Guest guest Posted March 20, 2012 Report Share Posted March 20, 2012 Hi All, (3 years old) was just denied by by Medicaid for continued speech services. She has been going 1x weekly since she was 1.5 years old. The State indicates that it is not " medically necessary " . I am waitng for the Speech Therapist to get more specific information. I know some have been succesful in getting the authorization approved and some have been successful with appeals. Any suggestions on what to include in my appeal? Thanks, Kim Pinsch Mom to ------------------------------------ Join us for our 2011 Research & Awareness Conference in Orlando FL! http://imdsa.org/overview ******************************************************* Become a member of IMDSA today at http://www.imdsa.org ************************************************************************** Contact IMDSA Today at: IMDSA~PO Box 354~Trenton~OH~USA~1-~1-888-MDS-LINK ********************************************************************* Join IMDSA on Facebook: http://www.facebook.com/pages/International-Mosaic-Down-Syndrome-Association/124\ 966854183961 ********************************************************************** Share your story today! http://www.mosaicdownsyndrome.com ********************************************************* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2012 Report Share Posted March 20, 2012 Speech therapist should appeal for you. Make sure the appeal states why she needs speech therapy other than what is written in the IEP if she is getting therapy from school as well. Re: Denial Hi All, (3 years old) was just denied by by Medicaid for continued speech services. She has been going 1x weekly since she was 1.5 years old. The State indicates that it is not " medically necessary " . I am waitng for the Speech Therapist to get more specific information. I know some have been succesful in getting the authorization approved and some have been successful with appeals. Any suggestions on what to include in my appeal? Thanks, Kim Pinsch Mom to ------------------------------------ Join us for our 2011 Research & Awareness Conference in Orlando FL! http://imdsa.org/overview ******************************************************* Become a member of IMDSA today at http://www.imdsa.org ************************************************************************** Contact IMDSA Today at: IMDSA~PO Box 354~Trenton~OH~USA~1-~1-888-MDS-LINK ********************************************************************* Join IMDSA on Facebook: http://www.facebook.com/pages/International-Mosaic-Down-Syndrome-Association/124\ 966854183961 ********************************************************************** Share your story today! http://www.mosaicdownsyndrome.com ********************************************************* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2012 Report Share Posted March 20, 2012 In WI, the member needs to appeal the decision. So, I did request the appeal today and will have a fair hearing in 3-4 months. Kim Pinsch From: MosaicDS [mailto:MosaicDS ] On Behalf Of Jen Bolduc Sent: Tuesday, March 20, 2012 3:36 PM To: MosaicDS Subject: Re: Denial Speech therapist should appeal for you. Make sure the appeal states why she needs speech therapy other than what is written in the IEP if she is getting therapy from school as well. Re: Denial Hi All, (3 years old) was just denied by by Medicaid for continued speech services. She has been going 1x weekly since she was 1.5 years old. The State indicates that it is not " medically necessary " . I am waitng for the Speech Therapist to get more specific information. I know some have been succesful in getting the authorization approved and some have been successful with appeals. Any suggestions on what to include in my appeal? Thanks, Kim Pinsch Mom to ------------------------------------ Join us for our 2011 Research & Awareness Conference in Orlando FL! http://imdsa.org/overview ******************************************************* Become a member of IMDSA today at http://www.imdsa.org ************************************************************************** Contact IMDSA Today at: IMDSA~PO Box 354~Trenton~OH~USA~1-~1-888-MDS-LINK ********************************************************************* Join IMDSA on Facebook: http://www.facebook.com/pages/International-Mosaic-Down-Syndrome-Association /124966854183961 ********************************************************************** Share your story today! http://www.mosaicdownsyndrome.com ********************************************************* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2012 Report Share Posted March 21, 2012 Where in WI are you? We live just north of West Bend and speech was always covered at school for Mahrya from the time she was two all the way through middle school when she no longer required it. Subject: RE: Denial To: MosaicDS Date: Tuesday, March 20, 2012, 5:20 PM  In WI, the member needs to appeal the decision. So, I did request the appeal today and will have a fair hearing in 3-4 months. Kim Pinsch From: MosaicDS [mailto:MosaicDS ] On Behalf Of Jen Bolduc Sent: Tuesday, March 20, 2012 3:36 PM To: MosaicDS Subject: Re: Denial Speech therapist should appeal for you. Make sure the appeal states why she needs speech therapy other than what is written in the IEP if she is getting therapy from school as well. Re: Denial Hi All, (3 years old) was just denied by by Medicaid for continued speech services. She has been going 1x weekly since she was 1.5 years old. The State indicates that it is not " medically necessary " . I am waitng for the Speech Therapist to get more specific information. I know some have been succesful in getting the authorization approved and some have been successful with appeals. Any suggestions on what to include in my appeal? Thanks, Kim Pinsch Mom to ------------------------------------ Join us for our 2011 Research & Awareness Conference in Orlando FL! http://imdsa.org/overview ******************************************************* Become a member of IMDSA today at http://www.imdsa.org ************************************************************************** Contact IMDSA Today at: IMDSA~PO Box 354~Trenton~OH~USA~1-~1-888-MDS-LINK ********************************************************************* Join IMDSA on Facebook: http://www.facebook.com/pages/International-Mosaic-Down-Syndrome-Association /124966854183961 ********************************************************************** Share your story today! http://www.mosaicdownsyndrome.com ********************************************************* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2012 Report Share Posted March 21, 2012 We live in Oconomowoc. does receive Speech in the Early Childhood setting at school, however we have been continuing with private speech therapy that insurance has thus far covered. The goals at school and in the private setting are different. At school, it appears that most of the services are in a group rather than individually.  Kim Pinsch Subject: RE: Denial To: MosaicDS Date: Tuesday, March 20, 2012, 5:20 PM  In WI, the member needs to appeal the decision. So, I did request the appeal today and will have a fair hearing in 3-4 months. Kim Pinsch From: MosaicDS [mailto:MosaicDS ] On Behalf Of Jen Bolduc Sent: Tuesday, March 20, 2012 3:36 PM To: MosaicDS Subject: Re: Denial Speech therapist should appeal for you. Make sure the appeal states why she needs speech therapy other than what is written in the IEP if she is getting therapy from school as well. Re: Denial Hi All, (3 years old) was just denied by by Medicaid for continued speech services. She has been going 1x weekly since she was 1.5 years old. The State indicates that it is not " medically necessary " . I am waitng for the Speech Therapist to get more specific information. I know some have been succesful in getting the authorization approved and some have been successful with appeals. Any suggestions on what to include in my appeal? Thanks, Kim Pinsch Mom to ------------------------------------ Join us for our 2011 Research & Awareness Conference in Orlando FL! http://imdsa.org/overview ******************************************************* Become a member of IMDSA today at http://www.imdsa.org ************************************************************************** Contact IMDSA Today at: IMDSA~PO Box 354~Trenton~OH~USA~1-~1-888-MDS-LINK ********************************************************************* Join IMDSA on Facebook: http://www.facebook.com/pages/International-Mosaic-Down-Syndrome-Association /124966854183961 ********************************************************************** Share your story today! http://www.mosaicdownsyndrome.com ********************************************************* Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.