’s recommendation for surgery, based on the documented failure of conservative treatments, carries significant weight. The physician’s assessment should clearly articulate the rationale for surgical intervention, emphasizing the limitations of non-surgical options and the potential benefits of surgery in alleviating symptoms and improving functional outcomes. The recommendation should be supported by objective findings from physical examinations and diagnostic testing.

The cumulative effect of these documented elements strengthens the case for surgical intervention. When presented effectively, the evidence of conservative treatment failure provides a compelling justification for insurance coverage, demonstrating that surgery is not a first-line option but a necessary step after exhausting all reasonable non-surgical alternatives. This approach aligns with the principle of medical necessity, which is often a primary consideration for insurance providers when evaluating claims for diastasis recti repair.

5. Surgeon’s Supporting Statement

A surgeon’s supporting statement serves as a critical component in the pursuit of insurance coverage for diastasis recti repair. This statement, a formal communication from the operating surgeon to the insurance provider, provides expert justification for the procedure, augmenting the overall claim.

  • Detailed Clinical Assessment

    The surgeon’s statement should incorporate a comprehensive summary of the patient’s clinical condition, including the extent of diastasis recti separation as measured during physical examination and potentially with imaging. It outlines specific symptoms experienced by the patient, such as abdominal weakness, back pain, or pelvic floor dysfunction, and explains how these symptoms directly correlate with the diastasis. The statement should not merely reiterate information but provide the surgeons professional interpretation and assessment.

  • Rationale for Surgical Intervention

    A clear and concise explanation of why surgical intervention is deemed the most appropriate course of treatment is essential. This rationale must articulate the limitations of conservative management, such as physical therapy or exercise, in addressing the patient’s specific condition. The surgeon must explain why non-surgical approaches have failed to provide adequate relief or functional improvement, thereby justifying the necessity of surgical correction.

  • Surgical Technique and Expected Outcomes

    The statement should describe the proposed surgical technique, including the specific steps involved in repairing the diastasis recti. A realistic assessment of the expected outcomes, focusing on the anticipated improvement in symptoms and functional abilities, should be provided. Overstating the potential benefits of the surgery is inadvisable; instead, a balanced and evidence-based projection of outcomes should be presented.

  • Documentation of Medical Necessity

    The overarching purpose of the surgeon’s statement is to document the medical necessity of the procedure. This involves explicitly stating that the surgery is not solely for cosmetic enhancement but is essential for alleviating significant functional impairments and improving the patient’s overall health. The statement should emphasize the ways in which the diastasis recti is negatively impacting the patient’s quality of life and how surgical correction will address these issues.

The surgeon’s supporting statement, when meticulously prepared and substantiated with clinical findings, significantly bolsters the likelihood of insurance coverage for diastasis recti repair. It represents a crucial link between the patient’s medical condition, the proposed surgical intervention, and the insurance provider’s assessment of medical necessity.

6. Pre-authorization Requirement

Pre-authorization represents a critical step in securing insurance coverage for diastasis recti repair. It is a process mandated by many insurance providers, requiring approval before undergoing the procedure. Neglecting this requirement can result in claim denial, regardless of medical necessity.

  • Verification of Coverage

    Pre-authorization serves as a confirmation of coverage. The process necessitates contacting the insurance provider to ascertain whether diastasis recti repair is a covered benefit under the specific plan. This involves verifying policy details, including potential exclusions or limitations that may affect coverage eligibility. Pre-authorization confirms the procedure is eligible under the active insurance policy, preventing unforeseen financial burdens.

  • Medical Necessity Review

    Insurance companies utilize pre-authorization to assess the medical necessity of the proposed surgery. This assessment typically requires the submission of comprehensive documentation, including the patient’s medical history, physical examination findings, imaging results, and physician’s recommendations. The pre-authorization process enables the insurer to evaluate whether the procedure aligns with established medical guidelines and is not solely for cosmetic purposes. In cases involving persistent back pain and core instability, detailed documentation significantly influences the approval outcome.

  • Cost Containment Measures

    Pre-authorization enables insurance providers to manage healthcare costs. By evaluating the appropriateness of the proposed procedure before it is performed, insurers can prevent unnecessary or inappropriate medical interventions. This aligns with the broader goal of containing healthcare expenditures and ensuring that medical resources are allocated efficiently. Insurance companies may request alternative treatment plans before granting authorization for diastasis recti repair.

  • Network Compliance

    The pre-authorization process often involves verifying whether the surgeon and facility are within the insurance company’s network. Utilizing in-network providers typically results in lower out-of-pocket costs for the insured. Pre-authorization confirms the surgeon’s network status and helps patients avoid unexpected expenses associated with out-of-network care. Insurance plans often offer a directory of in-network providers to facilitate the selection process.

Fulfilling the pre-authorization requirement represents a proactive approach to navigating the complexities of insurance coverage for diastasis recti repair. It not only verifies eligibility and assesses medical necessity but also facilitates cost management and ensures network compliance, thereby increasing the likelihood of claim approval and minimizing financial risks.

7. Appeals process knowledge

In the context of securing insurance coverage for diastasis recti surgery, understanding the appeals process is paramount. A denial of initial coverage is not necessarily the final determination; rather, it often necessitates navigation of the formal appeals procedure.

  • Understanding Denial Reasons

    Knowledge of the appeals process begins with a clear comprehension of the denial rationale. Insurance companies are obligated to provide a written explanation for their decision. This explanation often highlights deficiencies in the initial documentation, perceived lack of medical necessity, or policy exclusions. Identifying the specific grounds for denial allows for a targeted and effective appeal strategy, focusing on addressing the insurer’s concerns with supporting evidence. For example, a denial based on insufficient evidence of functional impairment requires additional documentation from physical therapists and physicians detailing the impact of diastasis recti on daily activities.

  • Gathering Additional Documentation

    The appeals process provides an opportunity to submit supplementary documentation that strengthens the case for coverage. This may include updated physician assessments, detailed reports from physical therapy sessions demonstrating the failure of conservative treatments, or independent medical evaluations. The aim is to provide a more comprehensive picture of the patient’s condition and demonstrate the medical necessity of surgical intervention. A well-documented case, bolstered by credible medical evidence, significantly increases the likelihood of a successful appeal. For instance, if the initial denial was due to the perception of the procedure as cosmetic, additional documentation emphasizing the impact of the diastasis recti on core stability and back pain can be crucial.

  • Following Appeal Deadlines and Procedures

    Insurance policies stipulate specific deadlines and procedures for filing appeals. Failure to adhere to these requirements can result in automatic denial of the appeal. Understanding the hierarchical structure of appeals, which may involve internal reviews by the insurance company followed by external reviews by independent entities, is crucial. Strict adherence to timelines and procedural guidelines demonstrates a commitment to the process and ensures that the appeal is properly considered. Knowing the different levels of appeal and their respective deadlines helps navigate the system effectively.

  • Seeking External Assistance

    Navigating the appeals process can be complex and challenging. In some cases, seeking external assistance from patient advocacy groups or legal professionals specializing in healthcare law may be beneficial. These resources can provide guidance on appeal strategies, assist with gathering documentation, and represent the patient’s interests in interactions with the insurance company. Such assistance can be particularly valuable in cases involving complex medical issues or persistent denials. Legal counsel may be necessary if the insurance company continues to deny coverage despite compelling medical evidence.

Knowledge of the appeals process equips individuals with the tools and understanding necessary to challenge initial denials of coverage for diastasis recti surgery. By understanding the denial rationale, gathering supplementary documentation, adhering to procedural requirements, and seeking external assistance when necessary, individuals can significantly improve their chances of securing the coverage to which they are entitled.

8. Coding accuracy verification

Coding accuracy verification is intrinsically linked to the successful attainment of insurance coverage for diastasis recti repair. Medical billing codes serve as the primary language between healthcare providers and insurance companies, effectively communicating the nature of the services rendered. Inaccurate or inappropriate coding can lead to claim denials, regardless of the medical necessity of the procedure. For example, if the repair of diastasis recti is incorrectly coded as a purely cosmetic procedure, the insurance company is likely to deny the claim. Conversely, using a specific code that reflects the functional impairment caused by the diastasis, such as related back pain or impaired core stability, increases the likelihood of approval. The correct use of ICD-10 and CPT codes, validated by the surgeon’s documentation, is paramount.

Consider a scenario where a patient undergoes diastasis recti repair to alleviate chronic lower back pain directly attributable to the abdominal muscle separation. If the claim is submitted with a generic code for abdominal wall repair, the insurance company may perceive it as a cosmetic abdominoplasty. However, if the claim includes the appropriate code for diastasis recti repair (e.g., 15830 – Excision of skin and subcutaneous tissue of abdomen, with resultant scar revision), along with ICD-10 codes accurately reflecting the associated back pain diagnosis (e.g., M54.5 – Low back pain), the insurer is more likely to recognize the medical necessity of the procedure. Auditing the coding practices of the surgeon’s office and confirming the accuracy of the submitted codes before the claim is processed is a crucial step in the coverage process.

In conclusion, accurate coding verification is not merely a technicality but a critical determinant in the insurance approval process for diastasis recti repair. Challenges can arise from evolving coding guidelines or discrepancies between surgeon documentation and billing practices. Overcoming these challenges requires proactive engagement with the surgeon’s office to ensure coding precision and adherence to insurance company requirements. Neglecting coding accuracy verification can lead to unnecessary claim denials, delaying or preventing access to medically necessary surgical interventions. Addressing potential coding errors before submission significantly improves the probability of obtaining insurance coverage.

9. Plan Exclusions Awareness

A comprehensive understanding of plan exclusions is fundamental when pursuing insurance coverage for diastasis recti repair. Insurance policies often contain specific clauses that limit or deny coverage for certain procedures or conditions. Awareness of these exclusions is a proactive step towards navigating the complexities of insurance claims and maximizing the likelihood of approval.

  • Cosmetic Surgery Exclusion

    Many insurance plans explicitly exclude coverage for procedures deemed cosmetic. If an insurance company classifies diastasis recti repair as primarily cosmetic, rather than medically necessary, the claim is likely to be denied. Thoroughly reviewing the policy language to ascertain how cosmetic surgery is defined and whether there are exceptions for procedures that address functional impairments is crucial. Demonstrating that the surgery is not solely for aesthetic improvement but necessary to alleviate symptoms such as back pain or core instability becomes paramount in overcoming this exclusion.

  • Pre-existing Condition Exclusion

    While the Affordable Care Act largely eliminated pre-existing condition exclusions, some grandfathered plans may still contain clauses that deny coverage for conditions that existed before the policy’s effective date. If the diastasis recti developed before the individual obtained insurance coverage, this exclusion could potentially apply. However, even in such cases, demonstrating that the condition has worsened significantly since the policy’s inception and now necessitates surgical intervention may provide grounds for appeal.

  • Specific Procedure Exclusions

    Some insurance policies may specifically exclude coverage for abdominal wall repair or related procedures. This exclusion may be worded broadly, encompassing all types of abdominal wall reconstruction, or it may be more narrowly tailored to exclude only procedures performed for cosmetic purposes. Careful examination of the policy language is essential to identify any specific exclusions that could affect coverage for diastasis recti repair. If a specific procedure exclusion exists, exploring alternative surgical techniques or arguing that the proposed procedure falls outside the scope of the exclusion may be necessary.

  • Experimental or Investigational Procedures

    Insurance companies typically do not cover procedures considered experimental or investigational, meaning that the procedure is not yet widely accepted within the medical community or lacks sufficient evidence of safety and efficacy. While diastasis recti repair is generally recognized as a standard surgical procedure, newer or less common techniques may be subject to this exclusion. Providing evidence that the chosen surgical approach is well-established and supported by clinical research can help overcome this objection.

Proactive awareness of plan exclusions empowers individuals to anticipate potential challenges and develop strategies to address them. By carefully reviewing policy language, gathering supporting documentation, and working closely with healthcare providers, individuals can increase their chances of securing insurance coverage for medically necessary diastasis recti repair. Thorough plan scrutiny allows individuals to tailor their appeals and justifications, improving the odds of a successful claim and access to vital surgical care.

Frequently Asked Questions

The following section addresses common inquiries regarding the pursuit of insurance coverage for diastasis recti surgery, providing concise and informative responses.

Question 1: What documentation is essential to demonstrate the medical necessity of diastasis recti repair?

Comprehensive documentation should include a detailed symptom log, physician assessments, a history of failed conservative treatments (such as physical therapy), and evidence of the condition’s impact on quality of life. Specific measures of diastasis width are also beneficial.

Question 2: How does insurance policy language affect coverage for diastasis recti repair?

Policy language dictates the extent of coverage, including any exclusions or limitations related to cosmetic procedures. Careful review is crucial to identify potential barriers to coverage and prepare accordingly.

Question 3: What constitutes sufficient evidence of conservative treatment failure?

Evidence should include records of participation in structured physical therapy programs, adherence to prescribed exercise regimens, and documentation of persistent symptoms despite these efforts. Physician statements confirming the ineffectiveness of conservative treatments are also beneficial.

Question 4: Why is pre-authorization necessary for diastasis recti surgery?

Pre-authorization verifies coverage, assesses medical necessity, helps manage healthcare costs, and ensures network compliance. It is a proactive step to avoid potential claim denials.

Question 5: What steps should be taken if an initial insurance claim is denied?

The appeals process should be initiated promptly. Gather additional documentation, address the denial rationale, adhere to deadlines, and consider seeking external assistance from patient advocacy groups or legal professionals.

Question 6: How can coding accuracy impact the success of an insurance claim for diastasis recti repair?

Inaccurate or inappropriate coding can lead to claim denials. The surgeon’s office should verify the accuracy of submitted codes, ensuring they reflect the medical necessity of the procedure rather than solely its cosmetic aspects.

Navigating the insurance landscape for diastasis recti repair requires diligent effort and a thorough understanding of policy requirements. Preparation and proactive engagement with insurance providers are key to a successful outcome.

The subsequent section will provide a checklist to help navigate the complexities of getting the surgery covered by the insurance.

Key Considerations

The following points provide a concise roadmap for maximizing the likelihood of securing insurance coverage for diastasis recti repair. Adherence to these guidelines is critical for a successful outcome.

Tip 1: Obtain a Comprehensive Medical Evaluation: A thorough assessment from a qualified physician, documenting the severity of diastasis recti and its impact on physical function, is essential. This evaluation should include objective measurements, such as the width of the abdominal muscle separation, as well as subjective reports of pain and limitations in daily activities.

Tip 2: Document Conservative Treatment Attempts: Meticulously record all attempts at conservative treatments, such as physical therapy and targeted exercise programs. Include details on the frequency, duration, and specific exercises performed, as well as any progress or lack thereof. This demonstrates that surgical intervention is not a first-line option but a necessary step after exhausting non-surgical alternatives.

Tip 3: Understand Your Insurance Policy: Carefully review the policy language to identify any exclusions or limitations related to cosmetic surgery or abdominal wall repair. Pay close attention to pre-authorization requirements, deductible amounts, and network restrictions. Contact the insurance provider directly to clarify any ambiguities or uncertainties.

Tip 4: Secure a Surgeon’s Supporting Statement: Request a formal statement from the surgeon outlining the medical necessity of the procedure. This statement should detail the patient’s clinical condition, the rationale for surgical intervention, the proposed surgical technique, and the expected outcomes. The surgeon’s perspective is crucial in convincing the insurance company that the surgery is medically justified.

Tip 5: Verify Coding Accuracy: Ensure that the medical billing codes used to submit the insurance claim accurately reflect the nature of the procedure and the associated medical conditions. Inaccurate coding can lead to claim denials, even if the surgery is otherwise medically necessary. Proactively engage with the surgeon’s office to confirm the coding practices and address any potential errors.

Tip 6: Prepare for the Appeals Process: Understand the insurance company’s appeals process and be prepared to challenge an initial denial of coverage. Gather additional documentation, address the denial rationale, adhere to deadlines, and consider seeking external assistance if needed.

Tip 7: Document the Impact on Quality of Life: Evidence should address the overall impact of diastasis recti on the individual’s quality of life. This includes limitations in physical activity, emotional distress, reduced self-esteem, and any other ways the condition negatively affects daily functioning.

Adhering to these points provides a structured approach to navigating the intricacies of obtaining insurance coverage for diastasis recti repair. Meticulous preparation and proactive engagement with insurance providers significantly increase the likelihood of a successful outcome.

The subsequent section provides a conclusion that encapsulates the essence of this article.

Conclusion

This exploration of how to get diastasis recti surgery covered by insurance has detailed essential strategies for navigating the complexities of insurance claims. It underscores the significance of comprehensive medical documentation, meticulous adherence to policy requirements, and proactive engagement with insurance providers. Understanding policy exclusions, demonstrating medical necessity through conservative treatment failure, and ensuring coding accuracy are all pivotal elements in the process.

Securing insurance coverage for a medically necessary procedure is often a challenging endeavor, requiring persistence and a thorough understanding of the applicable processes. Individuals pursuing diastasis recti repair should utilize the information presented to advocate effectively for their healthcare needs, thereby increasing the likelihood of obtaining the coverage to which they are entitled and improving their overall health and well-being.