Nov 29 Advocating for Life-Changing Supports
By the time Mary requested the implantation of a neurostimulation device to treat her excruciating occipital and trigeminal nerve pain, she had tried every possible treatment and drug—including opioids—to deal with her debilitating condition. Nothing had worked, and the medications she took resulted in terrible side effects. Nearly incapacitated, Mary was forced to quit both her job and work on her Master’s degree, and effectively parenting her son was almost impossible. The neurostimulation device, recommended by a pain clinic, was her last chance at relief, but her Medicaid HMO refused to pay for this treatment, arguing the device was not an effective treatment for her condition.
DRW supervising attorney Mitch Hagopian represented Mary before, during, and after a hearing before the Division of Hearings and Appeals to compel Medicaid to cover the cost of the device, citing studies and articles that showed the implant was an effective treatment for her condition. With Mitch’s help, Mary won her hearing and was allowed to trial the device. It worked extremely well, providing her with immediate pain relief. But as she was preparing to switch from her temporary neurostimulation device to a permanent one, her provider balked at requesting the permanent implant because of the low Medicaid reimbursement rate.
Mitch intervened to convince the provider that it had an obligation to complete the treatment that it had started. But once submitted, the Medicaid HMO sent another denial letter saying they would not cover the permanent device. Within an hour, Mitch sent an appeal letter and, only hours later, the HMO withdrew their denial and covered the device. Since the implantation of Mary’s permanent neurostimulation device, her pain has been almost entirely eliminated. She’s finished her Master’s degree and now advocates for the use of the implant as a pain control device to help others.