Friday, April 29, 2011

SB 1274 just keeps getting better for the health insurance companies

New amendments added to SB 1274 yesterday benefit the health insurance companies while segregating everyone currently receiving Medicaid into an experiment in civil rights.

According to Rafael del Castillo, who attended Thursday's brief meeting, "Senators Baker and Green have sent amendments to the House committee members proposing to segregate Medicaid members from the external review population with the supposed purpose of “studying” whether your welfare suffers if you are limited to the DHS process, in which you have to pay for the services you receive if you lose your case, and you will not get legal help unless you pay for it or qualify for legal aid."

As someone who has had personal experience with the "DHS process", I can say this logic is based on the mistaken assumption that DHS provides some sort of oversight over the health insurance companies.

CMS has been reviewing complaints for months that DHS is providing any sort of oversight at all. Twice I'm aware of State Medicaid Director Ken Fink has responded to these federally-filed complaints by writing the enrollee the insurance company has done no wrong.

The state has never acknowledged publicly that they had to place Evercare/UnitedHealthcare under a corrective action plan a year ago for on-going violations of federal Medicaid law. The families who were victimized were never notified.

The state has never acknowledged publicly that federal regulators recently began looking into potential Medicare fraud involving Evercare.

Evercare regularly refuses to authorize medications for my daughter, either new ones or ones that she has been taking for years. Complaints filed with Patti Bazin go nowhere. Every time, the only way I've been able to get Hannah's medications filled is by emailing CMS.

From my experience, DHS provides no oversight and in fact appears to collude in the health care insurance companies' strategy of essentially meaningless terrorism against families. The state gave the companies a premium increase last summer, so it is not for lack of funds.

I am one of so many families right now where a child or loved one is alive because of our current external review law.

SB 1274 needs to be killed. Please email the following representatives now to let them know they have to stand up against the insurance companies.

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About Me

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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.