I Did It!
Today was our TEFRA appeal hearing. Background: Michael got denied TEFRA medicaid because they said they did not meet the criteria for a disability. He met all the other criteria, but not that one.
So today we went to the hearing, with one of my trusty-dusty notebooks in hand. (Everyone has commented on my notebooks!)
The other side explained their points, why Michael was denied TEFRA, and then it was my turn.
Oh about an hour later, I had completed everything in my outline. The Hearing Officer asked the other side if they had any questions. The man just looked at me and said, "I have no questions. That was very complete and well organized!"
I was sure we had won.
But then the Hearing Officer asked the other side his opinion on if Michael "Meets the Listing". (This is a Social Security term for determining a disability.) Since I had gone through the Autistic Disorder criteria for "Meets the Listing" step by step, I was sure we had it in the bag.
The other side said though that we did not show enough scores to demonstrate "Meets the Listing". So he wasn't sure if he was satisfied. I went back over all the scores I had, and emphasized that autism is not a condition where there is a concrete test to see if you have it. A lot of it is using related testing (which I had shown), and direct observation.
The other side said that he wished there was something to show exactly how the medical doctor came to the Autistic Disorder diagnosis. (Because apparently all the test results I had given, all of the questionnaires completed, and behavioral observations documented were not enough.)
So I pulled out the DSM-IV checklist that Dr. Kelly had given us when he first made Michael's diagnosis. The other side looked at it, nodded, and said, "THIS was what I needed!"
Again the Hearing Officer asked if the other side felt Michael "Met the Listing".
The answer was YES!
So unless something horrible happens, we should have documentation in hand soon that he qualifies for TEFRA, and we'll be able to get some help with the medical bills!!!
YEAH!!!!!
The Hearing Officer and the representative from Voc-Rehab were both very accommodating and professional.
So today we went to the hearing, with one of my trusty-dusty notebooks in hand. (Everyone has commented on my notebooks!)
The other side explained their points, why Michael was denied TEFRA, and then it was my turn.
Oh about an hour later, I had completed everything in my outline. The Hearing Officer asked the other side if they had any questions. The man just looked at me and said, "I have no questions. That was very complete and well organized!"
I was sure we had won.
But then the Hearing Officer asked the other side his opinion on if Michael "Meets the Listing". (This is a Social Security term for determining a disability.) Since I had gone through the Autistic Disorder criteria for "Meets the Listing" step by step, I was sure we had it in the bag.
The other side said though that we did not show enough scores to demonstrate "Meets the Listing". So he wasn't sure if he was satisfied. I went back over all the scores I had, and emphasized that autism is not a condition where there is a concrete test to see if you have it. A lot of it is using related testing (which I had shown), and direct observation.
The other side said that he wished there was something to show exactly how the medical doctor came to the Autistic Disorder diagnosis. (Because apparently all the test results I had given, all of the questionnaires completed, and behavioral observations documented were not enough.)
So I pulled out the DSM-IV checklist that Dr. Kelly had given us when he first made Michael's diagnosis. The other side looked at it, nodded, and said, "THIS was what I needed!"
Again the Hearing Officer asked if the other side felt Michael "Met the Listing".
The answer was YES!
So unless something horrible happens, we should have documentation in hand soon that he qualifies for TEFRA, and we'll be able to get some help with the medical bills!!!
YEAH!!!!!
The Hearing Officer and the representative from Voc-Rehab were both very accommodating and professional.
posted by Susan | 4:14 PM
3 Comments:
That is awesome! You are an amazing mom and advocate!!
AWESOME Susan!! You are an awesome mom Susan...you are an inspiration!!
~Jennifer S
YOU ROCK! Organization and determination pay off! Good for you! This post cheered me completely!
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