Sunday, January 23, 2011

Hawaii Medicare Alert

A Kauai family says they were tricked by a UnitedHealth employee into changing their medically fragile son's Medicare plan, resulting in new pharmacy co-payments that did not exist previously.

According to complaints filed with Hawaii Department of Human Services, Leonard Cabral made an appointment to come to the family's home to discuss the son's Evercare Medicaid policy.  As of December 2010, the son had yet to receive his Medicaid ID card from Evercare, apparently because his primary physician was not on UnitedHealth's provider list. 

The "new Medicaid" card that arrived, however, was in fact a membership card for UnitedHealth's Medicare plan for Hawaii.  The physician is on that provider list. 

But when the family went to the pharmacy to pick up three essential medications their son has been taking all along, suddenly a co-payment was due that had never existed before.  The family did not have the money to make the co-payment and so the son is without his life-saving medications.

Sources tell me that health insurance carriers like UnitedHealth get paid a premium for every Medicare patient they enroll.  Cabral's apparent deception resulted in UnitedHealth getting the membership premium, and gaining a new monthly capitation fee from Medicare while keeping the existing capitation payment for their Medicaid program.

If this has happened to one family, it has likely happened to others.  Medicare plans can be changed back to the original carrier, and complaints filed with federal Medicare authorities.  The legality of UnitedHealth's actions in this care is being questioned.

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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.