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Medicaid: Cost and Care Effective?

Jill Shaw Ostrander has given Upgrade Medicaid permission to share her post from the MCO Watchdog Facebook group describing the issues she is having with accessing necessary medication and care for her daughter, Jessica.


“My daughter is 32. I have to consider myself lucky to still be able to carry her on my insurance through work. However, this year we have run into crazy issues related only to the MCO as secondary insurance.


1. My daughter has had a transplant and is on daily anti-rejection medications. My insurance requires me to go through a specific mail order pharmacy that is not contracted with Medicaid. I contacted everyone and the only solution is either I pay the $100 each co-pay myself ($200 total) or I drop her from my insurance so that the MCO can pay the full amount.


Why would the state rather take on the full cost of very expensive medication??


2. My daughter's knee swelled up and became very sore back in March. Her primary care physician ordered an MRI which read that there was a torn meniscus, sprained MCL and a large effusion (fluid). Took her to an orthopedic doctor who never once looked at her knee, said the MRI was a false diagnosis and the X-ray just showed arthritis. When asked what could be done he said she wasn't a good candidate for a shot or cortisone and he could do surgery if I wanted but wanted to know if I would blame him if it didn't work. I thought this was a horrible appt and asked for a second opinion. We tried two other orthopedic offices and they denied a second opinion. I found out that my insurance makes full payment for second, third and sometimes even forth opinions...the reason she was being denied was due to her secondary insurance the MCO. She has since gotten worse and can not even sleep through the night because her pain is so bad and she can't put any weight on that leg anymore. After making several phone calls we have decided to try the Broadlawns Ortho doctor.


I'm still amazed that our disabled community are getting denied care due solely to this fiasco they call privatization of Medicaid.”


It was obvious from the comments below Jill’s post that many people are dealing with similar issues, and they included some great responses on how to problem solve and appeal. But that brought a larger issue into light. The Iowa Department of Human Services does not have “customer support” staff. Each of us is left to our own defenses, using only our personal resources to fight these issues unless we have a large network of people like the MCO Watchdog provides.


So next time the Iowa General Assembly votes on a “raise” for the MCO’s, let’s fight for transparency in how to deal with the issues that have been created by privatization for a Department of Medicaid Customer Service, along with all the other problems!



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