Iowa Code r. 641-3.19 - Application procedures
(1) A
child, or the parent or guardian of a child, desiring hearing aids or
audiologic services may apply to the contractor.
(2) The following information shall be
provided to the contractor by the applicant to be considered for eligibility
under this program:
a. Patient's first name,
middle initial and last name.
b.
Patient's date of birth.
c.
Patient's address, including city, state and ZIP code.
d. Parent/guardian's first name, middle
initial and last name.
e.
Parent/guardian's telephone number.
f. Parent/guardian's email address.
g. Parent/guardian's or child's medical
insurance plan coverage.
h. Hearing
aid/audiologic service provider name and telephone number.
i. Whether the request is for hearing aids or
audiologic services or both.
j.
Estimated service costs.
(3) Applicants will be enrolled in the
program on a first-come, first-served basis upon the date the application is
received by the contractor.
(4) The
contractor will provide written notification to the applicant regarding
determination of eligibility or noneligibility and the applicant's right to
appeal a denial. For those applicants deemed eligible, an enrollee number will
be assigned by the contractor.
(5)
An applicant must submit a renewal application form on an annual basis,
accompanied by all information requested by the department.
Notes
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