questions for

[Guest guest]

> Why did you keep what you felt was such a terrible product?

I don't know about , but I know that I keep a boxful of

EMF protection devices around that I initially didn't find useful,

in the off-chance that later down the road I may find some use

for them...

And you can't determine if a product is terrible unless you

use it! (although I know that doesn't stop some people here,

who write negative things about products that they have never

tried)

Marc

[Guest guest]

,

My son's medicaid coverage (his secondary insurance) was presented to me as if

it was an HMO. They are very strict about only covering in-network doctors and

only if there has been a referral. To give you an example, my child's PCP is

part of both my son's primary/private insurance and the medicaid group. So are

most of his specialists. One time I forgot to ask the PCP to write the referral

to the specialist (because our private insurance is a PPO and does not require

referrals). Even though the specialist was " in-network, " I could not be

reimbursed for the co-pay. In light of our brief experience, I have a difficult

time following what you have accomplished in your state (and others in their own

states). Can you please explain step 1 in fighting medicaid denials for

out-of-network treatment facilities (or how to get treatment in-network for

off-label treatments) for my particular state?

http://www.pascenter.org/state_based_stats/medicaid_waivers_info.php?title=Conta\

ct%20Info%20and%20Descriptions & state=arizona

I don't expect you to explain the entire process, but what is step 1 since our

state does not have the Beckett Waiver?

Also, the families that I know who have medicaid as their primary insurance

cannot even get into see a specialist (medicaid refuses to authorize/approve the

visit even though the PCP made the proper referral). I know of a family who has

a child with seizures and medicaid refuses to let the child see a neurologist by

not authorizing the referral. In another case, a child has been diagnosed with

lead poisoning by the medicaid PCP and chelation has been approved *if there is

an in-network doctor who will do it,* but none can be found. Therefore the

child has never been treated.

Thanks,

---------------------------------

Boardwalk for $500? In 2007? Ha!

Play Monopoly Here and Now (it's updated for today's economy) at Games.

[Guest guest]

>,

>

> My son's medicaid coverage (his secondary insurance) was

presented to me as if it was an HMO. They are very strict about only

covering in-network doctors and only if there has been a referral.

To give you an example, my child's PCP is part of both my son's

primary/private insurance and the medicaid group. So are most of his

specialists. One time I forgot to ask the PCP to write the referral

to the specialist (because our private insurance is a PPO and does

not require referrals). Even though the specialist was " in-network, "

I could not be reimbursed for the co-pay. In light of our brief

experience, I have a difficult time following what you have

accomplished in your state (and others in their own states). Can you

please explain step 1 in fighting medicaid denials for out-of-network

treatment facilities (or how to get treatment in-network for off-

label treatments) for my particular state?

>

> http://www.pascenter.org/state_based_stats/

medicaid_waivers_info.php?title=Contact%20Info%20and%

20Descriptions & state=arizona

>

> I don't expect you to explain the entire process, but what is

step 1 since our state does not have the Beckett Waiver?

>

> Also, the families that I know who have medicaid as their primary

insurance cannot even get into see a specialist (medicaid refuses to

authorize/approve the visit even though the PCP made the proper

referral). I know of a family who has a child with seizures and

medicaid refuses to let the child see a neurologist by not

authorizing the referral. In another case, a child has been

diagnosed with lead poisoning by the medicaid PCP and chelation has

been approved *if there is an in-network doctor who will do it,* but

none can be found. Therefore the child has never been treated.

>

> Thanks,

,

Thanks for your questions.

First, whether there's a waiver or not is not really relevant. For

us, in Georgia, the Beckett waiver is the route we take to get

to Medicaid. Medicaid is Medicaid. EPSDT applies to all Medicaid

recipients--whether they get there because they have a waiver, a

disability, or low revenue. It's all the same once you get there.

That said, most likely, your Medicaid/HMO does not know what legal

responsibilities they have as a hired-hand provider of Medicaid

services in Arizona and/or the state of Arizona itself doesn't know

what responsibilities it has. This has happened before, very soon

after the group started. In Colorado there was a

similar situation where Mom wanted HBOT for her son

(I think is his name). The HMO was Kaiser. Kaiser had a

contract to only provide services " covered under the State plan, " and

so they believed they had no responsibility to cover anything outside

of the plan.

The bureaucrats at the state of course believed it was Kaiser's

problem and not theirs--so neither the state or Kaiser showed up at

the hearing because each believed it was the other's problem. Still,

the judge made the s provide proof of HBOT efficacy for --

which they did and the judge ruled the state of Colorado was

responsible--who in turn decided Kaiser was responsible--who in turn

resigned their HMO-ish contract with Colorado. All of this can be

found at medicaid/files/.

Bottom line. I don't actually know what Step 1 is for you. Right now

you've got everything in place to repeat the events in Colorado so it

may be best to try and fly in under the radar. I think I'd make the

requests for HBOT services in writing to whoever your listed HMO is

and include references to EPSDT, explaining what it says and what it

means.

At the same time, I would encourage your friends to do the same, re:

the pediatric neurologist and the chelation therapy.

Educate your providers on this too.

It might be worthwhile to first go back and start with an attempt to

get Medicaid to make that co-pay. Make the argument using EPSDT and

weigh in heavily on the reference to " whether or not such services

are covered under the State plan " as it's their state plan policy

that has forced you to make the co-pay. Even if it's just $25 or $30,

press them on it and see if they'll break. If they do and then pay

you back, this creates an acknowledgment on their part that they do

have a responsibility to cover services " whether or not such services

are covered under the State plan. " More importantly, this creates a

precedent that you can then reference (and they then can't deny) when

you come back to them with a request for reimbursement of hyperbaric

therapy.

Freels

2948 Windfield Circle

Tucker, GA 30084-6714

770-491-6776 (phone)

404-725-4520 (cell)

815-366-7962 (fax)

mailto:david@...

fearlessparents/

http://www. .com

http://www.davidfreels.com