Monday, January 30, 2012

Speech Therapy Medicaid Denial: Part One


This past October, Ian's Prior Authorization (PA) for his private speech therapy was denied by our state. His therapist had made the PA for one 45 minute session per week, which is the same frequency that he had been receiving for more than a year. When the PA came back denied, I was shocked (and angry). While it's true that Ian attends school part time now, and does receive speech therapy there, his private therapy is a very different and important part of his therapies as a whole. We've seen so much progress with Ian's speech and communication since he has starting doing school therapy in addition to his private therapy. Denying the private therapy is putting the brakes on progress that is just beginning to gain momentum.

Anyway, I started the appeal process with the state by writing them a letter stating that I wanted an appeal hearing and why I thought the decision should be reversed. The state then countered with a letter detailing why they denied the services and their argument for not reversing the decision. I then received a letter notifying me of a phone hearing with a judge. I called the judge and asked him if I could bring Ian in for an in-person hearing instead of a phone hearing. I said I didn't think he could make an objective decision about my son's case unless the hearing was in-person. He said no, he would only do the hearing by phone. Because of his inflexibility, I requested a new hearing date and time, hoping that they would schedule it with a different judge. I waited three more weeks to get a new hearing letter, and when it came it was another phone hearing, but with a different judge. I proceeded to call that judge and request an in-person hearing, and she easily granted my request.

The hearing is tomorrow, and I believe I'm on the cusp of developing an ulcer. I have letters recommending the private speech therapy from Ian's pediatrician, as well as the specialist he sees at spina bifida clinic. His therapist will attend the hearing via phone, and Justin and I will take him to appear in front of the judge and make statements for our case. Never having appealed a state medicaid decision, I'm hopeful that the judge will overturn the decision based on the recommendations and seeing that Ian is a three and a half year old child that does not speak and needs as much intervention as possible. We will see...stay tuned for Part Two: The Decision.


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