• Appeals
  • Liev

    Increasing Independence By Securing a New Activity Chair for a Child on Medicaid

    Liev is a 5-year-old medically fragile child with a rare genetic disorder, low muscle tone, and many other diagnoses. His family contacted PHLP after his Medicaid insurer denied coverage for a Rifton Activity chair.

    Liev’s Occupational Therapist recommended the Rifton Activity because it would allow for safer transfers, reduce the risk of Liev choking while eating, allow him to practice his fine motor skills, and promote independence, which includes playing with his older brothers. The chair would also provide continuity from school to home, as Liev already used the Rifton Activity Chair at school. The insurer denied the request, approving instead a lightweight stroller; something the family already had and was using in the community, and which would not serve the same purposes for Liev. The approved stroller would fail to address Liev’s most pressing needs.

    After proceeding unsuccessfully through two levels of appeal against the insurer, Liev’s parents contacted PHLP for help. Together, we prepared diligently for the fair hearing, working alongside Liev’s family, pediatrician, and multiple Physical and Occupational Therapists.  We were able to gather ample supporting evidence showing the medical necessity of the Rifton Activity chair for Live. Ultimately, the Judge sided with Live and ordered that the insurer immediately approve the Rifton Activity Chair. Liev has already received his chair and his been able to use it with great success. Thanks to the efforts of PHLP, Live’s independence and quality of life have improved; he is now able to interact more with his family and with his surroundings at both home and school.

    Here's a message from Liev’s mother underscoring the impact of PHLP’s work:

    “Our attorney at PHLP was such a big help in getting the Rifton Activity Chair for our son. I've had to challenge the insurance several times for his medical equipment in the past 5 years, but I never had to go so far as appealing it to a judge. She helped guide me through all of it and prepped me for the hearing and gave our case a fighting chance. I wouldn't have been able to do this on my own and with her guidance we were able to finally win the case and get the chair for my son. She was very quick to respond to any question that I had throughout the process and I was thankful to have her on my side. The service was free of charge which as most parents with special needs kids know their expenses add up quickly.”

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