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Thread: Recent Accident to My Son

  1. #151
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    This was a busy week for Brian. He has started the on-line immunology class from UC Berkeley in addition to this and therapy on Tuesday and Wednesday he spent a half day each day at two doctor's offices observing. He hopes to continue this so that he can add clinical experience to medical school application. My wife found out that the son of one of the people she plays bridge with is a physiatrist. Her friend talked to her son and he said that he would be pleased to have Brian come to his office and observe. This all adds to the clinical experience that Brian needs.

    Also on Friday Brian went to the AZ Division of Motor Vehicles and a driving school to learn how to drive a specially equipped car. For some reason Brian's AZ drivers license was still valid we don't know why. Several years ago when Brian was going to school at Berkeley he got a California drivers license. For some reason AZ never canceled his AZ drivers license. Brian's California license expired last July. At the time he wasn't physically able to renew it. The California motor vehicle division requires that you notify them if you have sustained an injury that interferes with you ability to operate a motor vehicle. Anyway that problem has seemed to have taken care of itself. The next step is the drivers training class.

    On Monday I called Restorative Therapies about the RT-300 freezing up in the middle of a session. The technician at RT there changed an INTERNET network setting and we haven't had any more problems. This week I also received the first denial letter from Blue Shield for the Easy Stand 6000 claim that I submitted. A few months ago I purchased a used Easy Stand 6000 from a Carecure member in Albuquerque. The Easy Stand 6000 is no longer available from Easy Stand and Brian preferred the 6000 rather than their new Evolve model. After I purchased the 6000 I submitted a claim to Blue Shield claim for the $800 purchase price. With the claim I submitted: the doctors script, a letter of medical necessity, procedure code and a receipt. The claim was denied because I didn't submit a diagnosis code. Brian thinks that he has the diagnosis code so I'll get that from him today and resubmit the claim again. I doubt that this will be the last denial. You would think that Blue Shield would see that $800 was a bargain because a new Easy Stand Evolve is ~$5000. I don't think that they recognize a savings they just deny everything the first time and hope that you'll go away empty handed.

    Brian received an email from the director of communications at Dr. Keirstead's Lab. She is talking to the doctors at the lab to find a place that Brian can work to get research experience. We're hoping that these arrangements can be completed in the next few months. When they are we'll get an apartment or an extended stay hotel room for the time that he is working at the lab.

    Roger
    Last edited by Roger; 01-26-2008 at 06:22 PM.

  2. #152
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    Roger,
    It certainly sounds like things are coming along well, and both you and Brian need a big pat on the back for your perseverence though all of these "steps" back to a life Brian desires. I think you're right, btw, Blue Cross seems to always initially deny and hope that the problem will go away. I bet in the end they pay, it's just how many hoops they make you jump through first. Good luck!

  3. #153
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    Eileen

    I don't want to create the impression that everything happens smoothly. there are good and bad days.

    Roger

  4. #154
    Roger, you may want to look back at your original posts so that you yourself appreciate how far you and your son have come since you first posted here. Your story is such a good example of the importance of family support and advocacy and never giving up or taking "no" for an answer. I hope that others can benefit for your posts here.

    (KLD)

  5. #155
    Quote Originally Posted by Eileen
    Roger,
    It certainly sounds like things are coming along well, and both you and Brian need a big pat on the back for your perseverence though all of these "steps" back to a life Brian desires. I think you're right, btw, Blue Cross seems to always initially deny and hope that the problem will go away. I bet in the end they pay, it's just how many hoops they make you jump through first. Good luck!
    I recall reading in the NSCIA newsletter that 75% of all claims for DME are orginally denied; 35% of those are appealed. about 75% of all appeals are granted on the first go round. I believe the percentages remain level for re-appeals and denials for additional rounds but I cannot say for certain. Based on that alone, it certainly seems as though the system is designed to thwart us until we go away frustrated, our condition changes or we die.
    My blog: Living Life at Butt Level

    Ignite Phoenix #9 - Wheelchairs and Wisdom: Living Life at Butt Level

    "I will not die an unlived life. I will not live in fear of falling or catching fire. I choose to inhabit my days, to allow my living to open me, to make me less afraid, more accessible, to loosen my heart until it becomes a wing, a torch, a promise. I choose to risk my significance; to live so that which comes to me as seed goes to the next as blossom and that which comes to me as blossom, goes on as fruit."

    Dawna Markova Author of Open Mind.

  6. #156
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    Today Brian and my wife Ann went to Tucson. It was arranged for Brian to spend the entire day at a doctors office observing. This is the clinical experience that he needs for his medical school application. Brian's therapist from St. Josephs Hospital arranged this for him. The doctor that Brian is observing is also in a chair with an injury similar to Brian's. They left this morning at 6:00 am, I talked to Ann at about 6:00 pm and they were headed over to the doctor's home so that Brian could see how he had his home setup. It's almost 10:00 pm and they're still not home. I got the impression from Ann that things were going well.

    The doctor that Brian was visiting told him that he should move to Tucson and take classes at the University of Arizona. Tuscon is where the only medical school in Arizona is located.

    Brian has a strange situation with regard to residency. Brian went to UC Berkeley as an out of state student all four years. After he graduated he started working in San Francisco. At that time he became a California resident. The University of Arizona Medical School in Tucson only accepts Arizona residents. Before Brian's injury he resided and worked in California and was ineligible to attend the University of Arizona Medical School. When Brian and I visited the University of California Irvine Medical School last December we met with the director of admissions. She told Brian that the UC Irvine Medical School only accepts students who are California residents and that Brian needed to move back to California as soon as possible otherwise he would not be eligible.

    Brian seems to be a man without residency in any state. He pays taxes and receives disability from California but he's living in Arizona. He has an identification card from California and a drivers license from Arizona. At the moment based on the letter of the law I don't think that Brian is eligible to attend either school. Obviously, we need a plan so that he doesn't get ruled ineligible because of a residency requirement. It's very difficult to get into medical school and Brian doesn't want to be reject for that reason.

    This weekend three of Brian's friends from San Francisco are coming to Phoenix. We own the house next door so we keep that available for people when they come to visit.

    I've been talking to a lady at Kennedy Krieger about the Blue Shield Rt-300 denial. She is working with the insurance coordinator at Restorative Therapies to file a grievance with the California Managed Health Care Commission on our behalf. I'm going to call Blue Shield tomorrow and ask them to explain why they think that the RT-300 is exercise equipment and not necessary durable medical equipment. This was the most recent reason that we were given for why the RT-300 was denied. The original reason that the Rt-300 claim was denied was that the RT-300 was experimental equipment and not covered by Blue Shield. The reasons for the Blue Shield denials never stop changing. Each written denial is different from the preceding written denial. On the telephone the claims representatives say that the equipment is covered if the doctor writes a script. It seems like Blue Shield tries to create confusion to discourage people.

    Roger

  7. #157
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    Roger-

    Sounds like today was a great day...I'd love to hear more about it after he gets home

    The university system rules for residency are quite complex & require specific documentation & timeframes living in said state(1yr minimum)...Seeing as how Brian has valid gov't ID's from both states(depending on date of issue), he's halfway there to having legal residence for school/tuittion purposes...If you'd like to PM me I can explain a little more about how it works & what he'll need...
    'Chelle
    L-1 inc 11/24/03

    "My Give-a-Damn's Busted"......

  8. #158
    Voters registeration is a key piece as is where he receives his mail.
    Every day I wake up is a good one

  9. #159
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    Brian and Ann got back from Tucson at about 11:00 pm. The Physiatrist that Brian observed on Wednesday was very kind and Brian was happy about the day. Brian was in the room with the doctor and the patient while the doctor tested the patients for any nerve damage. At the end of the day the doctor invited Brian and Ann over to his home to see how he had made his home accessible. The doctor was injured about four years ago in a skiing accident.

    On Thursday Brian went to the St. Josephs inpatient rehab and spent the day observing a doctor there. The doctor spent most of his day in consultations with the patients. Brian plans to go back next week when the doctor is going to be doing tests and examinations. I should mention that these opportunities for clincial experience have been setup by the director of the St. Josephs outpatient rehab, Sonya. She has been very helpful to Brian and we really appreciate her efforts.

    Three of Brian's college friends arrived last night from San Francisco, they're stayed up late last night hanging out. Brian's friends have really been great about coming to visit him. Several of them came to Atlanta when Brian was at the Shepherd Center and now they've been coming to Phoenix. This really raises Brian's spirits, hanging around with your parents and sister gets old.

    Last night Brian showed his friends the RT-300, so today they want to see him ride it. I went into work today to check on a computer stress analysis that I'm doing so while I'm waiting for that to finish I'm typing this message.

    Roger

    Roger

  10. #160
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    I had rehab at St. Josephs in Phoenix AZ a few years ago. I think the folks there was very nice and did a good job. Don’t recall all the names but one PT woman originally from Minnesota working there I remember, she was very good looking too

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