Denail Letter

We got a certified letter from the Florida Department of Management Services State Group Insurance denying our Level II appeal on Blue Cross's denial of Selah's nursing. since my husband works for the state, the appeal went to the FDMSSGI for the appeal.  The reason they cite   "is because the care Selah gets at home, can be performed by family members and is not medically necessary to have a licensed nursing professional to care for her." 

Again we are appalled....even tho every doctor involved in her care wrote letters stating the great need for nursing care for this child, some NON medical person makes a decision that she does not need nursing.....  However the interesting thing is Medicaid has approved her for 24/7 nursing care.... so one state agency says she needs NO nursing care and another one says she needs 24/7 care BASED on the doctors orders. 

We strongly believe that Blue Cross/Blue Shield is aware we qualify for Medicaid and they rather that Medicaid pick up the cost of her nursing care.  We believe this is fraud.  Obviously the Florida Dept of Management Services that oversees the State Workers would tend to also go with Blue Cross's decision as it is cheaper to have Medicaid pay for her nursing than to have BC do it. 

The Department of Justice has filed a lawsuit against the state of Florida for not having home health care available so children can stay in their homes and not go to a nursing home.  You can read about it here....    http://www.justice.gov/opa/pr/2013/July/13-crt-823.html   or here...   http://www.tampabay.com/news/courts/justice-department-files-lawsuit-against-florida-over-medical-care-for/2132566


Our situation is not quite the same but I feel that our private insurance -which is STILL a state insurance (since Jon is a state worker) is trying to push Selah's care over onto Medicaid. 

I have contacted the Department of Justice, and will contact both the Governor's office and the Insurance Commissioner tomorrow.   I have also contacted some friends in the media and we will be really pushing this publically.  If you have any contacts with any news organizations, please contact them for us, tell them our story and this new struggle and ask them to contact us.  ABC Action News  will be doing a story on this on Monday.  I've contacted a friend at FOX Tampa Bay and will be contacting the other local folks tomorrow. 

We now will file a petition for a formal hearing.  I have 21 days from today to file it.  In the mean while I will be contacting everyone who could help us on this.  If you can help in any way, please let me know.

--------------------------------------------------------------------------------------------------------------------------

This afternoon our new friends from the Bahamas came for lunch and a playdate:)  We had three little kids with Peter's Anomaly in the house!  Our friends have taken their son all over the world for various treatments and it was just amazing to see how well he does.  We had a good time, lots of laughs, we "spoke the same language"  They understand many of the things we have been through because they also have gone through it with their child.  It was a blessing to be able to spend some time with them!!!!  We are so encouraged by the help he has received at the HBOT (Hypobaric Oxygen Therapy). 

__________________________________________________________________________________

 https://www.facebook.com/selahclanton  here is the Facebook link for Selah.  Please join and pray and fast something for her while she is in treatment next week.  I am so encouraged by all the messages I've gotten from folks who are going to be involved in some way.  If you  can't do a Daniel Fast, or a regular fast, even fasting a soda or something you crave and saying a prayer for Selah would be a blessing.  I've never done a Daniel Fast and I hope I am not so grumpy that I invalidate the whole prayer and fasting LOL  That is why I'm still going to drink tea and coffee:)     You know I'd love for her just to be healed and NOT need nursing care at all anymore!!!!  That would be the biggest blessing!!!!

Thank you all for all you do, you all have prayed many prayers for Selah and have never forgotten her or our family!  Thank you for that!!!!