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Thread: Physical Therapy Not Considered Medically Necessary

  1. #1

    Unhappy Physical Therapy Not Considered Medically Necessary

    Here's my statement how Medicaid Amerigroup HMO in Texas is treating their disabled community:daughter's provider HealthSouth received a denial of services. What they told provider wasn't what I was told on phone. I was told visits would no longer be paid because physical therapy isn't medically necessary.Someone should let Medicaid providers know it’s extremely necessary for spinal cord injured clients to get as much traditional physical therapy as they can afford.We pay for extra non-traditional therapy at Project Walk Austin, TX. Both therapies have made an amazing return of function.Please see our daughter's blog thesam4r2wblog.blogspot.com.

    Please if anyone out there is facing the same dilemma with a government agency, please don't let them get away with making a health care decision for someone with a spinal cord injury. The state should not give power to these Medicaid HMO plans because they aren't even knowledgeable of the client's spinal cord injury. You can thank HIPPA for that! Only your doctor should be allowed to make that decision for a client with spinal cord injury.
    Last edited by jhorn4012; 07-04-2011 at 03:15 PM. Reason: emotion icon
    Aggie Mom 2007

  2. #2
    I thought HIPPA was just a set of laws meant to protect patient privacy and who could see your medical records. Is there something about HIPPA I don't know about?

  3. #3
    Once I had my gall bladder out and the anesthesia was deemed medically unnecessary. I was young and dumb and did not fight it...just paid by the month...sighhhhh.

  4. #4
    Appeal?

    (HIPPA is the privacy act, I thought )
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  5. #5
    Senior Member rdf's Avatar
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    Texas cut Medicaid big time from what I've been reading.
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  6. #6
    It is pathetic I been down this road and felt like it is unfair

    My ill mom is got me worried sick . We live so far from each other I am like puzzled because she needs particular medications .

    They are cutting back too much and it hurts the SCI community as a whole but I look at the whole medical cutbacks and they even started swapping
    ( compromising ) some of my important meds because of some bloody idiots

    I learned that Even though I spoke up about this crap yrs ago I am only one person
    No one would sign pettitions and get their ideas / thoughts / views heard
    So when I did complain and call the Governor for instance Their stupid office gave me the Run Around spinning me in circles

    I Tried so many times but no matter which route Trust me they do not answer computer messages or phone messages the nicest . As a matter a fact they always had a excuse .

    I dont know at what level do they draw the line on having Compassion because I never seen anything get easier over the Yrs it only got worse and then Badder .

    This is why Our Votes count so very much
    Then again I am puzzled at who is honest .

    Average smalltown ppl are struggling . I know many of these ppl working 3 jobs etc... Husband / Wife totally wiped out ... BTW many just are lucky if they can keep a full time job as many job cutbacks affected millions

    I love people and do not see reasons for the medically needy to suffer . This is what makes me a simple humanitarian .

    Sorry I spilled my guts but I care
    Sincerely ; GL

  7. #7

    Unhappy Texas Medicaid HMO Amerigroup

    Quote Originally Posted by GL View Post
    It is pathetic I been down this road and felt like it is unfair

    My ill mom is got me worried sick . We live so far from each other I am like puzzled because she needs particular medications .

    They are cutting back too much and it hurts the SCI community as a whole but I look at the whole medical cutbacks and they even started swapping
    ( compromising ) some of my important meds because of some bloody idiots

    I learned that Even though I spoke up about this crap yrs ago I am only one person
    No one would sign pettitions and get their ideas / thoughts / views heard
    So when I did complain and call the Governor for instance Their stupid office gave me the Run Around spinning me in circles

    I Tried so many times but no matter which route Trust me they do not answer computer messages or phone messages the nicest . As a matter a fact they always had a excuse .

    I dont know at what level do they draw the line on having Compassion because I never seen anything get easier over the Yrs it only got worse and then Badder .

    This is why Our Votes count so very much
    Then again I am puzzled at who is honest .

    Average smalltown ppl are struggling . I know many of these ppl working 3 jobs etc... Husband / Wife totally wiped out ... BTW many just are lucky if they can keep a full time job as many job cutbacks affected millions

    I love people and do not see reasons for the medically needy to suffer . This is what makes me a simple humanitarian .

    Sorry I spilled my guts but I care
    Sincerely ; GL
    GL:
    You and I need to get our viewpoint heard by our Texas officials. I've already started making calls and emails to all officials in Texas, Joe Barton, Kay Bailey Hutchison and others. I'm not even going to waste my time with governor's office. He's an idiot for signing the bill at the 13th Legislative Committee 82nd meeting that no longer allows universities in Texas to use certain lines of stem cell in clinical trial settings in all of our universities. First the governor said Texas will become one of the largest industries of biomedical engineering and then signs no stem cell to be used in universities. I hope this doesn't mess up clinical trials that Dr. Young is trying to setup with Brackenridge in Austin for umblical cord blood/lithium!

    Turns out Texas Department of Insurance has a phone number that only goes to faxmachine. I'll get the new number and let the Texas clients know the number to that office to make complaints to Amerigroup HMO/StarPlus and other insurance companies doing business in Texas.

    Thank you for all your replies. This isn't happening to small town areas in U.S. it's happening all over the Medicaid system in the U.S. We live in an upper/middle class city close by the DFW metroplex. I had a chat with my internal medicine dr. and he said what is happening is Medicaid is pushing the disabled into assisted living which to me doesn't make sense because if the idiots in Austin don't realize, this is going to cost Texas taxpayers more money in the long run than providing physical therapy to the disabled and try to keep them as independent and living in their own homes.
    Aggie Mom 2007

  8. #8

    Unhappy Disabled being denied Physical Therapy Amerigroup HMO Texas

    I've already started making calls and emails to all officials in Texas, Joe Barton, Kay Bailey Hutchison and others. I'm not even going to waste my time with governor's office. He's an idiot for signing the bill at the 13th Legislative Committee 82nd meeting that no longer allows universities in Texas to use certain lines of stem cell in clinical trial settings in all of our universities. First the governor said Texas will become one of the largest industries of biomedical engineering and then signs no stem cell to be used in universities. I hope this doesn't mess up clinical trials that Dr. Young is trying to setup with Brackenridge in Austin for umblical cord blood/lithium!

    Turns out Texas Department of Insurance has a phone number that only goes to faxmachine. I'll get the new number and let the Texas clients know the number to that office to make complaints to Amerigroup HMO/StarPlus and other insurance companies doing business.

    Update:
    Texas Dept. of Insurance State Office
    cant help w/Medicaid claims and Amerigroup complaints because they are Medicaid HMO(s) so after spending over an hour on phone (amerigroup HMO complaint *dept 817 861-7700 x36017) I posted my story on FB at Christopher and Dana Reeves Foundation on their wall and I left a message for Bernadette Mauro at CReeves that deals with these type of Medicaid HMO issues and help people to get their info out to Advocacy groups that deal with problems concerning the rights and well being of someone that is disabled and needs physical therapy. *I don't need to go into detail of why SCI need PT!!!!!!!!!!





    Thank you for all your replies. This isn't happening to small town areas in U.S. it's
    happening all over the Medicaid system in the U.S. We live in an upper/middle class city close by the DFW metroplex. I had a chat with my internal medicine dr. and he said what is
    happening is Medicaid is pushing the disabled into assisted living which to me doesn't make
    sense because if the idiots in Austin don't realize, this is going to cost Texas taxpayers more
    money in the long run than providing physical therapy to the disabled and try to keep them
    as independent and living in their own homes.[/QUOTE]

    Update:
    Last edited by jhorn4012; 07-07-2011 at 02:32 PM. Reason: posted incorrectly from iphone
    Aggie Mom 2007

  9. #9
    Things are no better in New York. Medicaid approved 6 weeks of physical therapy, first at 3 times a week, then down to twice a week, and would not re-approve anymore.

    I was on the phone with a number of people for a long time and could not make any headway. I was told there is no appeals process either.

    I have a prescription from my doctor for PT 4 to 5 times a week but no agency will honor it. I was told flat out Medicaid would refuse to pay them no matter what the prescription says.

    It was/is sickening. They just prefer I stay this way. With PT I have a decent chance of becoming independent again eventually.
    -Joe.

  10. #10

    Unhappy Disabled being denied Physical Therapy - Amerigroup HMO Texas

    Quote Originally Posted by jhorn4012 View Post
    I've already started making calls and emails to all officials in Texas, Joe Barton, Kay Bailey Hutchison and others. I'm not even going to waste my time with governor's office. He's an idiot for signing the bill at the 13th Legislative Committee 82nd meeting that no longer allows universities in Texas to use certain lines of stem cell in clinical trial settings in all of our universities. First the governor said Texas will become one of the largest industries of biomedical engineering and then signs no stem cell to be used in universities. I hope this doesn't mess up clinical trials that Dr. Young is trying to setup with Brackenridge in Austin for umblical cord blood/lithium!

    Turns out Texas Department of Insurance has a phone number that only goes to faxmachine. I'll get the new number and let the Texas clients know the number to that office to make complaints to Amerigroup HMO/StarPlus and other insurance companies doing business.


    Texas Dept. of Insurance State Office
    cant help w/Medicaid claims and Amerigroup complaints because they are Medicaid HMO(s) so after spending over an hour on phone (amerigroup HMO complaint *dept 817 861-7700 x36017) I posted my story on FB at Christopher and Dana Reeves Foundation on their wall and I left a message for Bernadette Mauro at CReeves that deals with these type of Medicaid HMO issues and help people to get their info out to Advocacy groups that deal with problems concerning the rights and well being of someone that is disabled and needs physical therapy. *I don't need to go into detail of why SCI need PT!!!!!!!!!!





    Thank you for all your replies. This isn't happening to small town areas in U.S. it's
    happening all over the Medicaid system in the U.S. We live in an upper/middle class city close by the DFW metroplex. I had a chat with my internal medicine dr. and he said what is
    happening is Medicaid is pushing the disabled into assisted living which to me doesn't make
    sense because if the idiots in Austin don't realize, this is going to cost Texas taxpayers more
    money in the long run than providing physical therapy to the disabled and try to keep them
    as independent and living in their own homes.
    Update:[/QUOTE]

    Quote Originally Posted by BirdOPrey5 View Post
    Things are no better in New York. Medicaid approved 6 weeks of physical therapy, first at 3 times a week, then down to twice a week, and would not re-approve anymore.

    I was on the phone with a number of people for a long time and could not make any headway. I was told there is no appeals process either.

    I have a prescription from my doctor for PT 4 to 5 times a week but no agency will honor it. I was told flat out Medicaid would refuse to pay them no matter what the prescription says.

    It was/is sickening. They just prefer I stay this way. With PT I have a decent chance of becoming independent again eventually.

    Update: Disability.gov Update: Submit Your Questions Online for the July 14 White House Virtual Town Hall Meeting
    Friday, July 8, 2011 3:27 PM

    On Thursday, July 14th from 1:00 - 2:00 PM Eastern, Disability.gov will air a live "Virtual" Town Hall meeting to introduce top White House advisors on disability policy. If you have questions about disability-related subjects or issue areas, please submit them online by 6:00 PM on July 13th. To watch this live event, go to Disability.gov's home page on July 14th at 1:00 PM, and click the button that says "Watch the White House Virtual Town Hall Live!"

    Joe:
    There is an appeal process with every state insurance company. Call your state officials and let them know what is happening in the Medicaid HMO companies. I also went to christopher and dana reeve facebook site and their working on an advocacy group to help everyone that is going through this. So get all your friends to help get the point across because you and my daughter and all the 1.5 million in the U.S. disabled don't want to have your physical therapy denied.
    Last edited by jhorn4012; 07-08-2011 at 11:12 PM. Reason: iphone errors
    Aggie Mom 2007

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