Hi Friends – it’s taken me many months to wrap my mind around the insanity of all of these denials. We are now up to 34 denials and it’s had my head spinning for sure.
We are in an insane gridlock with the dol. They’ve instituted an unpublished procedure change and are routing all massage auth requests to an internal medical director instead of allowing the MBE to make a decision (with the help of an unbiased contract Dr. if needed). The MBE then must enforce her denial.
What we need to do at this moment is have you all request a recommended decision.
- In writing – something simple like: I disagree with the denial of massage therapy benefits and wish to have a recommended decision issued in this case. Sign, date, white card number
- Take your signed/dated, written statement AND a copy of your massage denial letter to the resource center and ask for both to be uploaded to your electronic file. (I have a copy of the denial if you need it)
In about a month, you will receive a letter that begins with Recommended Decision… It will reiterate the reasons they denied it to begin with and it will include two waivers.
Do not sign the waiver.
3. Call me as soon as you receive this letter. We will object to the Recommended Decision and begin a rebuttal and provide additional supporting evidence as to why it should not have been denied to begin with.
All of this will then be sent to the Final Adjudication Branch.
The FAB independently reviews the case to ensure it follows EEOICPA policies. The FAB can accept, deny, or send the case back to the district office for further development (a remand), and it can also consider claimant objections through written statements or oral hearings before issuing a final, written decision.
- Meanwhile, start making a list of the symptoms that have returned and how that is impacting your quality of life.
- Have your nurses document, in detail, the decline in your health since massage has been denied.
- Make a doctor’s appointment just dedicated to this, and have the decline in your health and need for massage documented there as well.
You will need that documentation for the recommended decision.
On my end, I am fighting this from the standpoint of systemic denials that breach published policy and block your access to care.
Senator Cantwell’s office is helping to get my FOIA request honored to access the conversations that led to this. They wanted $4800 when I requested it so I reached out and requested a congressional inquiry into this entire situation. Click here to read the letter I wrote explaining the situation and asking for her help.
We are going to get on the other side of this by everyone taking action to bring awareness to the erosion of your access to health care promised by law!