Another letter from the Health and Human Services guy?

This is in reply to your email requesting to appeal the denial of a prosthetic device (brace).



I was informed that the Department of Medical Assistance Services’ Appeals Division is attempting to schedule a hearing for Tuesday, April 27, 2010, at 10:00 a.m. You should receive a letter in the near future about your hearing. I assure you that you will have a full and fair opportunity to present your case at the hearing for this appeal.



Thank you for letting us know of your concerns. I hope that this information is helpful.



William “Bill” A. Hazel, Jr., M.D.

Secretary of Health and Human Resources

1111 East Broad Street

Richmond, Virginia 23219
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Did I mention the state of Virginia is run by morons?? They have requested an appeal, which I did not file because the device I needed when I broke my back is absolutely useless to me at this point...unless I re-break my back!

My Response:
Unfortunately I will not have a full and fair opportunity to present my case. I broke 2 vertebrae in my spine on Feb 12, 2010. It is now the end of March and it will be the end of April before the hearing. At this point the brace that would have aided in my recovery is completely pointless. It is like someone breaking their arm and then fighting 3 months later to get a cast. At that point, the arm would have to be re-broken to fit the cast. As I stated in my original letter, we do not yet know the irreparable damage done to my spine that could have been prevented had I been approved for the brace.

I was denied for the brace initially because I am over the age of 21. And the final decision was based on the fact that I was not in "in-patient intensive therapy". Apparently if you are over 21 and living with an incurable disease that has left you disabled and unable to work therefore forcing you to become a Medicaid patient, you are not allowed to break your back or sever a limb as it is not covered unless you are under the age of 21! Thank God I didn’t break my arm and have it sticking through the skin; I would still be waiting for the cast. This is a ridiculous system that is flawed to say the least. Yet, Medicaid approves all pain medications with no questions asked.

As of today’s follow up with my Orthopedic doctor, the bones are still broken but healing, I am still in extreme pain, and the brace is absolutely futile at this point. I am asking you to look into this so that no one else has to go through what I did if ever they find themselves in the same predicament.

I have been fighting for SSDI for the last 9 months, and I have twice been told a decision was made and I should be informed by mail on two separate occasions, yet I still have not received a determination. Had they not kicked my application out the first time that they lost the paperwork I mailed them, I would have had a decision on the appeal that I filed. Instead, the application was not only denied, it was kicked out of the system entirely which made my appeal void, and I was forced to apply a second time. I do thank you for looking into this matter for me, it seems to have at least gotten the case to the medical review doctors. I am hoping to have the decision that was supposedly sent last week any time now.

I do also thank you for looking into the Medicaid issue on my behalf and thank you for getting back to me so quickly. But this is a regulation issue that needs to be addressed with the Medicaid system. I do not see how an item that is prescribed as medically necessary to treat a fracture can be denied based on age.