Tuesday, November 20, 2012


I'm not certain that I've ever written two posts in two days on this blog, s0 here's a first.  I wanted to write about the Medicaid hearing I had today.  I had no idea when I appealed the decision of HHSC regarding the co-pay they expected for Billy, how it all worked.  I'm still not certain, but I know much more now than I did before. 

First of all, you don't go to a place for this hearing, you call a number that is given to you at a specific time on a specific date.  You are given an access code to input when you call the number.  The person hearing the appeal does not work for the entity of the department making Medicaid decisions. She works in the legal department of HHSC.  The three of us had a conference call, and the hearing officer had allotted one hour for the appeal.  We were asked to raise our right hands and swear to tell the truth.  The representative from Medicaid was given the first turn to present her evidence.  I was told to wait until the hearing officer gave me the go-ahead to ask questions. Between the hearing officer asking questions, and the rep from Medicaid presenting her evidence, I got to ask questions after about 45 minutes. 

I know that I am far too verbose, and I really try to cut to the chase, but I felt a need to explain why I was asking to keep $500 a month of Billy's money. It will not surprise anyone who reads this blog regularly to know that Billy's case doesn't fit the "norm" for most Medicaid applications. In essence, I was allowed to ask ONE question, and we never really got an answer. 

The evidence I sent by way of the case manager for Billy did not get to the Hearing Officer. The representative from Medicaid explained that Billy had been denied benefits at first because they did not have the Medical Necessity document that should have been submitted from the nursing home. At that point, I interjected that the document was in their system, but it had not been found because at some point in the beginning, Billy's social security number was put into the system wrong - it wasn't even close. 

Without telling all the details of the hour long conference, I will just say that the hearing officer offered me an opportunity to get my evidence to her by December 3rd, and she would then determine if we needed to have another hearing. She gave me specific directions on how to send the information to her. I agreed to do that.  

I feel like I understand better what to do now. The representative is not there to help me, and they are not eager to tell any mistakes they have made. I will gather my evidence, and I will make certain it is received by the correct person. The hearing officer did not have to do that for me today, and once again, God has intervened and given me an opportunity for do-overs!  

I'll keep you posted, and as always, I appreciate your prayers. 

1 comment:

  1. Oh my, how frustrating for you!!! Keeping you in my prayers.