Austin is an 8 year-old who is charming, bright, and full of life. He is diagnosed with a severe language disorder that makes his limited speech unintelligible. After three years of attempting to use a communications device, Austin was only able to combine two symbols and was completely unable to navigate between pages of the device without heavy prompting and cueing. This was a source of great frustration for Austin. For three years he and his parents stressed over the loneliness caused by Austin’s inability to communicate.
A different device which enabled him to communicate much better, was denied by his TennCare HMO. They told him they would only cover the one he had been using, the one that did not work.
The HMO denied the medical equipment as “not medically necessary,” even though Austin’s speech therapist and pediatrician found that the device was medically necessary to enable Austin to communicate basic survival skills, make requests, and to express the need for medical assistance and medical care.
When Austin’s parents appealed, TennCare sided with the HMO.
Desperate to end the isolation Austin was forced to live in for three years with his unsuccessful speech generating device, Austin’s parents contacted the Tennessee Justice Center. TJC used the protections of the John B. class action law suit to get Austin the medical equipment his doctor and speech therapist recommended.
Austin was thrilled to learn that that he would be getting the medical equipment he needed. The smile on his face when it arrived, just in time for Christmas, was priceless.
Austin had trouble again shortly after, when he and his 5-year-old sister, Megan, were denied occupational and physical therapy because TennCare had allegedly not paid the bills for these services. In April 2006, TJC successfully advocated on behalf of Austin and Megan to get their care reinstated.