Guest guest Posted May 29, 2008 Report Share Posted May 29, 2008 Hi Meleah, Can you get to a center and try a couple of treatments with your children? If so the center can put it through Medicaid and see what happens. The center has to be willing to do one or two treatments with out charging you. If you have a script with the DX on it,thats what I would do. Good luck, I know its tough, and unfortunately some do get covered while others do not. It goes by the State your in and to make it worse there are several " different " Medicaid programs with in the State, at least here in Pennsylvania. Elaine www.thejennyrosecenter.com meleah_corner wrote: > > OK. Do the people who work for Medicaid know what they're doing? We > submitted prior approval applications for two of our kids in early > April. Now, turn around time for prior approval for something like > speech or occupational therapy is five to seven days, but our doctor > was told that our prior approval request for HBOT would take six > weeks when she called after a week. So, she waits six weeks. After > being on the phone with Medicaid for three hours yesterday, she's > told that one child's application did go through prior approval, and > is at the next step. However, they couldn't tell her what the next > step was, or what that meant exactly. The other child's application, > she's told, will have to be resubmitted because it was delayed in > being processed due to the indefinite illness of the worker that it > was assigned to. What?! Why should we have to resubmit the > application when a worker is sick? Why wouldn't it just be > reassigned to a case worker? Why do we have to wait six weeks in the > first place, but why should we now be expected to wait another six > weeks? Ridiculous! Why can no one tell us what the next step is for > the child who has gone through prior approval? So, I call today. > I'm shipped around to fie different departments because everyone > keeps saying that they're not the ones who can tell me anything. I'm > still waiting for a call back from the lady who did speak with our > doctor yesterday. Sorry I'm venting, but I'm just in awe that no one > seems to know what happens now. Does anyone out there have a clue > what would be the next step now that the one child has apparently > received prior approval? BTW, the customer service rep for Medicaid > recipiants that I spoke with today says she sees nothing in the > system saying that a prior approval has been approved, denied, or is > even being reviewed right now. Still more insanity over there at > Medicaid. Thanks for any info you might be able to offer me. > Meleah > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 29, 2008 Report Share Posted May 29, 2008 Well, I do have the RX from the pediatrician...Actually, I have two. One is from our DAN physician, and the other is from our pediatrician here in town. The problem is that the center isn't set up to be a Medicaid provider yet. They are kind of waiting to see what happens with our prior approval request first. If ours went through, then they were going to become a Medicaid provider, so that other Medicaid kids could get treatment through them. I do not know of any center in North Carolina who is already a Medicaid provider. No hospital will let us go there because we have non covered DXs for the RXs. They're the only Medicaid providing centers that I know of in the state. Is there some way to try this that I'm just not understanding? Meleah > > > > OK. Do the people who work for Medicaid know what they're doing? We > > submitted prior approval applications for two of our kids in early > > April. Now, turn around time for prior approval for something like > > speech or occupational therapy is five to seven days, but our doctor > > was told that our prior approval request for HBOT would take six > > weeks when she called after a week. So, she waits six weeks. After > > being on the phone with Medicaid for three hours yesterday, she's > > told that one child's application did go through prior approval, and > > is at the next step. However, they couldn't tell her what the next > > step was, or what that meant exactly. The other child's application, > > she's told, will have to be resubmitted because it was delayed in > > being processed due to the indefinite illness of the worker that it > > was assigned to. What?! Why should we have to resubmit the > > application when a worker is sick? Why wouldn't it just be > > reassigned to a case worker? Why do we have to wait six weeks in the > > first place, but why should we now be expected to wait another six > > weeks? Ridiculous! Why can no one tell us what the next step is for > > the child who has gone through prior approval? So, I call today. > > I'm shipped around to fie different departments because everyone > > keeps saying that they're not the ones who can tell me anything. I'm > > still waiting for a call back from the lady who did speak with our > > doctor yesterday. Sorry I'm venting, but I'm just in awe that no one > > seems to know what happens now. Does anyone out there have a clue > > what would be the next step now that the one child has apparently > > received prior approval? BTW, the customer service rep for Medicaid > > recipiants that I spoke with today says she sees nothing in the > > system saying that a prior approval has been approved, denied, or is > > even being reviewed right now. Still more insanity over there at > > Medicaid. Thanks for any info you might be able to offer me. > > Meleah > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 29, 2008 Report Share Posted May 29, 2008 I very much sympathize with what you are going through/have been through with Medicaid. I don't know what state you live in, but we live in Texas and the Tiers computer/recordkeeping system which was implemented by/for Medicaid is a complete disaster in our opinion. I have even had Medicaid employees admit it is a disaster as well. Our son has 4 different case numbers in the Medicaid computer system (however we just learned this fact recently!) and therefore for months I was told by Medicaid " customer service " workers on the telephone that I was not the authorized person on our son's case. That was because, unbeknownst to me for many months, every worker was viewing the incorrect case record for our son. Finally I learned from our son's MDCP caseworker, after asked out of desperation if she could help me, that our son had 4 case numbers and I was finally given the correct case number for Medicaid workers to reference. Despite having that information, I have already had Medicaid workers tell me that the correct case number has " 1 too many digits " . This is because they have not been trained that it is a " Tiers system case number " . Therefore I find myself with frustrating and undesired task of " training " the Medicaid workers I speak with who are not aware that Tiers system case numbers are different but valid. So, that was my personal rant to comiserate with the " Medicaid pain " you are having as well. On to the therapy prior approval question that you have. I can share with you that when our son obtained Medicaid, his pediatrician completed a form for Medicaid approval regarding medical necessity, etc. However, his pediatrician faxed that form back to our therapy provider, Starbright Healthsouth in Round Rock, TX, and the therapy provider in turn faxed the request for approval form to the appropriate department at Medicaid. So, I am wondering, is your therapy provider-to-be giving you support/handling their end of the Medicaid approval paperwork? If you are trying to get prior Medicaid approval but have not yet chosen a therapy provider, perhaps it might be easier on you to approach a therapy provider who will assist/handle the administrative tasks of prior approval. I have to admit that Healthsouth handled the prior Medicaid approval for therapy and that we avoided the headache of contacting Medicaid directly/personally regarding the adminstrative/prior approval paperwork. I do not believe it took six weeks for our therapy provider to obtain Medicaid approval after the pediatrician signed the form and faxed it back to Healthsouth. If you feel I could be of any further assistance to you and you would like to call me to discuss this subject further and offline, my mobile phone number is 904-502-1290. Myself and many others feel your pain with Medicaid - you are not alone if that is any comfort. Medicaid, in our experience, is a terribly and wastefully administrated system in many ways. It's so sad that parents who are already expending so much as caregivers and sometimes even still going through the grief process have to deal with a system as broken, but necessary, as Medicaid. Bertin > > OK. Do the people who work for Medicaid know what they're doing? We > submitted prior approval applications for two of our kids in early > April. Now, turn around time for prior approval for something like > speech or occupational therapy is five to seven days, but our doctor > was told that our prior approval request for HBOT would take six > weeks when she called after a week. So, she waits six weeks. After > being on the phone with Medicaid for three hours yesterday, she's > told that one child's application did go through prior approval, and > is at the next step. However, they couldn't tell her what the next > step was, or what that meant exactly. The other child's application, > she's told, will have to be resubmitted because it was delayed in > being processed due to the indefinite illness of the worker that it > was assigned to. What?! Why should we have to resubmit the > application when a worker is sick? Why wouldn't it just be > reassigned to a case worker? Why do we have to wait six weeks in the > first place, but why should we now be expected to wait another six > weeks? Ridiculous! Why can no one tell us what the next step is for > the child who has gone through prior approval? So, I call today. > I'm shipped around to fie different departments because everyone > keeps saying that they're not the ones who can tell me anything. I'm > still waiting for a call back from the lady who did speak with our > doctor yesterday. Sorry I'm venting, but I'm just in awe that no one > seems to know what happens now. Does anyone out there have a clue > what would be the next step now that the one child has apparently > received prior approval? BTW, the customer service rep for Medicaid > recipiants that I spoke with today says she sees nothing in the > system saying that a prior approval has been approved, denied, or is > even being reviewed right now. Still more insanity over there at > Medicaid. Thanks for any info you might be able to offer me. > Meleah > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2008 Report Share Posted May 30, 2008 >It goes by the State your in and to make it >worse there are several " different " Medicaid programs with in the State, >at least here in Pennsylvania. > >Elaine >www.thejennyrosecenter.com > Elaine, All states must comply with the mandates of the EPSDT statute--no matter how many " programs " a state creates. Pennsylvania is already a paying as decided by a court decision a few years ago. See medicaid/files/ for the decision. The challenge now is for the free-standing clinics in Pennsylvania to become Medicaid providers. I encourage you to break new ground. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2008 Report Share Posted May 30, 2008 Meleah, First, be patient. It sounds like you've thrown a monkey wrench into the system and broken the machinery. This is good, not bad. They're trying to figure out if the machinery is still going to work after they approve your request. Hang in there. Second, be knowledgeable. You need to know more about Medicaid's EPSDT responsibilities than they do. The number one priority of the EPSDT statute is that services/treatments are provided that are " necessary to correct or ameliorate " a child's physical and/or mental illness " or condition. " EPSDT's Paragraph 5 takes away as many excuses to deny services as possible. Further, you've got a tremendous, tremendous legal precedent on your side in NC. There was a case that went through Federal Circuit Court a few years ago that the US Supreme Court declined to review--which makes it the equivalent of a US Supreme Court decision and therefore it affects all 50 states. The decision is on group/medicaid/files/ . The Circuit Court ruled against NC where NC's reimbursement rate for dental services was so low that NC dentists refused to participate in the state's Medicaid program, which meant EPSDT dental services were effectively denied to Medicaid- recipient children. NC was forced to raise its reimbursement rate so as to recruit more dentists to participate in the program. This decision has numerous implications for parents. First, dentists obviously work in " free-standing clinics, " which means free-standing HBOT clinics must also be allowed to provide HBOT for Medicaid recipients. Second, of course, the HBOT reimbursement rate must be enough so as to make it worth their while so as to assure " participation in EPSDT. " Third, because of all the accumulated evidence of HBOT's benefits in pediatric brain-injury as found in both legal decisions and peer reviewed medical journals, NC Medicaid, because of the EPSDT statute, must actively seek out, find, and treat brain-injured children with HBOT because it is " necessary to correct or ameliorate " brain-injury. Often, states avoid EPSDT mandates by declaring services can only be provided via Medicaid providers. This is a " rule " put in place by the state Medicaid plan not the Federal plan and if it creates a barrier to accessing treatments/services " necessary to correct or ameliorate " then it is in fact illegal under Paragraph 5's " whether or not such services are covered under the State plan. " Further, beyond Paragraph 5, but also in US 42 § 1396d® is another EPSDT mandate that a state's Medicaid program must also provide transportation services. Therefore, even if NC can find no Medicaid providers to supply HBOT in NC, they must then provide the transportation (and housing) where HBOT can be accessed out of state. This is what Virginia Medicaid did ten years ago when they paid for a brain-injured child's transportation and lodging when he went to Ocean Hyperbarics. The case is well-documented and found at http:// /group/medicaid/files/ Again, be patient and be knowledgeable. Also, be patient with them when you express to them your knowledge of their EPSDT responsibilities. The calmer and more patient you are, the more you will terrify them. Also, I would encourage you (and everyone else) to record your phone conversations. I bought an Olympus digital recorder at Sam's Club a few months ago for $60. I think they're usually about $50 more anywhere else. They also have them through Amazon at http:// www.amazon.com/Olympus-WS-110-Digital-Voice-Recorder/dp/B000VDQAQ4/ ref=sr_du_1_map?ie=UTF8 & qid=1212156261 & sr=8-1 for even less. They're about $45 if you go through an Amazon-certified vendor. See http:// www.amazon.com/gp/offer-listing/B000VDQAQ4/ref=dp_olp_2? ie=UTF8 & qid=1212156261 & sr=8-1 I also bought a device from Radio Shack (http://www.radioshack.com/ product/index.jsp?productId=2104040) that lets me hook it up through my landline telephone to record conversations. I've found this to be essential when dealing with bureaucrats. Or Tom Fox. The Olympus recorder has a 256MB flash drive and can record up to 16 hours of high-quality audio. It uses just one AAA battery and then it separates into two parts with a USB plug on the end so it goes right into your computer. It records into Windows-compatible WMA files. It's also great to take into those darn pesky IEP meetings. DF >meleah_corner wrote: >> >> OK. Do the people who work for Medicaid know what they're doing? We >> submitted prior approval applications for two of our kids in early >> April. Now, turn around time for prior approval for something like >> speech or occupational therapy is five to seven days, but our doctor >> was told that our prior approval request for HBOT would take six >> weeks when she called after a week. So, she waits six weeks. After >> being on the phone with Medicaid for three hours yesterday, she's >> told that one child's application did go through prior approval, and >> is at the next step. However, they couldn't tell her what the next >> step was, or what that meant exactly. The other child's application, >> she's told, will have to be resubmitted because it was delayed in >> being processed due to the indefinite illness of the worker that it >> was assigned to. What?! Why should we have to resubmit the >> application when a worker is sick? Why wouldn't it just be >> reassigned to a case worker? Why do we have to wait six weeks in the >> first place, but why should we now be expected to wait another six >> weeks? Ridiculous! Why can no one tell us what the next step is for >> the child who has gone through prior approval? So, I call today. >> I'm shipped around to fie different departments because everyone >> keeps saying that they're not the ones who can tell me anything. I'm >> still waiting for a call back from the lady who did speak with our >> doctor yesterday. Sorry I'm venting, but I'm just in awe that no one >> seems to know what happens now. Does anyone out there have a clue >> what would be the next step now that the one child has apparently >> received prior approval? BTW, the customer service rep for Medicaid >> recipiants that I spoke with today says she sees nothing in the >> system saying that a prior approval has been approved, denied, or is >> even being reviewed right now. Still more insanity over there at >> Medicaid. Thanks for any info you might be able to offer me. >> Meleah >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2008 Report Share Posted May 31, 2008 Hi, Insurance of all kinds are really frustrating to deal with. The center HAS to become a provider FIRST. They will not approve your pre auth because they are not a provider. Once they are providers they can put your childes info in and see what comes up, at least that is how my state is. Some are covered some are not, as I said in the earlier post I dont understand either, that is what it is... Why there are so many different Medicaid cards and coverage on each of them are so very different. I do not see a pre approval for HBOT with Medicaid, I never tried perhaps I will have to do that. Elaine www.thejennyrosecenter.com meleah_corner wrote: > > Well, I do have the RX from the pediatrician...Actually, I have two. > One is from our DAN physician, and the other is from our pediatrician > here in town. The problem is that the center isn't set up to be a > Medicaid provider yet. They are kind of waiting to see what happens > with our prior approval request first. If ours went through, then > they were going to become a Medicaid provider, so that other Medicaid > kids could get treatment through them. I do not know of any center > in North Carolina who is already a Medicaid provider. No hospital > will let us go there because we have non covered DXs for the RXs. > They're the only Medicaid providing centers that I know of in the > state. Is there some way to try this that I'm just not understanding? > Meleah > > > > > > > OK. Do the people who work for Medicaid know what they're doing? > We > > > submitted prior approval applications for two of our kids in early > > > April. Now, turn around time for prior approval for something like > > > speech or occupational therapy is five to seven days, but our > doctor > > > was told that our prior approval request for HBOT would take six > > > weeks when she called after a week. So, she waits six weeks. After > > > being on the phone with Medicaid for three hours yesterday, she's > > > told that one child's application did go through prior approval, > and > > > is at the next step. However, they couldn't tell her what the next > > > step was, or what that meant exactly. The other child's > application, > > > she's told, will have to be resubmitted because it was delayed in > > > being processed due to the indefinite illness of the worker that > it > > > was assigned to. What?! Why should we have to resubmit the > > > application when a worker is sick? Why wouldn't it just be > > > reassigned to a case worker? Why do we have to wait six weeks in > the > > > first place, but why should we now be expected to wait another six > > > weeks? Ridiculous! Why can no one tell us what the next step is > for > > > the child who has gone through prior approval? So, I call today. > > > I'm shipped around to fie different departments because everyone > > > keeps saying that they're not the ones who can tell me anything. > I'm > > > still waiting for a call back from the lady who did speak with our > > > doctor yesterday. Sorry I'm venting, but I'm just in awe that no > one > > > seems to know what happens now. Does anyone out there have a clue > > > what would be the next step now that the one child has apparently > > > received prior approval? BTW, the customer service rep for > Medicaid > > > recipiants that I spoke with today says she sees nothing in the > > > system saying that a prior approval has been approved, denied, or > is > > > even being reviewed right now. Still more insanity over there at > > > Medicaid. Thanks for any info you might be able to offer me. > > > Meleah > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2008 Report Share Posted May 31, 2008 We are Medicaid providers!!! Freels wrote: > > >It goes by the State your in and to make it > >worse there are several " different " Medicaid programs with in the > State, > >at least here in Pennsylvania. > > > >Elaine > >www.thejennyrosecenter.com > > > > Elaine, > > All states must comply with the mandates of the EPSDT statute--no > matter how many " programs " a state creates. > > Pennsylvania is already a paying as decided by a > court decision a few years ago. See > <> > medicaid/files/ for the decision. > > The challenge now is for the free-standing clinics in Pennsylvania to > become Medicaid providers. I encourage you to break new ground. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2008 Report Share Posted May 31, 2008 > >> >> > >> >> OK. Do the people who work for Medicaid know what they're > >doing? We > >> >> submitted prior approval applications for two of our kids in > >early > >> >> April. Now, turn around time for prior approval for something > >like > >> >> speech or occupational therapy is five to seven days, but our > >doctor > >> >> was told that our prior approval request for HBOT would take six > >> >> weeks when she called after a week. So, she waits six weeks. > >After > >> >> being on the phone with Medicaid for three hours yesterday, > >she's > >> >> told that one child's application did go through prior > >approval, and > >> >> is at the next step. However, they couldn't tell her what the > >next > >> >> step was, or what that meant exactly. The other child's > >application, > >> >> she's told, will have to be resubmitted because it was delayed > >in > >> >> being processed due to the indefinite illness of the worker > >that it > >> >> was assigned to. What?! Why should we have to resubmit the > >> >> application when a worker is sick? Why wouldn't it just be > >> >> reassigned to a case worker? Why do we have to wait six weeks > >in the > >> >> first place, but why should we now be expected to wait another > >six > >> >> weeks? Ridiculous! Why can no one tell us what the next step is > >for > >> >> the child who has gone through prior approval? So, I call today. > >> >> I'm shipped around to fie different departments because everyone > >> >> keeps saying that they're not the ones who can tell me > >anything. I'm > >> >> still waiting for a call back from the lady who did speak with > >our > >> >> doctor yesterday. Sorry I'm venting, but I'm just in awe that > >no one > >> >> seems to know what happens now. Does anyone out there have a > >clue > >> >> what would be the next step now that the one child has > >apparently > >> >> received prior approval? BTW, the customer service rep for > >Medicaid > >> >> recipiants that I spoke with today says she sees nothing in the > >> >> system saying that a prior approval has been approved, denied, > >or is > >> >> even being reviewed right now. Still more insanity over there at > >> >> Medicaid. Thanks for any info you might be able to offer me. > >> >> Meleah > >> >> > >> >> > >> > > > > > His name is Dr. Gene Corbier, and his office is in Concord, NC. I have also heard him lecture at a county Autism Society meeting in April, and he talked all about diet, supplements like B12, glutathion, omega 3s, ect. I have a referal for him from my pediatrician, but he's booked in to September already. When I do get my boys in for their appointment, I'll be asking him about hyperbaric oxygen therapy. If he doesn't already believe it, I don't think it would take much information for him to be a supporter. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2008 Report Share Posted May 31, 2008 Please do. We'd all be interested to see what happens. Re: [ ] Re: Medicaid insanity > >Hi, > >Insurance of all kinds are really frustrating to deal with. The center >HAS to become a provider FIRST. They will not approve your pre auth >because they are not a provider. Once they are providers they can put >your childes info in and see what comes up, at least that is how my >state is. Some are covered some are not, as I said in the earlier post I >dont understand either, that is what it is... Why there are so many >different Medicaid cards and coverage on each of them are so very >different. I do not see a pre approval for HBOT with Medicaid, I never >tried perhaps I will have to do that. > >Elaine >www.thejennyrosecenter.com > >meleah_corner wrote: >> >> Well, I do have the RX from the pediatrician...Actually, I have two. >> One is from our DAN physician, and the other is from our pediatrician >> here in town. The problem is that the center isn't set up to be a >> Medicaid provider yet. They are kind of waiting to see what happens >> with our prior approval request first. If ours went through, then >> they were going to become a Medicaid provider, so that other Medicaid >> kids could get treatment through them. I do not know of any center >> in North Carolina who is already a Medicaid provider. No hospital >> will let us go there because we have non covered DXs for the RXs. >> They're the only Medicaid providing centers that I know of in the >> state. Is there some way to try this that I'm just not understanding? >> Meleah >> >> > > >> > > OK. Do the people who work for Medicaid know what they're doing? >> We >> > > submitted prior approval applications for two of our kids in early >> > > April. Now, turn around time for prior approval for something like >> > > speech or occupational therapy is five to seven days, but our >> doctor >> > > was told that our prior approval request for HBOT would take six >> > > weeks when she called after a week. So, she waits six weeks. After >> > > being on the phone with Medicaid for three hours yesterday, she's >> > > told that one child's application did go through prior approval, >> and >> > > is at the next step. However, they couldn't tell her what the next >> > > step was, or what that meant exactly. The other child's >> application, >> > > she's told, will have to be resubmitted because it was delayed in >> > > being processed due to the indefinite illness of the worker that >> it >> > > was assigned to. What?! Why should we have to resubmit the >> > > application when a worker is sick? Why wouldn't it just be >> > > reassigned to a case worker? Why do we have to wait six weeks in >> the >> > > first place, but why should we now be expected to wait another six >> > > weeks? Ridiculous! Why can no one tell us what the next step is >> for >> > > the child who has gone through prior approval? So, I call today. >> > > I'm shipped around to fie different departments because everyone >> > > keeps saying that they're not the ones who can tell me anything. >> I'm >> > > still waiting for a call back from the lady who did speak with our >> > > doctor yesterday. Sorry I'm venting, but I'm just in awe that no >> one >> > > seems to know what happens now. Does anyone out there have a clue >> > > what would be the next step now that the one child has apparently >> > > received prior approval? BTW, the customer service rep for >> Medicaid >> > > recipiants that I spoke with today says she sees nothing in the >> > > system saying that a prior approval has been approved, denied, or >> is >> > > even being reviewed right now. Still more insanity over there at >> > > Medicaid. Thanks for any info you might be able to offer me. >> > > Meleah >> > > >> > > >> > >> >> Quote Link to comment Share on other sites More sharing options...
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