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Parity & Access

Parity & Access Hotline Form

The information you provide will remain confidential within MiBAP unless otherwise discussed and agreed upon.

Date of Report(Required)

MM slash DD slash YYYY

Name of Person Reporting(Required)

First Last

Your Email Address(Required)

Your Phone(Required)

Provider Organization(Required)

CMH/PIHP(Required)

CMH/PIHP Contact(Required)

Type of Service Denied or Limited(Required)

Date of Suspected Violation(Required)

MM slash DD slash YYYY

Reason Given for Denial(Required)

Was an appeal filed?(Required)

Yes

No

Appeal Outcome(Required)

Impact on Patient Care(Required)

Parity

Access to Care

Arbitrary Cap on Hours

Payor Dictated Length of Tx

Delay in Treatment

Worsening Condition

Discharge from Service

Pause in Service

Loss of Hours

Loss of Staffing

Other

Number of clients impacted:(Required)

Individual

Impact of Group

Did the insurance company or school provide a written explanation?(Required)

Yes

No

Can MiBAP contact you for follow-up?(Required)

Yes

No

Additional Comments

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ABOUT MIBAP

The Michigan Behavior Analysis Provider (MiBAP) Association was founded in the Spring of 2019 as a 501(c)(6) non-profit membership organization.

OUR MISSION

MiBAP’s mission is to promote access to the science of applied behavior analysis (ABA) through advocacy, education, and quality practices.

CONTACT

Send mail to:
MiBAP
208 N. Capital Ave., 3rd Floor
Lansing, MI 48933

Contact Us or Join us: membership@mibap.org

© MiBAP Association