What do I do!? Medicaid CMO nightmare

[Guest guest]

My kids were stuck with Peachstate for another year last year, so this year I made sure I switched well before the deadline. The OT said that Amerigroup was better with paying for services, seems Peachstate was the worst with getting anything without pulling out teeth. SO, as of July 1, they were officially with Amerigroup. My boys OT had mentioned something about her not getting approval and she needed some paperwork from me to prove to them that services were needed. Then today I get 3 letters from Amerigroup, 2 regarding my older son and 1 regarding my youngest son. One letter was the same for both reads as follows:

Your doctor asked for approval of service(s) for you on July 14, 2008. Based on the information sent by your doctor, the service(s) you asked for will be denied because: Sensory Integration Therapy is considered to be investigational for your condition. As outlined in the Member Handbook, experimental or investigational procedures are excluded and therefore not covered by Amerigroup. For your information, a list of services not covered by Amerigroup may be found in the member hanadbook. Per Amerigroup Therapy for Disabilities Procedure and review by a board certified physician of the information we received, the request for the Sensory Integration Therapy is not approved as medically necessary.

First off I never recieved the Member handbook, I finally got the cards in the mail a few days ago.

The second letter for my older son was for Occupational therapy, denied because they need reports showing abnormal development or functional testing that indicates presense of a disabling condition requiring skilled therapy to correct or ameliorate......not approved as medically necessary and so on.

Reprots were sent to them, you name it from Emory genetics, Emory Autism Center, and so on. Reports for the MRi's and chromosomal defect.Time for vacation? WIN what you need. Enter Now!