BUFFALO, N.Y. (WKBW) — Gigi's Playhouse in Buffalo is a free facility that helps people of all ages living with Down syndrome.
Emily Mondschein is the Executive Director, and her husband, Will, is the co-founder. The Mondscheins are inspired by their 10-year-old son, Paul, who was born with autism and Down syndrome. He has faced numerous medical challenges throughout his life, resulting in more than $1 million worth of medical bills.
"He's had five major surgeries by the age of three," said Will.
For most of his life, the family has relied on secondary insurance, Medicaid, which has been essential in managing his health care needs.
In May, Will transitioned to a new job with new primary insurance. They submitted a letter and a copy of the new insurance information to the state's Medicaid department, believing that the transition would be seamless. However, they were unprepared for the complications that followed.
"Medicaid goes through their records and says his current primary insurance and what we have on file don't match, so they deny the claim," said Will.
Since May, approximately a dozen of their claims have been denied.
Seeking Help
As the denials piled up, Mondschein attempted to reach out to Medicaid for clarification, but was met with further challenges.
"When I called Medicaid, they said the call volume was too high and hung up," said Mondschein.
The Mondscheins then reached out to 7 Problem Solvers. I took immediate action, contacting local federal and state representatives to advocate on behalf of the family. I contacted Congressman Tim Kennedy's Office and Senator Sean Ryan, emphasizing the urgency of the situation.
Swift Resolution
Within three hours of intervention, the Mondscheins received a call from the New York State Office of Medicaid in Albany. The office addressed the issue, updating Mondschein's insurance information.
"You guys get it done," said Mondschein.
The Mondscheins hope this can help other families also having communication issues with Medicaid.
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