Long day…unfortunately, I miss understood the decision from Medicaid. The Medical Director did not approve skilled nursing. She approved a home health aide as well as depleting the current hours we currently have (and still attempt to fully staff) to 1/3 of what we have in place. So the appeal is back to square one…right where we were in May of 2011 before we moved home.
If you’ve never appealed an insurance decision, the following is standard procedure;
The case is reviewed and a decision is rendered. We disagree and file an appeal. If denied, we file a 2nd and 3rd level appeal each time presenting more documentation. If those levels are denied we ask for a formal hearing. This process can take up to 4 months. Current services will continue throughout the appeal process. So we have at least one month to start building a very strong case that will hopefully change the Medical Director’s decision to keep skilled nursing with our current hours so we can work, sleep and possibly attempt to have a somewhat normal existence.
In the meantime, we keep working every day.
Corey started her day very disoriented but fortunately, once we talked through Kate’s re-introduction, we accomplished a new level of cognitive therapy. We are working on reading and discovering Corey’s visual deficits. If we hand her the word cards and she manipulates the distance for her field of vision, her accuracy in recognizing sight words has increased to 90%.
What I am most excited to report is an observed behavior from lunch.
Corey had a bottle of Propel Zero. I poured about 4 ounces in a cup for her to drink. She finished the beverage and instinctually reached for the bottle with her right hand. I knew she wanted more but sat very still waiting to see what she’d do.
She concentrated on the top as she tried to open the twist off cap with her right hand. The bottle began to teeter. She lifted her left hand from her lap and opened her grasp to hold onto the bottom of the bottle. She successfully steadied the bottle with her left opening and removing the cap with her right. She wasn’t finished…
Corey pulled the bottle from her left hand and started to pour the Propel into her plastic cup. The cup lurched to the side from the force of the liquid. She stopped pouring and placed the bottle back on the table. She used her right hand to help her left reach to hold the cup. The grip of her left hand was so tight the cup began to collapse (I sat holding my breath). Despite the concave opening, she felt comfortable that her left hand had the cup. Once again she reached for the bottle and began to pour more Propel into the cup. It was a slow, deliberate movement. She did not overflow the cup nor spilled a drop. The bottle was placed back on the table and she methodically used her right hand to carefully remove the cup from her left. She took a drink, swallowed her reward and looked at me with a huge smile! With tear filled eyes I lifted my glass to her!
These are the amazing moments that keep us focused on what’s truly important. Tonight as I chronicle another first I remember we had no idea what support we would have when we headed home in 2011. We have no idea what to expect in the coming months but one way or another, we will find a way. Look at what she’s achieved so far!