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[lymphland] ALERT for New York State Medicaid
Recipients With Lymphedema
Friday, January 11, 2013 3:37
AM
From:
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To:
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Cc:
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Court-Ordered Class Action Notice in Davis v. Shah On January 7, 2013, Judge Charles J. Siragusa certified Davis v. Shah as a class action lawsuit on behalf of “All current and future New York State Medicaid recipients for whom Defendant has directly or indirectly failed to provide coverage for medically necessary orthopedic footwear and compression stockings as a result of New York Soc. Serv. Law § 365-a(2)(g)(iii) and (iv) and regulations and policies promulgated thereto.” Judge Siragusa appointed the Empire Justice Center and the National Health Law Program as legal counsel for the class. The case alleges that the New York State Department of Health is violating the Medicaid Act when it denies coverage of orthopedic footwear and compression stockings to Medicaid recipients whose doctors have prescribed these services as medically necessary for their health conditions. The class notice follows:
REGARDING MEDICAID COVERAGE OF ORTHOPEDIC FOOTWEAR AND COMPRESSION STOCKINGS
Davis et al. v. Shah is a lawsuit filed in federal district court in the Western District of New York. The case was filed on March 14, 2012 (case number: 12-CV-6134-CJS).
On January 7, 2013, Judge Charles J. Siragusa has certified this case as a class action lawsuit on behalf of “All current and future New York State Medicaid recipients for whom Defendant has directly or indirectly failed to provide coverage for medically necessary orthopedic footwear and compression stockings as a result of New York Soc. Serv. Law § 365-a(2)(g)(iii) and (iv) and regulations and policies promulgated thereto.” Judge Siragusa appointed the Empire Justice Center and the National Health Law Program as legal counsel for the class.
The case alleges that the New York State Department of Health is violating the Medicaid Act when it denies coverage of orthopedic footwear and compression stockings to Medicaid recipients whose doctors have prescribed these services as medically necessary for their health conditions. The lawsuit also alleges that the Department of Health has violated the Medicaid Act and United States Constitution by denying these services without giving you notice of the denial and an opportunity to contest the denial.
If you are a Medicaid recipient and you have been unable to get Medicaid to cover your doctor-prescribed orthopedic footwear or compression stockings, contact the Health Law Unit at the Empire Justice Center at 1-800-724-0490.
If you're on
Medicaid, usually to get Lympedema therapy, you'll need a referral from your
PCP,
Primary Care Physician or whomever you see regularly. Make
sure the dr writes URGENT on the
referral or it can take up to 10 days for approval. An URGENT message will get it processed in 72
hours. I have Medi/Medi, Medicare & Medi-Cal, which is
California's version of Medicaid. They
require a referral for every
little thing I want to do away from my regular dr. You'll need to be referred
to a Lymphedema therapist who will do an initial evaluation. At
that evaluation, you'll talk to him/her,
be measured, discuss
therapy, skin care & more. Getting gastric bypass will help with your
weight. As
someone else already said, you'll still have
Lymphedema. There is NO cure for it, just management &
therapy.
Everyone responds to the therapy, some better than others.
In an ideal
fantasy world, insurance would pay for continued therapy to get the desired
results, without
long breaks or having to be discharged & start
all over. In reality, most of our insurances pay for a
certain
amount of therapy appointments & then want to quit paying due to high
costs, limits, lack of
progress, etc, whatever reasons they want to
use to quit paying.
On limits to therapy: Medicare has an "exception"
process whereby if your physician, after reviewing
your treatment
plan and your progress against that plan, determines that you will need
additional
treatments in order to reach the planned goal, and if
there are co-conditions (e.g. obesity, multiple
limbs, congestive
heart failure, peripheral artery disease, etc) which make progress slower than
normal,
an exception can be obtained to the annual therapy limits
and additional sessions can be obtained.
Court-Ordered Class Action Notice in Davis v. Shah On January 7, 2013, Judge Charles J. Siragusa certified Davis v. Shah as a class action lawsuit on behalf of “All current and future New York State Medicaid recipients for whom Defendant has directly or indirectly failed to provide coverage for medically necessary orthopedic footwear and compression stockings as a result of New York Soc. Serv. Law § 365-a(2)(g)(iii) and (iv) and regulations and policies promulgated thereto.” Judge Siragusa appointed the Empire Justice Center and the National Health Law Program as legal counsel for the class. The case alleges that the New York State Department of Health is violating the Medicaid Act when it denies coverage of orthopedic footwear and compression stockings to Medicaid recipients whose doctors have prescribed these services as medically necessary for their health conditions. The class notice follows:
REGARDING MEDICAID COVERAGE OF ORTHOPEDIC FOOTWEAR AND COMPRESSION STOCKINGS
Davis et al. v. Shah is a lawsuit filed in federal district court in the Western District of New York. The case was filed on March 14, 2012 (case number: 12-CV-6134-CJS).
On January 7, 2013, Judge Charles J. Siragusa has certified this case as a class action lawsuit on behalf of “All current and future New York State Medicaid recipients for whom Defendant has directly or indirectly failed to provide coverage for medically necessary orthopedic footwear and compression stockings as a result of New York Soc. Serv. Law § 365-a(2)(g)(iii) and (iv) and regulations and policies promulgated thereto.” Judge Siragusa appointed the Empire Justice Center and the National Health Law Program as legal counsel for the class.
The case alleges that the New York State Department of Health is violating the Medicaid Act when it denies coverage of orthopedic footwear and compression stockings to Medicaid recipients whose doctors have prescribed these services as medically necessary for their health conditions. The lawsuit also alleges that the Department of Health has violated the Medicaid Act and United States Constitution by denying these services without giving you notice of the denial and an opportunity to contest the denial.
If you are a Medicaid recipient and you have been unable to get Medicaid to cover your doctor-prescribed orthopedic footwear or compression stockings, contact the Health Law Unit at the Empire Justice Center at 1-800-724-0490.
If you're on
Medicaid, usually to get Lympedema therapy, you'll need a referral from your
PCP,
Primary Care Physician or whomever you see regularly. Make
sure the dr writes URGENT on the
referral or it can take up to 10 days for approval. An URGENT message will get it processed in 72
hours. I have Medi/Medi, Medicare & Medi-Cal, which is
California's version of Medicaid. They
require a referral for every
little thing I want to do away from my regular dr. You'll need to be referred
to a Lymphedema therapist who will do an initial evaluation. At
that evaluation, you'll talk to him/her,
be measured, discuss
therapy, skin care & more. Getting gastric bypass will help with your
weight. As
someone else already said, you'll still have
Lymphedema. There is NO cure for it, just management &
therapy.
Everyone responds to the therapy, some better than others.
In an ideal
fantasy world, insurance would pay for continued therapy to get the desired
results, without
long breaks or having to be discharged & start
all over. In reality, most of our insurances pay for a
certain
amount of therapy appointments & then want to quit paying due to high
costs, limits, lack of
progress, etc, whatever reasons they want to
use to quit paying.
On limits to therapy: Medicare has an "exception"
process whereby if your physician, after reviewing
your treatment
plan and your progress against that plan, determines that you will need
additional
treatments in order to reach the planned goal, and if
there are co-conditions (e.g. obesity, multiple
limbs, congestive
heart failure, peripheral artery disease, etc) which make progress slower than
normal,
an exception can be obtained to the annual therapy limits
and additional sessions can be obtained.