TennCare Denial
In support of
Jaxson Cummings
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Jaxson Cummings
Well… the denial letter for Jaxson’s AAC device finally came. And if TennCare thought this letter was going to make me quietly accept “no,” they clearly haven’t been paying attention.
Here’s what they actually said: Jaxson needs an eye-gaze communication device. It’s medically necessary. It’s a covered benefit. Great. We all agree.
BCBS of Tennessee which is his primary insurance even approved the out-of-network exception because they recognized the medical need. But *TennCare*, his secondary insurance, decided they’d rather send us to an in-network provider… that doesn’t even carry the device his medical team prescribed. Read that again.
They’re denying access to the very device his specialists evaluated, trialed, and documented as medically necessary, while pointing us toward a company that can’t provide it…somehow that’s considered “access”. Make that make sense.
This isn’t about a particular brand name device, this isn’t about me wanting something nicer or more expensive. This is about a little boy whose spent five years fighting through surgeries, hospitalizations, therapies, hearing loss, vision impairment, and every obstacle imaginable until he finally found a way to tell his mama what he wants, who he loves, and what’s on his heart. And now a desk somewhere thinks they get to decide that the voice he’s already found is interchangeable with something they’ve never proven will work for him. They. have. NO. DATA. And better yet, I’ve asked them to provide the credentials of the person qualified to even make this decision on their end and guess what? I got crickets.
Let me save everyone some time, I really don’t intimidate easily when it comes to my kids. I don’t back down because a denial letter showed up in my mailbox. If anything, it just handed me a roadmap for the appeal. Every weak argument, unanswered question and assumption will be answered with evidence. And we’re going to keep answering it until someone is willing to explain with a straight face why a child should lose access to the communication system his own specialists determined he needs simply because it’s easier for an insurance company.
I’ve spent the last five years teaching my son and daughter that just because someone has said “that’s impossible” doesn’t mean it’s the end of the story. I refuse to let an insurance company show them otherwise. The more they force me to fight for my son’s voice, the louder mine becomes and I’m just getting started. 💙
Here’s what they actually said: Jaxson needs an eye-gaze communication device. It’s medically necessary. It’s a covered benefit. Great. We all agree.
BCBS of Tennessee which is his primary insurance even approved the out-of-network exception because they recognized the medical need. But *TennCare*, his secondary insurance, decided they’d rather send us to an in-network provider… that doesn’t even carry the device his medical team prescribed. Read that again.
They’re denying access to the very device his specialists evaluated, trialed, and documented as medically necessary, while pointing us toward a company that can’t provide it…somehow that’s considered “access”. Make that make sense.
This isn’t about a particular brand name device, this isn’t about me wanting something nicer or more expensive. This is about a little boy whose spent five years fighting through surgeries, hospitalizations, therapies, hearing loss, vision impairment, and every obstacle imaginable until he finally found a way to tell his mama what he wants, who he loves, and what’s on his heart. And now a desk somewhere thinks they get to decide that the voice he’s already found is interchangeable with something they’ve never proven will work for him. They. have. NO. DATA. And better yet, I’ve asked them to provide the credentials of the person qualified to even make this decision on their end and guess what? I got crickets.
Let me save everyone some time, I really don’t intimidate easily when it comes to my kids. I don’t back down because a denial letter showed up in my mailbox. If anything, it just handed me a roadmap for the appeal. Every weak argument, unanswered question and assumption will be answered with evidence. And we’re going to keep answering it until someone is willing to explain with a straight face why a child should lose access to the communication system his own specialists determined he needs simply because it’s easier for an insurance company.
I’ve spent the last five years teaching my son and daughter that just because someone has said “that’s impossible” doesn’t mean it’s the end of the story. I refuse to let an insurance company show them otherwise. The more they force me to fight for my son’s voice, the louder mine becomes and I’m just getting started. 💙
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