I just wanted to share with you all that I was able to win our hearing and got Regional Center to fund 40 sessions of HBOT & housing at Ronald McDonald House. It's been a year since I started this whole thing (most of it was just a waiting thing), but it was worth it. I was able to choose the facility of my choice. (as long as the provider agreed to the rate the Regional Center would pay, this was based on a composite of rates throughout California and averaged out) I chose Sacramento with Ed Nemeth, it's only 2 hours from my house and I can go home on Friday right after the 2nd session. I preferred Dr. Stoller's recommendation of doing 20 sessions for two weeks then taking a break, Ryan has really benefited from it, so have I and our family. He seems to take more in by doing 20. To date he's had 180 sessions. Today in the chamber he was trying to pick up his head to look around, and then started rubbing his cheek with his fist, amazing, brought tears to my eyes. Enough about us, here's how I did it:

1.) I got Ryan's neurologist to write the script.

2.) I turned all my journals into timelines, using Word. It shows how the changes in Ryan increased dramatically during HBOT. Including how the 40 he did in San Bernardino in Jan 05, he was able to have the trach removed immediately when we got home. He then proceeded to do 20 in Sept 05 and his eating skills increased and he eats pretty much anything now.

3.) I created a financial statement using Word also, outlining how much it cost for trach supplies, every single little item need down to the swabs to clean, and all the feeding equipment he needed to be supplied, rental fees etc. I attached EOB's from my insurance company as proof of the charges.

I then totaled everything paid by my insurance and the balances and items not covered paid for by the state Medi-Cal program (for one whole year). It was hundreds of thousands of dollars! I compared the cost of HBOT...with an invoice as proof.

4.) I had Ryan's OT, teacher and PT write letters explaining the changes they saw in him after he had been treated, all positive, the tone had decreased dramatically, vision improvement, etc.

5.) I provided letters of justifications from the HBOT centers he had been treated at in past, with a copy of medical records, proof that he was treated.

6.) I provided studies, several, all that I could find. I was a pretty thick packet.

I lost the initial request, and we had to have a hearing, and I won!

I believe the most significant part was proving to our case worker it's effectiveness, and her aggressiveness to pursue this. I feel so blessed, as soon as I heard our arrangements had been made for us, and now I'm here in Sacrament at the Ronald McDonald House.

If anyone wants to talk or needs help preparing thier own statement, I would be happy to help where I could. Just email me privately or call 559-790-0292. Email: threeboyz@sbcglobal.net

Susy Jeff, 3025 W San Bruno, Fresno, CA 93711

PS: Suzy told me how she got 40 HBO at Rapid Recovery Hyperbarics inSan Bernadino and when she was on the freeway going home she noticed Ryan's trach had fallen out. She pulled over and called 911. The ambulance came and measured Ryan's oxygen saturation level, which was 100% and they asked why he had a trach. The emergency room called her pulmonologist and everyone agreed he no longer needed the trach!

strong> Subject: United Healthcare Insurance Approval for HBOT! Date: 14:44:38 16.01.2006

sly243 wrote: We were able to obtain Insurance pre-certification for HBOT from United Healthcare. HBOT was presented as a small adjunct catalyistic therapy critical to effectuate the overall comprehensive treatment plan consisting primarily of physical therapy. We were successful in obtaining insurance pre-certification for ambulance transport to and from the outpatient facility due to our stretcher transportation requirement. The insurance policy provides for 60 physical therapy sessions per year.

Physical Therapy

Physical therapy is limited to 60 visits per person per calendar year. Additional visits may be approved if medically necessary. The Plan covers short-term outpatient physical therapy to improve the patient's ability to perform tasks required for independent functioning when function has been temporarily lost and can be restored: i.e., strokes, cerebrovascular accidents. A licensed therapy provider, under the direction of a physician, must perform the services. Rehabilitation services that are not expected to result in significant physical improvement in your condition within two months and treatments that cease to be therapeutic and are administered to maintain a level of functioning or to prevent a medical problem from occurring or recurring of the start of treatment are not covered.

What we did: 1. Obtained referral from primary care physician to HBO facility and doctor.

2. Obtained referral from primary care physician for Physical Therapy.

3. Developed a comprehensive treatment plan in which physical therapy was primary treatment and HBOT was an adjunct catalyistic therapy. Submitted treatment plan to insurance for pre-certification (5 days advance notice requirement.) Received approval ...

------------ FOR HBOT PROVIDERS ----------------------------

Please consider bringing in physical therapy services to your facility. Consider developing comprehensive treatment plans primarily focused on physical therapy with HBOT as an adjunct treatment. Develop different treatment plans for various injuries, ie. stroke, diabetes, children, elderly etc... If planned and presented properly you should be able to receive precertifications for treatments and the ability to provide services to a broader spectrum of patients.

------------ FOR MEDICARE AND MEDICAID --------------------- Medicare helps pay for medically necessary outpatient physical and occupational therapy and speech-language pathology services when:

Your doctor or therapist sets up the plan of treatment, and

Your doctor periodically reviews the plan to see how long you will get therapy.

You can get outpatient services from a participating hospital or skilled nursing facility, or from a participating home health agency, rehabilitation agency, or public health agency. Also, you can get services from a Medicare-approved physical or occupational therapist, in private practice while in his or her office or in your home. Medicare doesn't pay for services given by a speech pathologist in private practice. There is no limit to the amount of medically necessary outpatient physical therapy, occupational therapy, or speech-language pathology services you may receive. You can get these services from any Medicare-approved outpatient provider.

http://www.medicare.gov/Coverage/Home.asp

Update: Beginning January 1, 2006, financial limitation of therapy services (therapy caps) will be implemented. The dollar amount for the 2006 limitation on physical therapy and speech-language pathology services from January 1, 2006, through December 31, 2006, will be $1,740.00. ------------------------------------------------------------------- Summary: HBOT is not the primary treatment for any condition. HBOT is a small adjunct catalyistic therapy critical to effectuate the overall comprehensive treatment plan.

Utah Hyperbaric Medical Center, c/o Dr. DeJohn, 540 S Arapeen Dr., Salt Lake City, Utah 84108-1250 would like to do a pilot study for hyperbarics and it's use with children with brain injuries or Cerebral Palsy. They are looking for a grant to fund this study. If there are any interested parents or professionals who would be able to help find funding please contact Dr. DeJohn at 801-582-4268