Securing Treatment for an Erie County Resident with Degenerative Disc Disease
Degeneration of one or more intervertebral disc(s) of the spine, often called "degenerative disc disease" or "degenerative disc disorder," is a condition that can be painful and can greatly affect the quality of one's life. Disc degeneration is a disease of aging, and though for most people it is not a problem, in certain individuals a degenerated disc can cause severe chronic pain if left untreated. PHLP recently helped one man get treatment.
“Bill”, a 57-year-old from Erie County, relies on injections in his neck to relieve pain, severe headaches, and numbness in his arms and hands that he regularly experiences due to degenerative disc disease. When his Medicaid managed care insurer denied him coverage of magnetic resonance imaging (MRI) he needed to get the injections, saying it was not medically necessary, Bill contacted PHLP for assistance.
According to Bill’s doctor, MRI was necessary to check for further deterioration and to ensure that injections were still the best course of treatment. Several years ago, prior to starting injections, Bill had undergone testing and had tried other treatments such as physical therapy. Since then, he changed insurers and his new Medicaid managed care plan didn’t have records of his prior services, tests, and treatment, so they didn’t know what Bill had tried and whether it had worked for him.
PHLP helped Bill appeal the denial. We also helped Bill contact his doctors to explain what additional information should be submitted to help him get a favorable decision from the appeal process. Bill’s doctor explained Bill’s need for MRI and described previous testing and treatment.
PHLP’s advocacy was successful: Bill’s managed care plan overturned their denial! Bill was relieved and grateful for PHLP’s support. PHLP is glad, too, that Bill could get the test he needed to move forward with a much-needed treatment.
PHLP Submits Comments on Healthy PA Proposal
Earlier this month, PHLP provided comments on behalf of the Consumer Subcommittee of the Medical Assistance Advisory Committee about Healthy PA
, Governor Corbett’s proposal to increase access to quality, affordable health care options for all Pennsylvanians.
Although Healthy PA
is in concept form, PHLP shared a number of concerns about the Medicaid-relevant reforms. As the Commonwealth crafts its proposal to the Secretary for the U.S. Department of Health and Human Services for permission to waive provisions of the Social Security Act governing Medicaid, PHLP hopes the Commonwealth will consider these comments. PHLP’s comments are available by clicking here
PHLP Leads Navigator Trainings
This fall, PHLP is leading several training sessions for advocates, providers, and other professionals who work with low-income individuals’ health care needs.
PHLP Staff Attorney Kyle Fisher is working with the Pennsylvania Association of Community Health Centers
(PACHC) to provide training to health center enrollment assisters. The in-person and webinar trainings cover how to determine eligibility for Medicaid and CHIP of those applying for health insurance through the Marketplace. This series of trainings conducted by PHLP will ensure that enrollment assisters know the ways in which low-income parents and children, pregnant women, the aged, blind, and individuals with disabilities can access the coverage they need. These training sessions are supported by a grant from the Department of Health and Human Services (HHS).
To learn more about PHLP’s education and outreach efforts, click here
PHLP Welcomes Two New Staff Attorneys
This fall, PHLP welcomed two new attorneys to our team of dedicated staff.
is a staff attorney in PHLP’s Pittsburgh office. Allison joined PHLP last summer as an intern, and we are thrilled to welcome her back. Allison says that the most rewarding part of her job is being able to relay good news to clients, especially concerned parents. “It’s great to hear the sigh of relief of a parent,” she commented when speaking about her work on PHLP’s Helpline. Allison received her J.D. from the University of Pittsburgh School of Law and is a graduate of the Health Law Certificate Program.
joined PHLP as a staff attorney in the Philadelphia office in September. Joline says that she appreciates that PHLP addresses systemic issues and policy in addition to doing direct service work with clients. From her experience working as a community organizer focusing on health care for the uninsured, she is aware of the ways in which the health care system has failed certain populations. Now she is able to provide not only a listening ear but also legal expertise to guide clients to, as she says, “make sure systems are treating people well, too.” Joline graduated from the University of Pennsylvania Law School.
Allison and Joline are no strangers to serving those Pennsylvanians in greatest need. Allison was a recipient of the Community Service Award from the University of Pittsburgh School of Law, where she worked with the Health Law Clinic and represented low-income clients on a variety of health-related issues. Joline received the Award for Extraordinary Service from the University of Pennsylvania Law School for completing more than 600 hours of pro bono while in law school. We’re thrilled to have two individuals join our team who have shown such dedication to serving those most in need.