Katie Beckett denial/appeal process

[Deleted]

Anyone familiar with the appeal process when denied for Katie Beckett coverage? I called to follow up on the status of our application today and was told my son was denied due to not fulfilling he level of care requirement (basically his condition did not warrant coverage). I informed them that I plan to appeal, so they are mailing me the appropriate paperwork to start the process.

Background: My son will be 4 in January. Current dx's are Developmental Coordination Disorder and Primary Epilepsy. Hes been in PT, OT, and speech since he was 16mo for a global developmental delay (first through EI, now gets services thru school district, and supplemental services outside of that). Seizures are well controlled on meds, but side effects of said meds sometimes exacerbate existing sensory/behavioral challenges.

I'm really pushing to get Katie beckett to not only help others various co-pays for specialists and therapies, but also to gain access to respite care/aba/hbts/pass program, which is only available to kids on Medicaid. I've talked to our local parent resource network, who has reiterated how strict the guidelines are, but feels that by appealing with additional documentation, we have a good chance at approval.

Anyone have any tips/advice for appeal process?

[mrsbuttinski]

It's hard to say. Every state manages this process a bit differently, so you local people probably have better ideas specific to your state. In some places, especially with SSI, it is routine to deny benefits on the first application and grant them on appeal.

Is he seen at a pediatric teaching hospital? Often these places have social workers who can help you present your case in terms that would strengthen it? In some places certain dxs are automatic without documenting degree of impairment. In most places, it would be unusual to get any meaningful level of ABA with the dxs you list; typically ABA is reserved for ASD, DS and other dxs with significant intellectual impairment associated. I don't know what the other 2 acronyms are- PASS and HBTS.

[Deleted]

Thanks, mrsbuttinski. Actually yes, I believe the children's hospital who a few of our specialists are through is a teaching hospital. I have a call in to our developmental pediatrician, so I will ask them when they call back and see what other resources may be available as we go through the appeal process. PASS (Personal Assistance Support Services) and HBTS (Home Based Therapeutic Services) are 2 Medicaid funded programs for kids with special needs, similar to the ABA program.

[Deleted]

Figured i would come back and quickly update. Not exactly sure what happened within the medicaid office, between the phone call i got telling me my son was denied and now, (maybe they ended up receiving additional info from our medical staff after the fact and reconsidered, or the woman who called had thr wrong info), but we just got the official determination letter in the mail and it says he was approved for Medicaid coverage!! Im thrilled and so relieved.

[numbbears]

That's awesome! Glad they got everything straightened out.

[mrsbuttinski]

@mrst0514, Strong work>

Thanks for the update.

[Deleted]

Nov 19, 2016 14:07:46 GMT -5 mrsbuttinski said:

@mrst0514, Strong work>

Thanks for the update.

Thank you! I pretty much flooded their office with every single piece of pertinent medical documentation i could find. So...i guess it worked!