Medicaid managed care and the "prior authorization" game

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.