This is what happened about the following case.
Client was unable to secure a PCP from Ohana and/or Psychiatrist, everyone he called (including his mother) would not take Ohana (Wellcare) Insurance. As a result when he went to pick up his prescriptions, it was denied for "prior authorization PCP". Martin had no PCP assigned and was unable to secure one, which was the responsibility of Ohana (Wellcare) Healthplan. He was never visited by his Care Coordinator as required by Contract for Ohana (Wellcare).
Although APS healthcare (Fee For Service Contractor for SMI) may be responsible for the payment of the psychotrophic drugs as he is a Severally Mentally Ill (SMI) client (see attached Demograpics Highlighted), a PCP was still required to pick up meds and Martin could not secure one (Ohana failed to get him one assigned since Feb 1, 2009). He was never visited by his Care Coordinator, his card from Ohana reflects no PCP, the system was rigged to deny services for client.
Ohana receives $3,890 per month for this client and was responsible for coordinating his care. The medication only cost $80-90 per month. Martin just wanted to die and because of his religion suicide was not an option. This is another example of Wellcare's practice.
Here is a link to the original story that appeared today in the Honolulu Advertiser.
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