Re: Hospital HBOT denial letters

[Guest guest]

My son AJ is pending his Medicaid now... should I wait until it's

approved to send my letter to the hospital?

>

> Please fax these to 815-366-7962.

>

> I have had a number of conversations with an attorney from CMS who

is

> specializing in pursuing violations of the Americans with

> Disabilities Act specifically regarding Medicaid recipient

children

> with disabilities. This is all he does. This is his fulltime job.

>

> I explained to him the Medicare policy regarding HBOT and gave him

a

> copy of the 35-10 document (found at

> http://www.cms.hhs.gov/manuals/06_cim/ci35.asp#_35_10) which

spells

> out what indications Medicare will pay for and what Medicare won't

> pay for. As I've suspected too, he believes even the existence of

> that document is illegal under ADA, but of course the 35-10 came

into

> existence long before the ADA, and what needs to happen is

> somebody--or somebodies--need to file a complaint to have it

removed.

>

> I have told him about Joann Brindley's circumstance, and he

believes

> she definitely has a case.

>

> Because our children are Medicaid recipients instead of Medicare,

we

> can't directly have the 35-10 removed unless we all gather our

state

> denial letters and file a complaint that Medicaid agencies are

> denying off-label HBOT based on Medicare policy. Paragraph 5 was

> created to prevent just this sort of denial. Unfortunately, state

> Medicaid agencies will continue to deny services based upon the

> Medicare plan until we as parents and caregivers seek legal

redress.

> We got a major shot in the arm with the SD v Hood decision

>

(medicaid/files/EPSDT_S.D._v_Hoo

d.pdf)

> in Nov, 2004 when the 5th Circuit Court decision S.D. v. Hood made

it

> illegal to deny Medicaid services for children based on Medicare

> policy. Also forces EPSDT decisions based on individual child's

> needs, undermining blanket policy made from decisions based on

> articles published in peer-reviewed medical journals.

>

> I know a lot of this stuff can be dizzying and sounds like

legalese,

> but that's why this list was created. If there's something you

don't

> understand--ask. Let's work together.

>

> And Rhonda, thank you for asking your question. All new

subscribers

> receive instructions on how to ask your local hospital for HBOT

for

> your child. This is all explained in detail at

>

medicaid/files/Accessing_HBOT_in

_hospitals.PDF

> . If you need to, download it again.

>

> Basically, you just need to send a letter without your phone

number,

> email address, or fax number to the hospital administrator. Once

you

> get your letter of denial back in writing, fax it to me at

> 815-366-7962. We will use these letters to file both an ADA

complaint

> and also a complaint that a US Dept of Health and Human Services

> provider is violating the civil rights of our kids. See

> http://www.hhs.gov/ocr/knowcivilrights.html .

>

> A sample letter is below:

>

> 23 January, 2004

> Mr. X, Hospital Administrator

> XYZ Hospital

> Atlanta, Georgia

>

> Dear Mr. ___________

>

> I understand ___________ Hospital has a hyperbaric chamber. My

wife

> and I are the

> parents of a brain-injured child. Jimmy is ten years old and

suffers

> from cerebral palsy

> that has impaired his mobility, balance, and speech. He is still

not

> yet sitting up or

> walking.

>

> However, we've researched his condition quite a bit and have found

an amazing

> amount of information that Hyperbaric Oxygen Therapy (HBOT) has

helped the

> functional status of over 90% of every cp child fortunate enough

to

> receive HBOT.

> Can our son Jimmy come to ___________ Hospital and receive HBOT in

your

> hyperbaric chamber to treat his cerebral palsy?

>

> Sincerely,

>

> and Sara Freels

> 2948 Windfield Circle

> Tucker, GA 30084-6714

> Thanks.

> --

>

>

> Freels

> 2948 Windfield Circle

> Tucker, GA 30084-6714

> 770-491-6776 (phone)

> 404-725-4520 (cell)

> 815-366-7962 (fax)

> mailto:dfreels@m...

>

> http://www.freelanceforum.org/df

>

[Guest guest]

Go ahead and send the letter now.

>My son AJ is pending his Medicaid now... should I wait until it's

>approved to send my letter to the hospital?

>

>

>>

>> Please fax these to 815-366-7962.

>>

>> I have had a number of conversations with an attorney from CMS who

>is

>> specializing in pursuing violations of the Americans with

>> Disabilities Act specifically regarding Medicaid recipient

>children

>> with disabilities. This is all he does. This is his fulltime job.

>>

>> I explained to him the Medicare policy regarding HBOT and gave him

>a

>> copy of the 35-10 document (found at

>> http://www.cms.hhs.gov/manuals/06_cim/ci35.asp#_35_10) which

>spells

>> out what indications Medicare will pay for and what Medicare won't

>> pay for. As I've suspected too, he believes even the existence of

>> that document is illegal under ADA, but of course the 35-10 came

>into

>> existence long before the ADA, and what needs to happen is

>> somebody--or somebodies--need to file a complaint to have it

>removed.

>>

>> I have told him about Joann Brindley's circumstance, and he

>believes

>> she definitely has a case.

>>

>> Because our children are Medicaid recipients instead of Medicare,

>we

>> can't directly have the 35-10 removed unless we all gather our

>state

>> denial letters and file a complaint that Medicaid agencies are

>> denying off-label HBOT based on Medicare policy. Paragraph 5 was

>> created to prevent just this sort of denial. Unfortunately, state

>> Medicaid agencies will continue to deny services based upon the

>> Medicare plan until we as parents and caregivers seek legal

>redress.

>> We got a major shot in the arm with the SD v Hood decision

>>

>(medicaid/files/EPSDT_S.D._v_Hoo

>d.pdf)

>> in Nov, 2004 when the 5th Circuit Court decision S.D. v. Hood made

>it

>> illegal to deny Medicaid services for children based on Medicare

>> policy. Also forces EPSDT decisions based on individual child's

>> needs, undermining blanket policy made from decisions based on

>> articles published in peer-reviewed medical journals.

>>

>> I know a lot of this stuff can be dizzying and sounds like

>legalese,

>> but that's why this list was created. If there's something you

>don't

>> understand--ask. Let's work together.

>>

>> And Rhonda, thank you for asking your question. All new

>subscribers

>> receive instructions on how to ask your local hospital for HBOT

>for

>> your child. This is all explained in detail at

>>

>medicaid/files/Accessing_HBOT_in

>_hospitals.PDF

>> . If you need to, download it again.

>>

>> Basically, you just need to send a letter without your phone

>number,

>> email address, or fax number to the hospital administrator. Once

>you

>> get your letter of denial back in writing, fax it to me at

>> 815-366-7962. We will use these letters to file both an ADA

>complaint

>> and also a complaint that a US Dept of Health and Human Services

>> provider is violating the civil rights of our kids. See

>> http://www.hhs.gov/ocr/knowcivilrights.html .

>>

>> A sample letter is below:

>>

>> 23 January, 2004

>> Mr. X, Hospital Administrator

>> XYZ Hospital

>> Atlanta, Georgia

>>

>> Dear Mr. ___________

>>

>> I understand ___________ Hospital has a hyperbaric chamber. My

>wife

>> and I are the

>> parents of a brain-injured child. Jimmy is ten years old and

>suffers

>> from cerebral palsy

>> that has impaired his mobility, balance, and speech. He is still

>not

>> yet sitting up or

>> walking.

>>

>> However, we've researched his condition quite a bit and have found

>an amazing

>> amount of information that Hyperbaric Oxygen Therapy (HBOT) has

>helped the

>> functional status of over 90% of every cp child fortunate enough

>to

>> receive HBOT.

>> Can our son Jimmy come to ___________ Hospital and receive HBOT in

>your

>> hyperbaric chamber to treat his cerebral palsy?

>>

>> Sincerely,

>>

>> and Sara Freels

>> 2948 Windfield Circle

>> Tucker, GA 30084-6714

> > Thanks.

>> --

>>

>>

>> Freels

>> 2948 Windfield Circle

>> Tucker, GA 30084-6714

>> 770-491-6776 (phone)

>> 404-725-4520 (cell)

>> 815-366-7962 (fax)

>> mailto:dfreels@m...

>>

>> http://www.freelanceforum.org/df

>>

>

>

>

>

>

>

>

>

>

>

> " I know the plans I have for you, " declares the Lord, " plans to

>prosper you and not to harm you, plans to give you a future and a

>hope. " [ 29:11]

>_._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.

>Join the International Hyperbaric Medical Association

>http://www.hyperbaricmedicalassociation.org/docs/JOIN_Friends_Apr04.pdf

>

>Is HBOT at your hospital?

>http://apps.nlm.nih.gov/medlineplus/directories/index.cfm

>

>EPSDT decisions http://healthlaw.org/pubs/200308.epsdtdocket.html

>

>Unrestricted downloads of 50+ pdf files on HBOT efficacy

>medicaid/files/ ,

> 2/files/ and

>http://www.drneubauerhbo.com/papers.htm

>

>Download your state EPSDT program

>http://www.hcfa.gov/medicaid/stateplan/Map.asp by doing a search on

>the word " ameliorate " . State Medicaid websites

>http://www.medi-cal.ca.gov/RelSites_Oth_States.asp . Medicaid waiver

>programs:

>http://www.geocities.com/HotSprings/Villa/1029/medicaid.html

>

>Find a hyperbaric clinic

>http://www.netnet.net/mums/hbolistAK-FL.htm,

>http://www.netnet.net/mums/hbolistGA-NC.htm,

>http://www.netnet.net/mums/hbolistOH-WI.htm

>

>HBOT can save billions of dollars and millions of heartaches.

>Subscribe to by sending a blank email to

>mailto:medicaid-subscribe

>