Elana’s Story

I am Elana*, a young mother and student.  For several years I experienced the deterioration of my facial muscles as a result of a rare disease.  This disease caused me severe pain and I felt embarrassed by this disfigurement.  My school work and ability to mother suffered.  My doctor finally recommended plastic surgery to ease the pain, stop the deterioration, and restore my face.  I did not imagine that Medicaid would deny this surgery because it was considered “cosmetic.”

My doctor and I tried unsuccessfully to convince Medicaid that the surgery was medically necessary for me.  I desperately needed legal assistance, but could not afford to hire an attorney.  Luckily, I was referred to DRI who agreed to take my case.  My attorney understood the Medicaid rules and obtained statements from my doctor supporting the criteria for Medicaid coverage for reconstructive surgery.  At one point, Medicaid agreed to pay for a more expensive surgery even though the surgery was more invasive.  Just before the hearing. The DRI attorney convinced Medicaid to fund the surgery that my doctor recommended.

Greatly relieved from the worry of not being able to pay for the surgery, I had the surgery and it was successful.  I am now able to focus on my schooling and child.  DRI’s advocacy certainly made a huge difference in my life.

*Name changed to protect privacy.

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