Second appeal denied!

[Guest guest]

The second appeal was denied for my son to stay at 's. This time it was a

different doctor from Blue Cross and he is also insisting my son is able to step

down to PHP (Partial Hospitalization Program). The whole thing is just beyond

ludicrous!

We found out that our Blue Cross policy is " self-funded " by my husband's

company. So that's both good and bad. Bad because this prevents us from being

able to go to the state insurance commission to try and overturn the appeal, but

good (maybe!) because my husband can go directly to the top level at his company

to plead our case.

I wrote a letter to the head of HR at his company detailing my son's conditions

and explained that taking my son out of 's at this juncture would be akin

to pulling the plug on a child on life support who had a great chance for

recovery if given adequate time and proper treatment. I also stated that the two

Blue Cross doctors who are denying my son's coverage have exhibited gross

negligence with their decision and are essentially throwing my son out with

nowhere to go because there isn't a PHP (partial hospitalization program) in

this country that would accept a child in my son's condition. That is their

argument, that my son is able to step down to PHP at this point. Of course, my

son's doctor at 's repeatedly told them this is not an option as no PHP

will take him, but they refuse to budge.

To take my son from 's right now, there is absolutely NO question in my

mind that he would decompensate very quickly and not only go back to square one,

but may end up a lot worse than he was when we admitted him. I would seriously

fear for his life! This child was basically a walking skeleton not more than a

month ago (among other things) and as far as I'm concerned, these doctors at

Blue Cross who denied coverage are akin to attempted murderers, there is just no

other way to put it!!

I will continue to fight this tooth and nail and will not stop until it gets

resolved. The next step is a higher level appeal and I spoke with the senior rep

at Blue Cross who is head of appeals for mental health. She seemed very

empathetic to the situation and seems to " get it, " so we'll see what happens.

She explained that this next appeal level enables me to submit " testimony " on my

son and also enables 's to submit all of his medical records and notes. So

I am in the process of putting together documentation, a timeline, etc., and

will also send her a DVD with video clips of my son's tics, photos of friction

burns on his arms from the tics, and other visuals that clearly show the

severity of his situation.

We can use many prayers right now...