Yes Sue this does help, very much! Gives me hope that there is light at the end of the tunnel in this situation. This patients mom is fired up and is calling the specialists she feels would speak on her behalf so we can all be there (on the fair hearing ...
Hello Staci, We actually had SHP attempt to deny hours for this exact reason. We had already been to medical review through TMHP so we already had letters of medical necessity on file from primary care physician, pulmonologist and neurologist. We submitted ...
Thank you Rebecca this is super helpful! Its so very frustrating that we have to fight tooth and nail for our patients who need the care. This kiddo has a GB, is progressing well with po feeds, however at any moment he could not eat the required amount and ...
Hi Staci, We recently had a reference to Superior policy TX.UM .10.20 as well. It is not available on their site so we requested a copy - it is attached. Their definition of need for PDN is very generalized but if you can demonstrate ...
I am curious to find out if anyone knows when and why Superior decided that Bipap was not "a skilled nursing intervention". Has anyone had any of their patients services denied with this verbiage included? This may have been discussed before but I don't ...
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