Persius

@persiusorg.bsky.social

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Empowering collective action in healthcare through digital tools, data, and patient advocacy. We help people with coverage denials for free. persius.org Newsletter: https://persius.org/newsletter

According to the medical records, the patient is a child with a past medical history of spastic quadriplegic cerebral palsy, prematurity, hydrocephalus with shunt, bronchopulmonary dysplasia, and developmental delay. The patient underwent selective dorsal rhizotomies of lower nerve roots (lumbar [L]4-sacral [S]1) for spasticity treatment and recently completed a course of inpatient rehabilitation. The patient is now doing outpatient physical therapy. Ambulation was originally being performed with a KidWalk gait trainer but the patient has made progress in therapy and can now ambulate for 100-200' with a posterior rolling walker. A Nimbo posterior rolling walker has been requested for home use. The previous request was denied due to not being medically necessary/insufficient information in the medical record. The health care plan did not act reasonably and with sound medical judgment and in the best interest of the patient. The patient has made progress in their walking abilities and
Insurance denial reviewed by a third party. The review reads: "Diagnosis: Seizure Treatment: inpatient stay The insurer denied the inpatient stay The health plan's determination is overturned. The patient is a young boy who presented with a first time seizure. He was well until naptime at school, when he began to flatten his back, foam at the mouths, and his eyes rolled back. He was unresponsive during the episode and it lasted from several seconds to a few minutes. An ambulance was called and he was noted to be 'spaced out' with a 'dead stare' for 10 minutes during transport. There were no other associated symptoms. He had no fever or recent trauma. He did have a runny nose for the past few days with a cough. He has a history of speech delay and is receiving speech therapy. His family history is significant for a seizure disorder in his sister. Inpatient Hospital Admission was medically necessary for this patient."
Picture showing an external appeal review committee's summary description of a health insurance denial involving treatment for metastatic cancer, and their decision to overturn the denial.
A medical reviewer's description of a health insurance denial related to treatment for acute myeloid leukemia. The reviewer determined that the denial should be overturned, and the requested treatment is medically necessary.
Screenshot showing a physician review of a health insurance denial for a patient with stage 4 metastatic breast cancer. The physician reviewer describes context, and overturns the denial.
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