Starting process for medicaid in PA Re:Our court decision

[Guest guest]

Nira,

If you already have Mediciad for your child, I would recommend waiting for a few

weeks before beginning to get things in place for coverage. First of all, your

child's Medicaid would most likely pay for spect scans without prior approval.

We did spect before and after, and Medicaid never questioned the neurologist's

order for it because it is a procedure that doesn't require prior approval in

North Carolina. I would try to find a neurologist in your state who is HBOT

supportive although I don't know if there is one. I would say the best way to

find out is asking other parents, calling HBOT centers in your state (free

standing because hospital facilities aren't going to know), ect. All that being

said, I believe Dr. Neubrander can order the spect to be done at your local

hospital (or closest one in PA that does a spect). If the imaging is done

within your state, it shouldn't matter if the physician is out of tstate or not.

That is something that Medicaid should be able to tell you. I would just tell

them that your child is seeing a specialist out of state, and that he has

recommended some brain imaging be done (don't tell them why). Ask them if it is

covered as long as it is done in state. I expect the answer is yes. The other

thing that needs to be done before you start treatment is that your EPSDT

request has to be submitted, and you either have to receive a denial or an

approval. If you begin without sending the request, then they aren't going to

cover you. You actually couldn't even appeal it to the court because you began

before you sent in the EPSDT request. I don't want to overwhelm you with too

much information, so I will stop here with the information. Before you do

anything else, you need to get that EPSDT request in and get an answer back from

them. Also, I am almost possitive that PA has covered this before. I know I

have seen something on line about PA and EPSDT, and I know it was when I was

doing all of my prep for HBOT coverage. I will say that it isn't an easy

process. Hopefully, your road for approval will be shorter and smoother though

since and I have fought and won battles in our states. I want to

encourage you to follow through with requesting coverage through EPSDT because

the medical world won't start changing unless we start standing up to them.

Meleah

>

> Congratulations on your win for HBOT coverage!

>

> Hi all, This is my first time posting to this group, and I would like some

advice on getting medicaid in PA to cover HBOT.

>

> We are just starting mHBOT treatment -- through Dr. Neubrander in New Jersey.

> Everything is private pay through him which is costly. We are doing a 50 day

trial, starting tomorrow.

> This includes 10 day, 30 day, 50 day follow-ups with extensive ratings we are

required to fill out to document changes, ±.

>

> We go for training today and will be taking home an Oxyhealth Vitaeris 320

soft chamber rental for 30 days.

>

> I wanted to do a SPECT scan before and after since it would give visible

documentation, but cannot afford it, and Dr. N recommends doing HBOT regardless

of the SPECT scan.

>

> What can you advise going forward to prep for going to the medicaid insurance

for reimbursement? (We do not have any private insurance since my husband was

laid off and cobra became too costly.)

>

> Do we need to see a neurologist? And how do I find one locally that is HBOT

supportive?

>

> Thanks for help.

> Nira

> Sent via BlackBerry from T-Mobile

>