It is almost as if UnitedHealth and Wellcare are playing a game with Hawaii's disabled population: anything that is asked for, deny because there is no prior authorization, then delay while the family tries to navigate its way through the appeals system.
It is a fabulous way to save money.
My ten year old daughter is a case in point. Hannah is medically fragile and has seizure activity in her brain constantly whether she is awake or asleep. She cannot get sick because as soon as her body temperature goes over 99 her seizures increase.
Every new prescription, every new service, and every visit to a specialist requested from Evercare since November has been denied.
The doctors do not seem ready for all the additional reams of paperwork that have been introduced into their practices. I saw the forms one pediatrician had filled out to get a severely disabled child into the 1115 Medicaid waiver program. There were pages upon pages of specific questions about the individual's condition, and the doctor had essentially used the comment sections to answer them.
The new forms are so complicated that my daughter's care coordinator at UnitedHealth is helping Hannah's pediatrician by filling them out and then giving it to the doctor's office to review and sign.
It is the same game that Wellcare played with Mycal Johnston and Martin Boegel, except the stakes were so much higher.
- Disability Mom
- I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.