DENVER — A third-party doctor has agreed with Children’s Hospital Colorado and the family of a mentally ill Commerce City teen that he needs residential treatment, which his Medicaid provider is refusing.
Colorado allows Medicaid providers to ignore doctors’ orders, creating a maddening appeal process that some experts say does not work for families in need.
Doctors admitted 15-year-old Jace Elliot to Children’s Hospital weeks ago after he grabbed a knife in his family’s kitchen and chased his mom into a bathroom. Elliott was born with an extra chromosome. Doctors say that is why his mood shifts from being sweet one moment to chasing his mom with a knife the next.
Elliott’s mom Amber Soderstrom called 911 while locking herself inside her bathroom.
“He’s coming after me,” she told the operator. “Stop, Jace. Put it down.”
“He was stabbing the door and kept stabbing and hitting the door and telling me he wanted to kill me and he wanted me dead and he hated me,” said Soderstrom.
Doctors at Children’s Hospital say Jace suffers from severe mental illness which includes homicidal and suicidal behaviors. However, his Medicaid provider Behavioral Healthcare says his primary diagnosis is autism spectrum disorder, “which is not a covered mental health diagnosis through BHI Medicaid.”
Children’s Hospital paperwork shows Jace’s autism is a secondary diagnosis and his primary diagnosis is “unspecified disruptive impulse control and conduct disorder.”
Dr. Sandra Fritsch is the medical director of the Pediatric Mental Institute at Children’s Hospital.
“The moment it was denied, we filed an appeal,” said Dr. Fritsch
Her first appeal to Behavioral Healthcare was quickly denied.
“It’s upsetting that it’s not unique. We want to get the kids and the families the care that they need when they need it,” Fritsch said.
Now, a third-party psychiatrist has weighed in on a new appeal, writing, “I conclude that Jace Elliott does meet criteria for residential treatment for mental health needs at this time.”
Meanwhile, Soderstrom is frustrated that Colorado allows providers to ignore the recommendation of an outside expert. Soderstrom and Children’s Hospital are now appealing to Colorado’s Department of Human ServicesAlertMe