Tennessee Freeping Help Needed {Tenn Care}

Tennessee Freepers I'm asking for help. Not money please {and I really mean that} but letters, E-mail, and phone calls to agencies and officals that run Tenn Care and one of it's HMO's. Some of you who know me know my wife as well as myself are disabled. The issue here is medical care being denied my wife that would be given to others not disabled.

Tenn Care about 10 years ago took over our Medicaid system. Most of us remember how it was done and the kaos it has brought upon us. Medicaid was intended for medical coverage to workers who illness became disabled and no longer able to work again. This happened to my wife in 1985. We think it was a result of a Spinal Stroke due to Polio Relapse Syndrome. She is a quadriplegic. Limited use of hands and arms no leg functions.

During this time I have been her caregiver I married her understanding this situation. We recieve no outside agency help in her day to day care and other functions that some of it in a nursing home would require an RN. In short I believe in as much as possible take care of your own.

She needs sooner rather than later a full mouth tooth extraction and it must be done in an operating room in the hospital by an Oral Surgeon. A previous dentist doing an extraction made a near fatal medication judgement. She has taken heart medications for 16 years as well. This added to her limited abilities has led to the teeth problem. Below is a letter I have sent to a local news paper. After reading it I think you can understand better where I'm coming from. Following the letter I will list as much information as possible as to agencies and officals as well as a way to identify her. I would rather not publish her name but Free mail me and I will gladly give that information as well as proof of this situation. Here's the lettter:

About 10 years ago this state saw fit to end portions of the Medicaid program which included the coverage for the disabled worker. A new and so called improved program born of scandal and down right black mail upon the medical community was born called Tenn Care. Persons who worked and had become disabled were put into a HMO type system. These are persons needing consistent and extended medical attention. The doctors know the patients needs and are extremely careful in their judgments in this care.

As time went along Tenn Cares HMO's each year were relieved of more and more responsibilities of coverage especially to those disabled who after 2 years disability become Medicare eligible as well. Medicaid was providing a co-payment to primary care physicians which made it possible for doctors to absorb the cost. Tenn Care HMO's are now not required to do so. But the doctors as well can not bill a Medicare patient for that payment if they are on Tenn Care. Doctors are being made to take substantial cuts in pay to treat disabled citizens in this state. I've seen the Medicare statements it's pathetic what a doctor ends up being paid. Most any other profession would not tolerate it.

So what are they to do? The doctors are now being forced by economics to not take on Medicare/ Tenn Care patients. Don't believe me? Try calling any doctors office and say you are disabled on Tenn Care and Medicare. Last year we went through nearly 6 months without primary care. Some medications were not taken as prescriptions had expired. The doctors practice owned by a hospital as a cost measure was closed. The doctor got re-established and luckily took us back. Many more disabled are not this fortunate.

Now for the intent of this letter. My wife is a quadriplegic and needs immediate extensive tooth extraction's. It is a medical necessity soon to be a medical crisis. We saw an Oral Surgeon last November who agreed to do the extraction's but had legitimate medical concerns he wanted addressed first due to her medical history. A prudent move I think anyone would say is justified. The testing was done and this took us into 2002 which brought a rule change in Tenn Care it seems. Up till this date the Oral Surgeons word was sufficient to justify need no referrals needed. We now find out her General Practitioner must say it is a necessity that has been done as well.

We jump through hoops and what happens? Tenn Care denies coverage on the basis of it not being medically necessary. We appeal and ask for a hearing before a judge which is supposed to be a Right in the appeals process. Now without even seeing the judge or having any form of appeal the matter is dismissed by Tenn Care saying Medicare pays for Dental Care. Medicare indeed does not. Tenn Care states they only pay for medications. Tenn Care says Medicare is responsible Medicare says Tenn Care is. As far as I know no one in this state oversees Tenn Care except Tenn care. They answer to no one not even the lawmakers as far as that goes.

But a person who is reasonably healthy and on Tenn Care due to income limitations and not being offered insurance at work gets better coverage that those in medical need and can get a doctor or if medical necessity tooth extraction's because Tenn Care pays for those services for them. They pay their doctors more than a Medicare patient's doctor receives for a Medicare/ Tenn Care disabled patient. Now I'm not one who likes to push such programs as Americans with Disabilities Act. Actually I'm not in support of Universal Health Care as it is a burden placed upon the taxpayer it is Socialized Medicine.

However I myself am disabled also. Both of us paid a portion of our wages we earned into Social Security and Disability Insurance. Which was the former Medicaid intent our lawmakers have lost any sight of. It was our Disability medical benefits this state has stolen to fund Tenn care and I want to be treated no less an equal that someone who never paid a cent getting premium care is getting on my dollar. Am I being unreasonable? So here is what is going to happen. This will soon be a life threatening medical crisis. Common sense says as much. Bad teeth lead to blood poison. It will become an acute medical crisis and she will be taken to a local Emergency Room where rather than a simple day surgery in and out preventive care procedure being done, she will likely be hospitalized for a week or more being pumped full of high dollar anti- biotic and the teeth extracted at that time.

I am one who supports the immediate abolishment of Tenn Care at least in regards to the disabled. We do not belong in such a reckless and unaccountable program and should be able to have our care overseen by the State Inspector Generals Office. This was the case up till the time Medicaid was deliberately made to fail. They honorably and fairly performed this function. We are former health care industry workers so we know what happened and what we lost. I here by in a public forum accuse Tenn Care and the State Lawmakers who support it of operating it in a fraudualant manner. The disabled workers have been robbed. I accues the Lawmakers who support Tenn Care of gross discrimination and prejudice toward the disabled workers who paid for services that are not being rendered. Those who don't support it have my respect ,and mine and families vote.

Ok I have a letter of first denial dated 5/21/02 I have a letter of acknowledgement of recieving our appeal date 5/30/02. It was over the phone to try and rush it up some. That and the fact I have trouble myself keeping this stuff straight and they know it. I'm not parinoid they have my medical records and know this fact about me through having that info on my medical records. That is part of my disability. It's sensory triggered Anxiety Disorder and concentration is a cherished commidity these days. Stress worsens the condition rapidly. They use it.

They act as if they do not have the appeal or will not consider it. I can't get a deffinate on that but I do have their acknowledgement one was filed. And I did request an Admin judge hearing.

When I ask to check the status they simply say Tenn Care does not pay for extractions. I have asked for further appeal and was told to call Medicare. I had to let it drop then and go another route for my sanity sake. That was earlier today. I know from past experience and shouting matches with them it's gets me nowhere. They even went as far one time as to give me the lawyers name in Nashville I can't remember it from the advocates office and laughed doing so.

I've tried Senator McNally before several times it was a joke all he got me was a phone call from the same ones who gave me telephone roulette. My Rep is a freshman a good one I will loose due to redistricting. I'm in a traditional Dem district now.

Unless you've fought this mess your self I guess it's hard to understand. They have no respect for you or even their own rules. And by the grace of congress they know they are exempt from any liability in the matter. It's an arrogance that would rival the Kennedy's and Clinton's. I'll try the route you mentioned tomorrow. I'm famuliar with it. Thanks

Yea we got Halarin {sp} Hill he's pretty good on things like this. I made some calls today One was to Tn Care Solutions who told me yesterday that it was medicares domain today tells me Medicare doesn't cover it. Tennessee Justice Center called me after I e-mailed them last night. It is Tenn Cares domain if we can prove medical necessity. A simple smile would say it all I think any person seeing her teeth would say as much doctor or no. It makes mine hurt seeing them. I'm going to let Tn Care Advac. see what they can do we may know something perhaps this afternoon likely Monday.

My last go arounds with Tenn Care was writting letters which no one could read due to my lousy hand writting. Computers make all the difference in getting needed info fast and for me is a valueable tool. My family got it for me a few years back and it has paid for itself several times over giving me quick valuable medical info. One example was she was hospitalized in January of this year and doctors were not locating the cause. She was having very out of character almost psychotic episodes. To get her ready for this extraction we sought some help getting her through the anxiety. 12 years ago a Knoxville Dentist nearly killed her. The dentist later on did kill a girl in his treatment room from improper medications.

To get her over this hurdle she was given anti-depressants. She developed what is called Serotonin Syndrome in January and went Comatose in the hospital Emergency Room. treatment was refused while we waited on Mobile Crisis. I took her in that state to another what I thought was more skilled hospital. The got her back around but after 5 days no diagnoses. She was detoxed from all medications including heart and started improving. At that time a shrink put her back on SSRI's andwithin two hours the episodes returned.

Prayers were said and quickly answered. I went home got on line and typed her last two medications the SSRI's +adverse reactions and got the Serotonin info. It saved her life. I had a debate with the doctors at the hospital none of whom was her primary care personal physican but house doctors and convinced them simply because it was a UT pharmacolgy professors alert. She's been through a lot and this left some scars for her to deal with as well as myself.

The doctors said Mobile Crisis had to act on her behalf. The doctors rather than doing simple and telling blood work were too interested in doing a patient dump to a place not equiped to take her. My biggest fear is seperation from her. Not like going fishing or something but government stepping in and trying to think for us. That night was a nightmare come true. It set us both back and has made me rather cynical toward the conditions that brought things to that point. 10 years ago this would not have happened. Tenn Care has ruined health care in this state.

Update: She is half way through her teeth extraction's and doing fine. It's being done in the office under a surgeons close watch. Now for the latest. WE WON!!!!!! The surgeons office called a few minutes ago and said Tenn Care had notified them it was approved and what had been paid so far by us would be re-paid back to us.

Those letter that were written and phone calls that were made for her is what did it. I deeply appreciate the efforts that was made for her. I don't think this would have happened otherwise. It took 3 months but they were made accountable. This came out of the blue as we had done been told by the advocacy office a few weeks ago more or less to forget it. Help wasn't coming. The approval came to them from some higher ups who can on their word do something about it.

The doctors office let it be known as well just how serious it had became while they dragged their feet. There was never a question of medical necessity but rather a race of getting infected teeth out before her throat swelled shut. That danger is now past as the worst ones are gone and the lower teeth are next starting in November.

I still oppose those of our elected who support this type of abuse of taxpayer money that support Universal Health Care. I honestly don't care what parties name they hold to I will vote them out on this issue. As citizens of Tennessee we know this issue is also a direct cause of the Income Tax fight so actually it covers many issues stemming from a single cause.

JimRob Thanks for letting me post this thread. It did make a difference. I have been fighting this insane program for over 10 years trying to see it's defeat. Unfortunately the GOP has been amongst the worst shills of supporting it as far as my state goes. I would say the pollster who called my house today got a weird reply. I was asked if I would support Van Hilleary-R for governor as well as my current state senator Randy McNally-R in November. I said yes to the first one and I said I would never vote for McNally again for anything. If nothing else I will leave the ballot space for him blank.

Universal Health Care needs to be stopped and none who support it should ever get our vote no indeed not at any price. No not even for the sake of a majority seating. Tennessee holds a good political lesson in that respect for those willing to learn from it. RINO's are not worth the effort of flipping the ballot marker to vote for them and are extremely destructive to any hopes of restoring accountability in government. They serve only as dividers to that cause and on issues such as this will stand with the DEM's. But then again some DEM's as well will fight the good fight too.

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