Success & Outrage

Success & Outrage

It seems that every day I hear a story from within the home medical device industry about something really outrageous and then later in the same day I hear another story about a great success.

Here are a few of the latest I’ve experienced:

SUCCESS!: A family in MI experienced multiple delay tactics and down coding issues by medicaid for one of our beds. Over the course of 6 or 7 months multiple letters had to be submitted, each reiterating what was already written in earlier letters. After hammering away at the system the bed was finally approved. Medicaid had the same information to make this decision last year yet it took a very dedicated medical dealer and persistent mom to finally make it happen. I’m happy to tell you the bed will ship out of our factory in just a few weeks.


OUTRAGE!: A paralegal I know has advocated for children with special needs for almost 20 years. She works for an agency that provides these families with pro bono legal representation as they fight insurance companies or medicaid for services they are entitled to receive.

She flew 400 miles across the state, attended 2 fair hearings and then flew home. The state Dept of Health has now refused to reimburse her agency for travel expenses and suggested she should have driven 8 hours, heard the hearings and then turned around and driven 8 hours back home because that would have been cheaper. This DOH policy is a reversal of what they have always done.

If the DOH doesn’t fairly reimburse these advocates, the family is at a great disadvantage. Fair hearings can be intimidating, difficult things to go through and my sense is most caregivers aren’t prepared to spar with seasoned Insurance/Medicaid representatives in that setting. I’ve been through a lot of fair hearings helping families get our beds and it takes a while to get use to the process.

This reimbursement policy gives an unfair advantage to the DOH. Families will lose access to well trained advocates and increase the ability of DOH to deny the services!


OUTRAGE!: A Grandmother in Ohio that takes care of her grandson with special needs has been fighting medicaid for close to a year to get one our beds approved and paid for. A fair hearing was held in January 2009 and the Hearing Officer issued a written decision that medicaid should authorize the bed.

It’s now 2 months later since the written decision was issued and OH medicaid still hasn’t authorized the bed. Phone calls don’t get returned, emails go unanswered. This Grandmother has a big team advocating for her (a case manager, the DME dealer, a pro bono attorney and myself) and we’re all on the warpath to try and get an answer. I’ll update you when we find out.

Every day brings a little good and little bad. I think the good guys are winning but sometimes it’s hard to tell.

Breaking Silos

Welcome,

I’d like to bust a few silos…care to join me?

My name is Kevin Currier and I work for HARD Manufacturing in Buffalo, NY.
We make medical beds and cribs for children with special needs.

For almost 13 years I’ve worked with parents, case managers, physical therapists, occupational therapists, respiratory therapists, durable medical equipment dealers, RN’s, LPN’s etc. to help them get the correct pediatric bed for their child.

Sometimes it’s pretty easy but it can often take multiple letters, phone calls and fair hearings to get the beds approved and paid for by insurance or Medicaid.

I’ve noticed that many people in different parts of the country have similar problems raising their child with special needs: battles with insurance companies to pay for nursing or equipment, battles with schools to follow the Individual Education Plan, case managers that don’t return phone calls, doctor’s offices that take 2 months to write a prescription and the list goes on and on.

I also see that the solutions someone found in one part of the country can help someone else in another part of the country.

If people are isolated and stuck in individual “silos” the good answers and best practices they have found can’t be shared easily with other people.

Let’s break a few silos, share the information freely and openly and help everyone advance.

This space is open to any and all topics that caregivers and families encounter. It is not restricted.

I’m calling this Kevin’s Kids because I often know a lot about the kids that get our beds. Each one of them is unique and it’s great to see it through to the final step of having a bed delivered and set up in the house. I know they’re not really my kids, but I think you get the point.

Just a final note for my first posting….the city of Buffalo gets a lot of publicity because of our snow. Consider this, Buffalo gets about 90” of snow a year which is more than Anchorage AK but less than Flagstaff AZ.

Cheers,
Kevin