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Physical Therapy Not Considered Medically Necessary

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  • #16
    Originally posted by jhorn4012 View Post
    Update:




    Update: Disability.gov Update: Submit Your Questions Online for the July 14 White House Virtual Town Hall Meeting
    Friday, July 8, 2011 3:27 PM

    On Thursday, July 14th from 1:00 - 2:00 PM Eastern, Disability.gov will air a live "Virtual" Town Hall meeting to introduce top White House advisors on disability policy. If you have questions about disability-related subjects or issue areas, please submit them online by 6:00 PM on July 13th. To watch this live event, go to Disability.gov's home page on July 14th at 1:00 PM, and click the button that says "Watch the White House Virtual Town Hall Live!"

    Joe:
    There is an appeal process with every state insurance company. Call your state officials and let them know what is happening in the Medicaid HMO companies. I also went to christopher and dana reeve facebook site and their working on an advocacy group to help everyone that is going through this. So get all your friends to help get the point across because you and my daughter and all the 1.5 million in the U.S. disabled don't want to have your physical therapy denied.

    Thanks... Guess I will keep looking for this elusive appeals process.

    But in my case it wasn't a Medicaid HMO, it was the actual company offering physical therapy- they wouldn't consider giving me any more visits because they knew they would not get paid. Even if a Doctor approved it they say Medicaid will audit them and deny payments regardless.
    Last edited by BirdOPrey5; 07-09-2011, 08:28 AM.
    -Joe.

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    • #17
      Joe:
      I apologize. I can't get my iphone to quote inside a thread. I will use my computer.

      Update: I received a call back from private insurance. We have an advocacy group within BCBS and they are going to find out why we haven't received the Denial Letter of service that Amerigroup has verbally informed our daughter's physical therapist at HealthSouth. For that matter our private insurance hasn't received any denial letter of service and Amerigroup stopped paying for visits in March?? Without any notice until now!!! Please everyone go to the Town Hall Meeting online :
      http://https://www.disability.gov/question/save#content
      https://www.disability.gov/question/save#content[/size] Update: Submit Your Questions Online for the July 14 White House Virtual Town Hall Meeting if that link doesn't work: https://www.disability.gov/question/save#content and submit your questions and let's get the government to work for helping the disabled and not putting them back into the shadows.
      Friday, July 8, 2011 3:27 PM

      On Thursday, July 14th from 1:00 - 2:00 PM Eastern, whitehouse.gov will air a live "Virtual" Town Hall meeting to introduce top White House advisors on disability policy. If you have questions about disability-related subjects or issue areas, please submit them online by 6:00 PM on July 13th at https://www.disability.gov/question/save#content. To watch this live event, go to whitehouse.gov's home page on July 14th at 1:00 PM, and click the button that says "Watch the White House Virtual Town Hall Live!
      Last edited by jhorn4012; 07-10-2011, 03:27 PM. Reason: editing url https://www.disability.gov/question/save#content
      Aggie Mom 2007

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      • #18
        According to Medicare's definition of Medically Necessary, forget about bathing or taking a dump, other than while in bed. "Medically Necessary" and Medicare coverage, as most of us have discovered, stops at the bathroom door.

        r
        Rick Goldstein
        GO! Mobility Solutions
        facebook.com/goes.anywhere

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        • #19
          Yeppers Agreed goldnucs Ty

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          • #20
            Did anyone watch Town Hall Mtg. online? There were so many people on the and it crashed and I lost 30 mins. The panel did answer one question d
            from a person in Colley Tx. If anyone would like to join our group to advocate a Cure for Paralysis please email stemcellsatombombs Dennis Tesolat in Osaka Japan. He sometimes posts to threads at CareCure.
            Aggie Mom 2007

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            • #21
              Physical therapy denied by Medicaid HMO March 2011

              Yesterday I received a letter from the Attorney General's office. I don't know who told them, but I'm grateful. The attorney general of Texas, Greg Abbott, if some of you aren't familiar with his background, sued the state of Texas when he was struck by a falling tree which resulted in making him a paraplegic. Hoping something may come to light in this state about how Medicaid HMOs are treating their disabled. I recently attended a Medicaid HMO Town Hall Meeting and the same people were there from last year and the same speakers were there and I told the audience how people who were suppose to be in traditional medicaid were taken out of and not notified and put into Medicaid HMOs.
              Aggie Mom 2007

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              • #22
                Regarding your 2 last post's jhorn4012 Hi I do not get those tele channels etc... I see good in all your heart and it is nice to read your informative posts
                Thank you
                GL

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                • #23
                  GL
                  Thanks I needed that . I do try!
                  Aggie Mom 2007

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                  • #24
                    Originally posted by GL View Post
                    It is pathetic I been down this road and felt like it is unfair

                    My ill mom is got me worried sick . We live so far from each other I am like puzzled because she needs particular medications .

                    They are cutting back too much and it hurts the SCI community as a whole but I look at the whole medical cutbacks and they even started swapping
                    ( compromising ) some of my important meds because of some bloody idiots

                    I learned that Even though I spoke up about this crap yrs ago I am only one person
                    No one would sign pettitions and get their ideas / thoughts / views heard
                    So when I did complain and call the Governor for instance Their stupid office gave me the Run Around spinning me in circles

                    There are a lot more illegitimate babies being born and using Medicaid than those of us with SCIs. Same with illegals crossing the border to have babies. There is not an infinate amount of money. There is a seventy four percent illegitimate birth rate in the black community.. Obama can not be reelected without the black and Hispanic vote. As a Quad post 42.5 yrs who has worked 35 yrs,I'm tired of paying more for my health care to make up for Medicaid recipient's free care.My HH agency charged me $140 per day and my insurance pd $95 per day with me responsible for the remainder. The reason my costs were so high was because Medicaid only reimbursed the $55 a visit so to stay in business,they billed my insurance and me more. now you can understand how those of us who work and pay for our insurance feel about paying higher taxes to support Medicaid.How would you like to pay $5 for a Big Mac and the guy behind you get one for free? Why does a paraplegic need PT anyway when dressing and rolling chair around provides exercise for your muscles.I'm for parents being responsible for their children and a real enforcement of immigration laws.

                    I Tried so many times but no matter which route Trust me they do not answer computer messages or phone messages the nicest . As a matter a fact they always had a excuse .

                    I dont know at what level do they draw the line on having Compassion because I never seen anything get easier over the Yrs it only got worse and then Badder .

                    This is why Our Votes count so very much
                    Then again I am puzzled at who is honest .

                    Average smalltown ppl are struggling . I know many of these ppl working 3 jobs etc... Husband / Wife totally wiped out ... BTW many just are lucky if they can keep a full time job as many job cutbacks affected millions

                    I love people and do not see reasons for the medically needy to suffer . This is what makes me a simple humanitarian .

                    Sorry I spilled my guts but I care
                    Sincerely ; GL
                    Please see above.

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                    • #25
                      Physical therapy Denied by Amerigroup HMO

                      The appeal process wasn't what I expected because the patient has no representation in these types of appeals. My daughter's appeal was denied and I have already started the paperwork for her first piece of physical therapy equipment since the ruling of the medical drs. appeal. I'm doing what Amerigroup said to do in the appeal to have an in home program for our daughter. Restorative Therapies (RT300 cycle) has already explained to me this may not be covered by our private insurance or our daughter's HMO medicaid. My husband suggested to me we should seek out an attorney if this isn't covered by both insurance plans.
                      Last edited by jhorn4012; 10-30-2011, 10:16 AM. Reason: typos
                      Aggie Mom 2007

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                      • #26
                        Spiderweb

                        jhorn4012 I feel your pain reading your posts , Appealing got me no where but a stupid letter telling me some bullcrap . They are really playing games with peoples well being and health .
                        Everyone deserves to be treated humane . Their hearts are black hard as a piece of coal . Hearts of coal is more like it , yea if it was their Daughter , mother , father their flutes play a different tune but for the common man they ignore him / her .
                        It is pathetic how they lied lied lied to me for over a year . They got caught in their own spiderweb . Eventually I caught them at their own mess ...
                        Disturbingly this is what boggles me !!! Look at the mountains of paperwork etc....
                        Just to get a possible telephone call or a letter if youre luck enough . I wonder if they will be cutting back on Paper to save $ .
                        Next they probably will be sending our letters all typed out on toilet paper to save a buck . Theres a idea !!! Hmmmm that would save on paper costs and who know's maybe I just started a new global typgraphical trend .
                        Old principles !!! I live and abide by them .
                        A little kindness , compassion goes very far in my simple life and it works !!! Maybe it is because I am old fashioned .
                        What we need is good honest down to earth people helping people in our medical system . These changes and political reforms etc .... are just a game of poker and I got my poker face on .

                        What a way to start a day now I feel politically refreshed ready to face the new day at the card table .
                        In the meantime I hope everything is ok for you all
                        Keep smiling and know that this is heavy on my mind I wish I could figure a way to make things better .
                        Sincerely ;
                        GL

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                        • #27
                          Just to clarify a typo
                          I do not recall me writing this paragraph ;
                          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

                          There are a lot more illegitimate babies being born and using Medicaid than those of us with SCIs. Same with illegals crossing the border to have babies. There is not an infinate amount of money. There is a seventy four percent illegitimate birth rate in the black community.. Obama can not be reelected without the black and Hispanic vote. As a Quad post 42.5 yrs who has worked 35 yrs,I'm tired of paying more for my health care to make up for Medicaid recipient's free care.My HH agency charged me $140 per day and my insurance pd $95 per day with me responsible for the remainder. The reason my costs were so high was because Medicaid only reimbursed the $55 a visit so to stay in business,they billed my insurance and me more. now you can understand how those of us who work and pay for our insurance feel about paying higher taxes to support Medicaid.How would you like to pay $5 for a Big Mac and the guy behind you get one for free? Why does a paraplegic need PT anyway when dressing and rolling chair around provides exercise for your muscles.I'm for parents being responsible for their children and a real enforcement of immigration laws.

                          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

                          Sincerely ;

                          GL
                          Last edited by GL; 11-01-2011, 09:23 AM.

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                          • #28
                            Latest rant about Medicaid

                            GL,
                            I understand your reasoning. But you also need to understand most parents can't afford all of the specialized equipment to allow our daughter to become a working adult and allow her to go back to school. I recently found out how much this specialized equipment for her w/c costs so she can go to work and support herself without the use of Medicaid and ssi. If it wasn't for these programs we (parents) we would be broke and no where to live. We were told by our daughter's doctors she would have to have 24 hr care and would always have to have someone nearby to check on her if she was to spasm out of her chair, or drop her phone, or her need for something which was not something she could pick up and grasp. Her parents have paid for specialized PT which isn't covered by insurance or Medicaid. Her parents paid for making our home w/c accessible minus the ability of getting out of the house on her own. We're still working on that problem. In our first year of hospital visits and costs we had to pay the 20% of all costs that insurance wouldn't cover and my husband has BCBS one of the top insurance providers that his company provides his family. I'm grateful for all the specialized equipment our insurance and Medicaid has paid for since we have paid for all hospital costs and doctor and PT visits
                            Last edited by jhorn4012; 11-06-2011, 09:31 AM. Reason: typos
                            Aggie Mom 2007

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                            • #29
                              Appealing Denial of physical therapy

                              Originally posted by jhorn4012 View Post
                              Yesterday I received a letter from the Attorney General's office. I don't know who told them, but I'm grateful. The attorney general of Texas, Greg Abbott, if some of you aren't familiar with his background, sued the state of Texas when he was struck by a falling tree which resulted in making him a paraplegic. Hoping something may come to light in this state about how Medicaid HMOs are treating their disabled. I recently attended a Medicaid HMO Town Hall Meeting and the same people were there from last year and the same speakers were there and I told the audience how people who were suppose to be in traditional medicaid were taken out of and not notified and put into Medicaid HMOs.
                              Have appealed denial for our submission of an FES cycle for our daughter. Appealing both insurance companies. Will continue to appeal until we run out of appeals.
                              Aggie Mom 2007

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