Diagnosis: Hypertension and multiple other medical conditions.
Treatment: Personal Care Assistance 56 hours/week.

The insurer denied the Personal Care Assistance 56 hours/week. The denial is overturned.

Yes, the Personal Care Assistance 56 hours/week is medically necessary.

The patient is a female with past medical history of hypertension, hypothyroid, emphysema, osteoarthritis, CVA (cerebrovascular accident), cervical radiculopathy, disc herniation, lumbar spinal stenosis, urinary incontinence requiring diapers, unsteady gait requiring walker usage, and frequent falls. The patient was determined by her treating physician to be totally dependent for adult daily living tasks. The patient lives alone.

The patient has history of hypertension, hypothyroid, emphysema, osteoarthritis, CVA, cervical radiculopathy, disc herniation, lumbar spinal stenosis, urinary incontinence requiring diapers, unsteady gait requiring walker usage, and frequent falls. The patient was determined by treating her physician to be totally dependent for adult daily living tasks. The patient lives alone. The health plan's currently approved plan of 32 hours per week is not sufficient to meet this patient's needs. Therefore, the requested Personal Care Assistance 56 hours/week is medically necessary.