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Thread: Great...Anyone else getting denied physical therpay?

  1. #1
    Senior Member mr_coffee's Avatar
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    Great...Anyone else getting denied physical therpay?

    Hello everyone, i just got a letter in the mail today with these tickets. It says I can go to 18 doctor related sessions, wether it be physical therapy or getting a check up, after that, you have to pay yourself. What the heck is up with PA!! Anyone else getting a limited number of physical therapy sessions now? I was getting unlimited because i was on Medical Assistance.
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  2. #2
    I have gotten the DR. visits tickets. therapy i do at home for now. are you sure they are for therapy visits. My tickets only say primary care doctor. I didnt have to use them to see my nero dr.
    For every minute you're angry you lose a second of happiness

  3. #3
    Senior Member cali's Avatar
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    i switched to gateway to get my therapy covered. i get 5 sessions at a time, then i have to get an evaluation for the next set of 5. i used to have MA. i don't know what exactly you have to do to change your situation. sorry buddy.
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  4. #4
    Quote Originally Posted by mr_coffee
    Hello everyone, i just got a letter in the mail today with these tickets. It says I can go to 18 doctor related sessions, wether it be physical therapy or getting a check up, after that, you have to pay yourself. What the heck is up with PA!! Anyone else getting a limited number of physical therapy sessions now? I was getting unlimited because i was on Medical Assistance.
    That's a total rip-off. You should be entitled to free lifetime physical therapy sessions and doctor visits.

    Complain to your US Representative John E. Peterson.

    And to your US Senators Arlen Specter and Rick Santorum.

    Hopefully they'll light a fire under the Medical Assistance bureaucracy in PA and get you what you're entitled to.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  5. #5
    Senior Member mr_coffee's Avatar
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    Thanks everyone for the info! On monday i'm going to call the DoW and see whats up, it doesn't seem right, maybe you are right Anty...it might just be for doctor visits not therapy, its very broad on how they wrote this letter. If that is the case and they are tryinng to give me that shaft i'll contact Peterson/Specter/Santorum, thanks for the links Bob.
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  6. #6
    I know how you feel. I had been working out with a local lady just out side of Atlanta for over 2 years and insurance paid every bit of it. Then I started working out in a new program at the Shepherds center here in Atlanta that cost me 3k a month. FES Bike, treadmill, mat time, swimming and weights 3 hours a day 3 days a week. Figuring insurance would still pick up the bill; only to find out they considered it maintaining therapy in stead of functional goal therapy. What we figured out is Shepherds can not supply the correct CPT codes because this program is deemed experimental. I was doing this to prepare for the surgery I’ll have in Portugal next Friday. So now I’ll have to focus on fundraising when I get back in order to get back in that program.

    Only in America do we have to put up with rackets like our insurance companies. Will they ever figure out they can pay some now or a bunch later?

  7. #7
    Is that per year, cory?
    Daniel

  8. #8
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    hello quad this is vicky i was at shepards to tried to get them to bill medicare
    no go i am buying fes bike for at home. yep its not right we can pay iilegals their medical but......

  9. #9
    Hi Mr_Coffee,

    In your other thread I was going to suggest you get an ankle brace for your left foot but I see that others who are familiar with your problem have it covered. I've heard of AFOs and KFOs but didn't even know what the acronyms stood for. Maybe an AFO or KFO with a portable electro-stim device located just at the right location would bring your foot into alignment and help the right muscles, tendons and nerves to keep it there. The longer you walk on it the wrong way the worse it will be for you. You don't seem to think that the PTs in your area have the expertise to help you in this regard. Maybe you'll need to look outside your "local" area and at least get an initial evaluation and perhaps the correct equipment before your 18 PT sessions or doctor visits are up. Doesn't Penn State have a medical "teaching" hospital there? At the University of Florida they have "Shands" hospital which is a teaching hospital with all the latest and greatest medical innovations.

    As long as you qualify as being "poor" you'll always receive "basic" healthcare through Medicaid.... either from a General Practitioner or the ER. I imagine it's the specialized care for quadriplegia that they're trying to stop.

    I'm not sure exactly how that works and I'm sure things have changed. When I was injured back in 1979 there must have been a "Title (I forget the number) Grant either from the State or the Federal Government in my name to cover the initial cost of SCI treatment. It was a lump sum of money used for my hospital bill, ICU, PICU and finally SCI rehab. But as soon as I was released from rehab everything stopped. Hey, upon checking out they even tried to charge me 8 bucks for a damn plastic wash basin. I was so pissed I told 'em to shove it up their ass. Like I'm gonna have 8 bucks in my pocket while still in the hospital/SCI Rehab. I haven't used my pockets since the day I was scraped up off the side of the road in July 1979. I guess the "Title X?X Grant" money ran out and as soon as it did.... out the SCI rehab door I went!!!

    Your SCI condition, unlike mine, calls for "outpatient aftercare" and that's what they seem to be limiting or trying to put an end to now. In your last thread I was serious when I said there is only so much money to go around. And they need to appropriate it where they think it's most needed. That's why it's important for you to "get in the good graces" of your case worker or whoever it is that's "designing" your outpatient aftercare. You want them to take a "special liking" to you so they'll go to bat for you and hopefully get you more of what you need. It's the old saying about "getting more flies with honey than vinegar." You don't want to be a wimp and accept whatever they want to give you but you definitely don't want to become aggressive and piss them off. You want to be assertive and most importantly "knowledgable about the system" and let them think they're doing the steering and decision making but with positive input and nudging from you. The system is a tough one to get your arms around so look in your area for a Medicaid advocate person or group who can direct you. You may not want the Medicaid people to know this.

    Then when all else fails contact your US Representative first... before your US Senators. Even though US Representative John E. Peterson is a Republican and probably voted for less Medicaid money than even President Bush asked for, he does need your and your family and friend's votes to stay in office. And though he's not on any full committees (such as The House Energy and Commerce Committee which has jurisdiction over Medicaid) yet (I imagine he's a Junior Representative... maybe first termer or whatever) he is on the "Subcommittee on Labor, Health and Human Services, Education, and Related Agencies" so holds some sway on the purse strings of the Medicaid services in your State. A single call from his office to the people in charge of your case "asking" them to re-evaluate your outpatient aftercare program would probably be enough to get you extra medical care.

    You may want to make a call to your "local" District State Representative or State Senators first. And at least ask them if there's anything they can do to help. The State does partially fund Medicaid in Pennsylvania so they may have some "pull" or influence too. You might get lucky and your District State Representative may be the Chairman of the Medicaid Committee or whatever it's called there in Pennsylvania. Ya never know.

    What is Medicaid?

    Medicaid is a federally-funded, state-run program that provides medical assistance for individuals and families with limited incomes and resources. It pays for your health care costs, including doctor's visits and eye care.

    It’s estimated that our Pennsylvania’s Medicaid program costs $14 billion to run, including $5 billion in state funds, while covering 1.85 million Pennsylvanians. Between 1990 and 2005, the budget for this program jumped 180 percent.
    So you do the math!!!! Divide 1.85 million people into 14 or 19 billions dollars and that's what your State has to work with each year.

    What does it cover?

    Doctor and dentist services
    Clinic and hospital services
    Nursing home and home health care
    Family planning services; Prenatal care
    Pediatric care
    Mental health care
    Prescription drug coverage
    Optometrist services and eyeglasses


    http://www.cms.hhs.gov/ Centers for Medicare and Medicaid Services

    http://www.cms.hhs.gov/home/medicaid.asp Medicaid -- You should go here and look and click around.

    Here's what the Republican's did to Medicaid funding for this year (2006).

    The House Energy and Commerce Committee has jurisdiction over some mandatory programs, including Medicaid, SCHIP, part of Medicare, and a number of smaller programs.

    Yesterday, the House Budget Committee voted on Chairman Nussle’s proposed federal budget plan for Fiscal Year 2006. The plan’s required reductions in mandatory programs are likely to lead to cuts in federal expenditures for Medicaid and the State Children’s Health Insurance Program (SCHIP) totaling $14.9 billion or more over the next five years. The cut to Medicaid would be as much as $20 billion if the Energy and Commerce Committee does not adopt Administration proposals relating to other programs in the Committee’s jurisdiction, as explained below. This cut significantly exceeds the savings the Congressional Budget Office (CBO) estimates would be achieved if all of the changes in Medicaid and SCHIP the President proposed in his budget last month are enacted.

    The House Committee budget plan would require the House Energy and Commerce Committee to reduce spending for mandatory programs (programs not controlled by annual appropriations) within its jurisdiction by $20 billion in 2006 through 2010. This reduction would be included in a so-called “reconciliation bill” considered under special rules in the Senate that do not allow a filibuster. The House Energy and Commerce Committee has jurisdiction over some mandatory programs, including Medicaid, SCHIP, part of Medicare, and a number of smaller programs.
    Kick some ass with that left foot! In a nice but assertive manner.
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  10. #10
    Senior Member abrooks311's Avatar
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    same thing here too..
    they gave me two weeks out patient therapy...after that im payin
    during that two weeks i was told ...pushing, transfering and baiscally everything i was hoping to acheive would never happen!
    Blah

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