An 18-year-old’s traumatic brain injury
When an 18-year-old’s traumatic brain injury left him unable to read, his physician prescribed an evaluation to discover the problem. The patient’s Medicaid Managed Care Organization denied the request until PHLP interceded and persuaded them of its medical necessity.
PHLP represented an 18-year old with traumatic brain injury who was unable to obtain an evaluation prescribed by his physician because the client’s Medicaid Managed Care Organization (MCO) denied the request. Our client had lost the ability to read and a behavioral optometry evaluation was prescribed so his physician could understand whether his reading difficulties stemmed from a need to train his vision or a larger cognitive problem. PHLP interceded, knowing that federal law requires such services for children under age 21 who are enrolled in Medicaid. Working with the client’s grandmother, his physician, and a lay advocate we persuaded the MCO of the medical necessity and obtained its approval for the physician’s request.