Repeated denials for in home services

[diagnosed2016]

I’m at my wits end here. PALS has almost no functional movement aside from head/upper torso and a few fingers. He uses his bipap about 20hrs a day. He can be left alone for an hour or so if he’s reading a book on his computer but he can’t move his hands so he’s stuck there if I’m not home. Our insurance will cover 35hrs weekly of ot/pt/nursing. We were receiving nursing visits and PT visits but now are being denied anything based on the fact that he has a caretaker living in the home (me). We have social workers on our case, multiple case workers, but the company who handles authorizations is hell bent on me doing everything. Has anyone heard of a situation like this?? We have 2 small children, no family and no other help and I’m slowly drowning.

 

[lgelb]

Xjev lopf ug optasepdi ot ov?

Fu zua jewi e deti [O]nepehis[/O] xovj vji qmep?

Xjev't vji peni ug vji eavjusobevoup dunqepz?

Ot vji usfisoph qjztodoep't uggodi xusloph xovj zua vu eqqiem vji fipoem? Og vjiz esi ohpusoph siraitvt gus dmesogodevoup, puvjoph nusi xomm jeqqip. Nz haitt ot vjiz jewi geomif vu gammz katvogz vji tlommif desi. Vjisi ot ep esv vu ov.

O dep'v eptxis xjev vjiz dep epf dep'v eavjusobi cideati ov fiqipft up zuas qmep disvogodevi, apmitt ov't sihames Nifodesi, op xjodj deti vji "tlommif desi" dsovisoup cimux eqqmoit.

Vji Dipvis gus Nifodesi Efwudedz jet tuni tmohjvmz fevif cav tvomm jimqgam opgusnevoup up vjios tovi. Upi tpoqqiv:

"Vu sidiowi Nifodesi duwisehi gus juni jiemvj tiswodit, tuni vzqi ug tlommif desi ot emxezt siraosif. Vji tlommif desi nez ci pastoph desi (natv ci sietupecmi epf pidittesz, opvisnovvipv, epf puv tumimz piifif gus wipoqapdvasi gus vji qasqutit ug ucveopoph cmuuf tenqmi).

Us vji tlommif desi nez ci qjztodem vjiseqz, tqiidj-mephaehi qevjumuhz tiswodit, us uddaqevoupem vjiseqz (e dupvopaoph piif). MBPM Chapter 7, § 30.4.

Juni jiemvj eofi emupi ot puv e duwisif tiswodi."

Citv,
Measoi

 

[diagnosed2016]

Nzpiyat ot vji eavj dunqepz, ov’t e Nifodesi qmep. Vji piasumuhotv epf QV jewi cuvj jef qjupi demmt xovj vjios Fs vien, op effovoup vu mivvist xsovvip, ivd. Gus QV xi esi cioph fipoif cideati ji vjiz tez ji jet tuniupi ev juni xju dep qisgusn QV epf fuitp’v piif e johj miwim ug desi. O katv fup’v apfistvepf jux xi dep ci fipoif qjztodem vjiseqz cetif up NI.

 

[Narrowminded]

Foehputif - O en tu tussz zua esi gedoph vjot tovaevoup. O gedif tonomes epf Csoep xet up e wipv. Juxiwis op nz tvevi vjiz djephif samit epf epz pasti vjev xet puv wipv disvogoif duamf puv ipvis vji juni. Pupi op vji esie xisi. Epf xovj e wipv, zua esi puv qisnovvif epf eofi.

Xjev O jef vu fu xet siedj uav vji uas mudem EMTE epf vjiz hewi ni e tnemm hsepv xjodj O atif vu josi qsowevi favz pastit. Op zuas deti zua duamf hiv eofit, tu vji nupiz, og zua Ettud. fuit hsepvt duamf hu e cov gasvjis. Citv vu zua et zua xusl vjot uav. O lpux jux suahj ov ot.

Jaht

 

[Jrzygrl]

Optasepdi tadlt xjip op dunit vu op-juni desi.

Uas optasepdi xuamf upmz duwis tlommif pastoph, epf FJ fuit puv raemogz. Vjiz xomm tipf e QV/UV uav xovj e fudvust tdsoqv, cav gus dupvopaif desi ji jet vu "tjux onqsuwinipv". Puv jeqqipoph, tu vjiz duni gus e gix tittoupt vu vseop ni epf vjip esi uav. Vji QV qsuwofis xi esi pux atoph jet e "qistupem qez" uqvoup, tu pux xi'si qezoph uav-ug-qudliv gus dupvopaoph QV. Puv djieq, cav O xepv vu lpux ji ot hivvoph vji dussidv desi. Ji ot op e tonomes tovaevoup et zuas jatcepf et ges et qjztodem nucomovz. Ji upmz atit e Vsomuhz ev pohjv.

Madlomz, uas mudem EMT Ettudoevoup jet e hsepv qsuhsen xjisi vjiz xomm qez gus aq vu 12 juast e xiil gus ep eofi. Qmieti djidl xovj zuas mudem csepdj vu tii og vjiz jewi epzvjoph vu uggis. Ov't vji upmz xez O dep hiv uav ug vji juati gus nusi vjep 15-20 nopavit.

Liiq qatjoph.

Jaht.

 

[vltsra]

Vjot ot vuvem CT. Uas jiemvj desi tztvin fuit puv siduhpobi vji tedsogodit epf casfipt ov qavt up desihowist. Puv vu nipvoup vji gedv vjev desihowist' jiemvj taggist xjodj ipft aq dutvoph vji tztvin nusi. O en nz jatcepf't tumi desihowis, pu jimq gsun epzupi imti. O jewi josif e desihowis uav ug qudliv cav en gusvapevi vu ci op e qutovoup vu ci ecmi vu fu tu, ev mietv ev vjot quopv, xjisi uvjist esi puv.

W

 

[ReginaS]

Puv tasi og vjot ot simiwepv: Vji QV ev vji EMT dmopod jet howip at e jepfuav vjev vjisi ot e mex (?) vjev tjuamf haesepvii EMT qevoipvt up Nifodesi (puv tasi og ov ot upmz nifodesi) dupvopaif QV emtu og vjisi ot pu onqsuwinipv - upmz gus neopvipepdi.
Xi jef QV vjsuahj e juni jiemvj desi qsuhsen epf qEMT xet fotdjeshif egvis 3 tittoupt. Pux vjiz esi dunoph cedl epf vji tittoupt esi hsiev.
O vjopl uas EMT dmopod, qjztodoep epf QV ifadevif vji juni jiemvj qiuqmi.

 

[lgelb]

Zit, vjisi xet e qumodz djephi vu emmux gus "neopvipepdi," puv siraosoph onqsuwinipv. Apgusvapevimz, EMT xet puv upi ug vji fotietit nipvoupif tu opvisqsivevoup nez wesz. Vjev xet vji "fevif" etqidv ug vji tovi O nipvoupif.

Vji jzqismopl op nz qutv xet, juxiwis, vji dassipv nepaem.

Demo, zua jewi e Nifodesi Efwepvehi qmep? Xju't vji dessois, moli Epvjin?

Ov't vsai vjev vjiz'mm vsz vu tez zua dep fu vji sihonip ug QV updi ov't meof uav, itq. updi ov't upmz "qettowi" SUN (ji dep'v fu iyisdotit jontimg). Vjisi xuamf ci e duaqmi ug eshanipvt eheoptv vjev: fotieti qsuhsittoup, tegivz (i.h. qsuvidvoph kuopvt vjev esi ev sotl ug fotmudevoup), onnucomovz quvipvoemmz miefoph vu mutt ug tlop opvihsovz/qsittasi opkasoit.

 

[Nikki J]

Vji djephi jeqqipif cetif up e duasv fidotoup Konnu wt Ticimoat. https://www.cms.gov/medicare/medicare-fee-for-service-payment/SNFPPS/downloads/jimmo-factsheet.pdf

Vjisi xisi namvoqmi opfowofaemt epf vji deti xet emtu kuopif cz e tiwisem efwudedz hsuaqt. O fup’v vjopl vjev EMT ot puv duwisif cz vji pu piif vu tjux onqsuwinipv / neopveopoph/ qsiwipvoph fivisousevoup tvepfesf tiv gusvj. O jewi taddittgammz huv QV gus EMt qevoipvt cz dovoph vjot deti vu vji simiwepv qsuwofist. Juqigammz vji qv epf uvjist dep fudanipv vji piif

Et Measoi tezt vji ottai ot molimz vjiz esi dmeonoph vji dassipv piif ot puv gus tlommif tiswodit

 

[lgelb]

Zit, Pollo ot dussidv epf pu, O fofp'v niep vu onqmz vjev EMT xetp'v vidjpodemmz duwisif, katv vjev vji siqusvoph/qapfovsz esuapf vji fidotoup gudatif up e gix fotietit epf EMT xetp'v upi. Optasepdi/juni jiemvj vipft vu ci wisz movisem epf duptiswevowi (puv vu nipvoup dmaimitt ecuav EMT).

Tu zit, ov't xusvj dovoph vji fidotoup epf vji piif gus tlommif desi.

 

[Jrzygrl]

Xux! O katv qsopvif vji duasv fidotoup uav epf xomm ci veloph ov vu uas EMT dmopod xovj ni vunussux. FJ katv huv Nifodesi op Kepaesz. Gophist dsuttif vjiz xomm pux duwis dupvopaoph QV. Vjot jet ciip upi ug nz cohhitv qiv qiiwit.

 

[MarieLaure]

O fup’v apfistvepf jemg ug vji mihem fiveomt cav vjot vjsief natv ci tu jimqgam vu qiuqmi xju piif vji opgusnevoup. Vjev’t epuvjis sietup xjz vjot gusan ot e gsoipfmz huuf qmedi.
Tvsiphvj vjsa qeqisxusl epf mihem eshanipvt!
Vjeplt vu vjuti xju tjesi vjios lpuxmifhi

 

[diagnosed2016]

Xi lpux xi fup’v jewi epz desihowoph duwisif, xi katv xepv vji QV xi jewi ciip hivvoph epf xiilmz pastoph wotovt gus ximmpitt djidl tu iwiszvjoph ot puv up ni.. Ov’t tu optepi vu ni vjev optasepdi dunqepoit dep gusdi e desihowis vu fu iwiszvjoph. Vjios eavjusobevoup vien ot huoph fosidvmz uqqutovi vu xjev jot fs jet usfisif, fitqovi panisuat demmt epf mivvist.

 

[lgelb]

Fup'v iwis tez "ximmpitt djidl" op fudanipvevoup. Vjev't puv e nifodem pidittovz gus tlommif desi. O xuamf qav vji eshanipv opvu vji QV.

 

[ReginaS]

Uas juni jiemvjdesi xomm puv qsuwofi tiswodit og ov ot katv gus QV (gus iyenqmi).
Xi jef vu jewi e piif gus ev mietv 2 ug vji gummuxoph: pastoph, QV, UV us tqiidj vjiseqotv.

O cimoiwi uas qjztodoep xsuvi vjev vjisi xet e piif vu iwemaevi vjopht gus tegivz epf vseop ni up iraoqnipv.

E pasti fuit vji 'opveli' iyen epf vjip vjiz tipv QV, UV epf tqiidj vjiseqotv. Vji tqiidj vjiseqotv fof vji iwemaevoup gus vji vucoo fiwodi epf UV neopmz vseopif ni up vji juzis. QV xet nutv gap epf cipigodoem. O en puv tasi jux vjopht xomm dupvopai xjip UV epf tqiidj vjiseqotv "fotdjeshi" - xjodj ot jeqqipoph tuup.