Bradley cannot talk or move, and is dependent on a ventilator and feeding tube. Despite his disabilities, Bradley loves to play basketball, and attend school with his friends. Bradley’s father’s employer provides health insurance for the family. But in 2006, the insurance company said that Bradley had exhausted his lifetime limits. With Bradley’s complex medical needs, the family was fortunate to have TennCare to rely on as a safety net. However, 2007, bills began to arrive, even though children on TennCare are not supposed to receive bills from providers. More and more of the illegal bills arrived. So, Bradley’s Mom, Suzette, contacted TJC. We wrote letters to TennCare, and soon they told the family that they were not responsible for the bills. Suzette said, “TJC became our advocate in the billing process, giving us the time to focus on what is important – Bradley’s care.”
Jacob, age 7, has a genetic disorder that requires him to use a machine to help him breathe. He needs another machine to eat, and braces and a walker to get around. But, when Jacob talks, and his friendliness and intellect shine through. In Fall 2007, Jacob’s doctor said he was ready to attend school, and prescribed a one-on-one nurse to ensure his safety. However, Jacob’s Mom, Amy, was unable to find a nursing agency that would provide a nurse for Jacob. She appealed to the insurance company for help, but was told that there was nothing the company could do. So, Amy contacted TJC. Since Jacob is on TennCare, they are responsible for providing care. After TJC contacted TennCare, Jacob was assigned a case manager, and soon a nursing agency arranged care for Jacob. He is now attending school, learning and socializing in a stimulating environment.
Six-year-old Chase Addington is developmentally delayed and cannot walk or talk. Chase needed home health care — to administer medicines, manage his tube feedings, and make sure he’s safe. But his mother, Donna had to fight TennCare for two years just to get home health care for her son.
Searching to find some way to help her son, Donna also called the Tennessee Justice Center. TJC stold her about new TennCare home health rules, gave her advice about getting a nurse when Chase needed one, and explained Chase’s rights. With TJC’s help, Donna was finally was able to secure a home health care nurse for her Chase.
“Being armed with knowledge of my son’s rights made it possible for me to get the care he needed,” said Donna. “I’d do anything I could to help other families avoid the pain we have suffered because TennCare wouldn’t provide what Chase needed.”
Judy’s twelve year-old son, Chase, had a vision problem that limited his activities and his ability to read. Chase’s optometrist prescribed vision therapy. After two months of therapy, his eyesight had improved significantly. But then, less than halfway through his program, Judy received notice from TennCare that it would not pay for any more treatment. She asked TJC to help her pursue the care which was bringing her son’s world into focus. We explained Chase’s rights, and helped her file an appeal. We also wrote a letter to TennCare, but they still denied the treatment. The only alternative TennCare offered was bifocals, which wouldn’t actually fix Chase’s eyes. Judy was determined to find a way to continue the therapy. Since Chase could not continue seeing his doctor, Judy performed the vision therapy for two months with his doctor’s guidance. Through prayer, tenacity, and friends’ support, Chase’s vision is now normal.
At age five, Sean was diagnosed with attention deficit hyperactivity disorder, post traumatic stress disorder, depressive disorder, bipolar disorder, developmental delays, and familial tremors. Then, when Sean was 14, his pediatrician told his mother, Lisa, that all of these diagnoses were wrong. He needed to be tested for a proper diagnosis. But most doctors who could administer the tests wouldn’t see him because they didn’t take TennCare insurance. So, Lisa contacted TJC. TJC helped Lisa arrange tests for Sean at a local hospital. However, the family had to pay the hospital $1,400 before testing could begin, because TennCare wouldn’t pay. The family didn’t have the money for the tests. Six months later, Lisa was still waiting for her son to be tested so that he could receive the treatment he really needed. Meanwhile, Sean’s behavior became harder and harder to control. “By delaying this test, TennCare is robbing Sean of his future,” said Lisa.