The ISPT and The Next Six Months

Writer’s note: This story is the continuation of Dr J. And The Next Six Months, and continues to chronical the process we go through every 6 months to justify the treatment our son recieves. I have decided to document our current renewal to show you how we go about getting our Medical Assistance Behavioral Health Management Organization (yes, they make HMO’s for behavioral health too) to authorize and pay for Behavioral Health Rehabilitation...

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Time for a Review

So we go in on Thursday for our semi-annual review. This is where PT’s psychologist sits down with me, PT, and Mr. M to see how PT is doing and what we might need in the next 6 months. He has made tremendous progress over the last year. We still have some social issues, but things are going. The potty is still a problem. Not at school, but he we don’t consistently remind him at home, he will pee in his pants. Poop, well that is...

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Where have we been??

Wow, I just realized that I haven’t updated this site since April. That is quite a long time. A lot has happened these past few months, and almost all of it good. First, the insurance company approved PT’s Therapy Support Assistant for the part of the summer he is at daycare. Yeah, surprised?? After all our luck with the insurance company, I was quite surprised too. Once the agency got the packet in, it wasn’t any problem at...

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Appeals Update

So the appeal went well, I think. The doctor reviewing the case pointed out that we had enough people to field a baseball team. I liked that he noticed that since we had myself, K, JZ, MJ, and his case manager. Dr. P was trying to make it but couldn’t make room in her schedule. We all explained the mistakes made in the internal notes, outlined the issues that supported our point, and presented a well made case as to why he needed more time...

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Time to Appeal

A few weeks ago, we posted that on a Saturday we received our denial letter. They denied part of PT’s prescription from Dr. P. In the mean time we have been reviewing documents, reading things, writing, and writing some more. We wrote a 5 page response that included a reference section and footnotes. We outlined the incorrect information in the  letter (yes there was stuff in the letter not mentioned in the meeting OR listed in any or the...

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Meeting Fail

So we are at the point that it is time for the six month “Inter-Agency Meeting”. This is a formal gathering of the parents, teachers, care givers, case managers, and insurance company to discuss PT’s progress, challenges and problems, along with the services he will need to help manage those problems and overcome his challenges. OR, at least that is what it would be in a perfect world. In reality it is something much different. It involves...

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