Christina
Occupational Therapists needs to be paid for services they render for medically fragile children. My daughter, Christina, is a medically fragile child, who is classified as a Severe and Profound child having a neuron migration disorder, Lennox Gastaut Syndrome, hypoplasis, and developmental delay. Occupational therapy is essential for her existence, and is not affordable unless assistance is received. Medicaid Rules, irrespective of the needs of each child, decide the number of treatments per month as well as the length of time of each session, not the children’s treating physicians, who should have the authority to prescribe treatment, and medication. Medicaid appears to search for reasons not to pay for treatment thereby causing friction between Therapists and Parents, who cannot afford to pay the Therapists, and the ultimate cessation of this very critical treatment. There does not appear to be any rhyme or reason for many of Medicaid’s denials. The same applies most aptly to forcing Generic Drugs instead of the Name Brand Drugs prescribed by the treating physicians.
My daughter requires 24/7 care, treatment, and observation, therefore I cannot divert any attention to any other purpose other that my daughter’s care who has, on average, 30 to 50 seizures every twenty four (24) hour period seven (7) days a week. Because Medicaid has refused to pay for Christina’s therapy I have to pay the therapists from child support needed to feed and clothe my children. We are still arguing with Medicaid to pay for Christina’s therapists. Medicaid says it is being considered but their dilatoriness has now stretched into a month, and NO WORD!!!! What are we to do?
Further, if a doctor asks to have my daughter’s prescription filled with a brand name drug, it should be filled as prescribed. Doctors know that Generics are not, most of the time, exactly the same as the related Brand name Drug. When you have extremely medically fragile children, such as Christina, this can be fatal!!!! The doctor certainly knows better than some Medicaid Clerk how the medicine may affect the systems of medically fragile children such as Christina who presently has breath stopping seizures almost every day. Christina was denied Brand Named seizure medicine. Christina is at the end of any type of seizure medication on the market. We have been trying to get Medicaid to fill her name brand prescription for Lamictal. We were told by Medicaid to borrow the money, so they could have a hearing on this. Sir, Christina’s medical expenses are extreme. WHO DO YOU THINK IS GOING TO LOAN ME ANY MONEY? PLEASE SEND THEM MY WAY!!!!! We are now three weeks into this problem, and Medicaid has not of yet decided to pay for Christina’s Lamictal. She needs this medication to help curtail the thirty to fifty seizures she is having a day. We have been trying to get Medicaid to pay for PediaSure. PediaSure is keeping my daughter alive. The PediaSure helps maintain her vitamin and mineral intake to help regulate her weight. Medicaid will not pay for this because she dose not have a stomach tube. PediaSure cost $10.50-$13.00 a six pack. Christina needs 18 to 20 packs a month. Inserting a stomach tube would cost Medicaid a lot more money not including the probability of infection and multiple tube replacement cost due to Christina’s pulling the tube out. WHERE’S THE COMMON SENSE IN ALL THIS!!!!
I have talked to all of the agencies I have been able to find on the City, County, State, and Federal levels. I have been told by several of these agencies that I have covered all of the areas that even they were aware of. No one has had an answer to this essential emergency situation. There appears to be only one area in which I can state that there is any professionalism, if you can call it that, and that is everyone will take a message but rarely is there ever any response, there is certainly consistently here! Handicapped Children are apparently at the bottom of the priority list for medical expense coverage. These children cannot scream for themselves, and good people with a conscious should take up their call for help!
Kimberly D.
Loganville Ga
Monday, October 2, 2006
