Diagnosis: COPD; Cardiovascular disease; Hypertension.
Treatment: Personal Care Assistance (PCA) Services.

The insurer denied the Personal Care Assistance (PCA) Services. The denial is overturned.

The patient is an male. He has a history of severe COPD (chronic obstructive pulmonary disease), dependent on supplemental home oxygen, cardiovascular disease and hypertension. Due to impairments related to these conditions, he requires assistance for completion of some of his activities of daily living (ADLs). An appeal review was requested for potential approval of Personal Assistance Services to offer increased ADL support.

This is a male with a history of severe COPD, dependent on supplemental home oxygen, cardiovascular disease and hypertension. Due to impairments related to these conditions, he requires assistance for completion of some of his activities of daily living (ADLs). Documentation from the patient's provider confirms that, due to the patient's severe COPD and numerous comorbidities, he requires assistance for completion of some of his activities of daily living. Hence, the recent denial of Personal Assistance Services is not appropriate and not sufficient to meet the patient's current needs. For these reasons, the proposed treatment Personal Assistance Services is deemed medically necessary.