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The stories
behind the claims.
The people
behind the wins.
A Single-Handed Battle
THE CHALLENGE
For Josh*, an 11 year old boy born with a congenital hand defect, every day was a painful struggle to keep up with his lively peers and his active lifestyle.
An electric arm prosthetic enabled Josh to participate in school and in social settings, boosting both his physical capabilities and his confidence. The problem? Due to religious reasons, the electronic prosthetic couldn’t be used on Sabbath, and his insurance wouldn’t cover the additional costly passive (non-electronic) prosthetic.
Without the passive prosthetic, Sabbath and Holidays would be absolute torture for Josh. The lack of a prosthetic meant limited mobility, and even worse —curious stares from other children.
THE ADVOCACY
When Josh’s mother approached us to advocate for her son, we knew we’d do whatever it takes to give this family a hand. And so the advocacy began.
Letters were sent in to the insurance company from Josh’s teacher, pediatrician, and orthopedist.
Their passionate letters pleaded for an additional prosthetic for Josh to use when his existing one was prohibited. They mentioned his social struggles, and how a quality prosthetic would help him achieve success in all areas.
When the insurance company pushed back, saying that there was no medical need for a passive prosthetic, we didn’t surrender. Instead, we submitted our arguments for external appeal by the State of NY.
THE RESOLUTION
Based on the comprehensive information and vast amount of proof we provided, the conclusion was made that the passive prosthetic was 100% necessary, and authorization was provided for total coverage of the additional prosthetic.
The Freedom to Breathe
THE CHALLENGE
Wheelchair-bound, suffering from a chronic respiratory disease, and dependent on 24/7 ventilator support, Nina* was cared for at home by her devoted mother and loving siblings.
In the past, Nina had been able to come off vent support for short periods of time. However, after undergoing an unrelated surgery, even mere moments off the ventilator would cause Nina tremendous difficulty breathing.
With just one ventilator at home, Nina’s dependence on the ventilator support kept her prisoner to one floor of her family’s 3-story home. In addition, in the event of the ventilator failing or getting damaged, there was zero back-up in place to provide Nina with the air she needed to survive.
Living at home meant everything to Nina and her family, but with insurance denying coverage for the prohibitively expensive second ventilator, every day at home was a tremendous risk to Nina's health.
THE ADVOCACY
We submitted Nina’s case for external appeal by the State of NY, determined to help this incredible girl and her family breathe easy.
We sent letters from Nina’s doctors, confirming that everything possible was being done to clear Nina’s airways— including constant monitoring and round-the-clock medication. But at present Nina was totally dependent on 24/7 ventilator support and needed a second ventilator.
THE RESOLUTION
Based on the powerful proof and detailed information we provided, the conclusion was made that a second ventilator was vital to Nina’s health at home, and authorization was provided for coverage of the additional ventilator.
The stories
behind the claims.
The people
behind the wins.
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