Dear Friends:
There is a nice insurance company named Nascentia, in Syracuse, NY. Our dear Medicaid pays them a premium every month to take care of Glendora.
Nascentia gave Glendora a useful bed rail to facilitate getting into and out of bed, and to keep her from falling out of bed. It has a handy pouch attached to it.
Every month, diligent Nascentia makes certain Glendora receives 100 diapers, 100 crotch pads, and 15 bed pads.
Nascentia generously provides Glendora 43 hours of personal care help, 28 hours from Helper A, and 15 hours from Helper B. These people are paid $18.65 an hour, about $800 a week. Helper A takes care of things 11 am-6 pm, Monday, Tuesday, Wednesday, and Friday. Helper B takes care of things Thursday 9 am-5 pm, and Saturday 12:15-8:15 pm.
Glendora pays Helper C out-of-pocket, $250 per week, from 7 pm Monday through 10 am Saturday, including overnight.
Sunday, Glendora is alone, and should not be. Glendora is totally blind. Glendora has lost her mobility, 95% from the waist down. She is totally dependent on a walker. She has not left her Happy House 3 home for three years. She cannot do anything standing up because she has to use her hands on the walker to keep from falling, so she cannot do any counter work. She can do work only sitting down. She will not go near a stove, because of the danger. Because of the blindness, she doesn’t know whether she has soiled the bathroom and is tracking it all over the floor. She sits in the midst of three garbage pails of diapers, urine and feces all day and all night. She has no food to eat and is hungry. There is nobody to talk to, and she is lonely.
She applied to her case manager, Tara, for five hours Sunday afternoon for assistance from Helper D, who has been volunteering. The request was made over the phone and Tara argued frigidly against it. Glendora said at the end of the discourse: “If I ever have a heart transplant, I want the heart of Tara; it has never been used.” I meant it to be funny, not insulting.
Glendora told her nurse practitioner, Rhonda Esposito that Tara had denied. Rhonda said the first request is always denied, and to tell Tara to put the decision in writing, so Glendora could appeal it. Glendora did, and Tara wrote back that she would take her case to the medical review board. Tara did this, and a week later telephoned Glendora that the medical review board had denied Glendora’s request. Glendora was aghast that a nice company like Nascentia would commit ex parte. Glendora’s case was being presented before the medical review board by somebody who was against her interests. Nobody was there to stand up for Glendora. Only one side was being heard. Why would such a nice company as Nascentia be so one-sided?
So my dear TV audience, will you please plead my case to Nascentia? I need your help. The nurse practitioner told Glendora that she would write a letter of medical necessity.
