A question of medically necessity
David Freels
Description
Collection
Title:
A question of medically necessity
Creator:
David Freels
Date:
4/24/2000
Text:
Dear List,
My wife and I are the parents of a 6-year old boy who is suffering from a
mid-brain injury that has impaired his mobility, balance, and speech. Jimmy
is not yet sitting up or walking.
We began patterning Jimmy three years ago and have had great success. He is
now crawling nearly 1000 feet per day, reads like a 10-year old (in both
English and German), and does algebra like an 8th grader.
A year ago we discovered Hyperbaric Oxygen Therapy (HBOT). If you're
unfamiliar with HBOT, the net result is that HBOT forces the growth of new
capillary systems into damaged tissue areas. With improved circulation
comes improved function.
It's kind of like when you wake up in the middle of the night and your arm
has fallen asleep. You can't move your arm, use your arm, or even feel
anything with that arm until the circulation is restored. Once circulation
returns, the function returns.
Jimmy has had 42 treatments of Hyperbaric Oxygen Therapy at a cost of $250
each. They were paid for by our church, family, friends, and neighbors.
They were quite beneficial as his language has improved 1000% and he can
now pick up a fork and feed himself with it.
In addition, through SPECT-scan imaging, we have been able to verify the
changes in the functional level of Jimmy's brain as a result of Hyperbaric
Oxygen Therapy. The SPECT-scans clearly reveal that brain tissue that
wasn't functioning before is now functioning.
We have requested HBOT reimbursement from Georgia Medicaid and been denied
four times for four different reasons--despite the EPSDT statute found in
42 USC § 1396d(r) that gives him a legal right to receive it.
I have emailed 49 of the 50 state Medicaid directors across the country and
learned that Missouri, North Carolina, Virginia, and West Virginia now
reimburse HBOT for brain-injured children. Arkansas, California, Kansas,
Maine, Michigan, Nevada, Wisconsin wrote back and also said yes if we could
prove to them that HBOT was effective. Alabama, Louisiana, and Kentucky say
no. I haven't heard back from the other states, but so far 75% are saying
yes.
My question to the list is this. In researching cp, I've learned that most
kids can expect to undergo a series of 15 to 20 corrective surgeries for
various orthopedic complications: dorsal rhizotomy, hip replacements,
femoral anteversion, scoliosis, etc.--by the time they're 20.
Since orthopedic surgeons would be the type of physician performing the
corrective surgeries for Jimmy, my specific question to is this: if there
were a treatment that was available to Jimmy (in this case, Hyperbaric
Oxygen Therapy) that would correct his brain-injury so that he could regain
his balance and mobility, could you say that this treatment was medically
necessary so that Jimmy could avoid the corrective surgeries?
Please feel free to call me to discuss further.
Thank you and God bless.
I have sworn upon the altar of God, eternal hostility against every form
of tyranny over the mind of man. --Thomas Jefferson, an early advocate of
Hyperbaric Oxygen Therapy.
----------------------------
David Freels
2948 Windfield Circle
Tucker, GA 30084-6714
USA
770/491-6776 (phone and fax)
<Email Address Redacted>
My wife and I are the parents of a 6-year old boy who is suffering from a
mid-brain injury that has impaired his mobility, balance, and speech. Jimmy
is not yet sitting up or walking.
We began patterning Jimmy three years ago and have had great success. He is
now crawling nearly 1000 feet per day, reads like a 10-year old (in both
English and German), and does algebra like an 8th grader.
A year ago we discovered Hyperbaric Oxygen Therapy (HBOT). If you're
unfamiliar with HBOT, the net result is that HBOT forces the growth of new
capillary systems into damaged tissue areas. With improved circulation
comes improved function.
It's kind of like when you wake up in the middle of the night and your arm
has fallen asleep. You can't move your arm, use your arm, or even feel
anything with that arm until the circulation is restored. Once circulation
returns, the function returns.
Jimmy has had 42 treatments of Hyperbaric Oxygen Therapy at a cost of $250
each. They were paid for by our church, family, friends, and neighbors.
They were quite beneficial as his language has improved 1000% and he can
now pick up a fork and feed himself with it.
In addition, through SPECT-scan imaging, we have been able to verify the
changes in the functional level of Jimmy's brain as a result of Hyperbaric
Oxygen Therapy. The SPECT-scans clearly reveal that brain tissue that
wasn't functioning before is now functioning.
We have requested HBOT reimbursement from Georgia Medicaid and been denied
four times for four different reasons--despite the EPSDT statute found in
42 USC § 1396d(r) that gives him a legal right to receive it.
I have emailed 49 of the 50 state Medicaid directors across the country and
learned that Missouri, North Carolina, Virginia, and West Virginia now
reimburse HBOT for brain-injured children. Arkansas, California, Kansas,
Maine, Michigan, Nevada, Wisconsin wrote back and also said yes if we could
prove to them that HBOT was effective. Alabama, Louisiana, and Kentucky say
no. I haven't heard back from the other states, but so far 75% are saying
yes.
My question to the list is this. In researching cp, I've learned that most
kids can expect to undergo a series of 15 to 20 corrective surgeries for
various orthopedic complications: dorsal rhizotomy, hip replacements,
femoral anteversion, scoliosis, etc.--by the time they're 20.
Since orthopedic surgeons would be the type of physician performing the
corrective surgeries for Jimmy, my specific question to is this: if there
were a treatment that was available to Jimmy (in this case, Hyperbaric
Oxygen Therapy) that would correct his brain-injury so that he could regain
his balance and mobility, could you say that this treatment was medically
necessary so that Jimmy could avoid the corrective surgeries?
Please feel free to call me to discuss further.
Thank you and God bless.
I have sworn upon the altar of God, eternal hostility against every form
of tyranny over the mind of man. --Thomas Jefferson, an early advocate of
Hyperbaric Oxygen Therapy.
----------------------------
David Freels
2948 Windfield Circle
Tucker, GA 30084-6714
USA
770/491-6776 (phone and fax)
<Email Address Redacted>
Citation
David Freels, “A question of medically necessity,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/214170.
