Author Archives: admin

Update On Our Success With KanCare – Sunflower

Advocate says

So, we were assigned our 2nd case manager from the MCO, Sunflower, and after he tried to ancel our appointment because he is being promoted to another location, we finally met. This is my update to a previous posting here but to refresh.  We were on the “underserved” list, never received a letter, the MCO case manager came out and never asked about additional services, and we were banished from the underserved list. Continue reading

Switch to KanCare complicates Medicaid fraud detection

Advocate says …

Attorney general’s report echoes challenges in other states with managed care organizations

Switch to KanCare complicates Medicaid fraud detection

By Andy Marso KHI News Service Aug. 29, 2014

TOPEKA — The state’s privatization of Medicaid is complicating efforts to detect fraud and abuse, according to a recently released report from Kansas Attorney General Derek Schmidt’s office. Continue reading

Wilted Sunflower Not A Winner

Cathy Pechin says …

Our son is an adult with DS and we fall under Sunflower. There phone system is defective and it takes several calls back before the system will allow me to put in an extension number. Perhaps this is to discourage me from calling? The booklet on services is so poorly written that I really cannot tell what they will or will not pay for. The MCO could not make the PCP meeting this year. I do not see how this added burden is improving the situation for anyone but the contractor – Sunflower. We were put on the waiting list for additional PCA hours since we care for our son 24/7 because the day/residential are unsuitable and I was informed by the state last week that there is no waiting list for the “underserved” because that was eliminated. I thought those hours were coming because we got a letter, saying we would get another letter about people receiving the services they were waiting for because the list was being funded. Since this whole KanCare thing started there has been a constant flow of letters and letters to tell you that you will be getting yet another letter. So, I’m guessing that there are others who think they are on a waiting list for a needed service and it will never come. Only ones benefiting seem to be Sunflower and the postal service.

Update on Sedation Dentistry

Aldona Carney says …

After months of trying to find a dentist to provide sedation dental services for my 19 year old son with autism in Sedgwick County to no avail, there is now an update.

Dave Sanford the CEO of GraceMed informed me that they have contracted with Amerigroup and have scheduled the first sedation dentistry day on August 13th. They have also contracted with Sunflower (Dental Health & Wellness) and will begin taking referrals soon. As of today United still needs to contract with GraceMed for sedation dental services for adults with I/DD.

Regarding referrals for sedation dentistry, folks covered by Amerigroup & Sunflower should speak with their care coordinators now to schedule appointments. Those who need the service and have United as their MCO need to reach out to their care-coordinator to let them know there is a need for this vital service in Sedgwick County and throughout the entire state of Kansas.

Megan Wise is the GraceMed contact person for the sedation dental services.  Here phone number is 316-866-2046.

Change in Tier

Debra Boss | ozwinkie@cox.net | 7852152629
Advocate says …

My son has been on HCBS MRDD Waiver since 1995. He has always been a Tier 1. With no justification, improvement in conditions, or explanation, after his meetings in June 2014, his Tier has been changed to Tier 2. I have tried to get answers as to why the change and have not been successful. I fear this is a way that services will be decreased without justification to parents/guardians/clients. I also would like legislators and elected officials to know that changes in services ARE taking place even though we were promised that with MCOs they would not. We all knew that wasn’t true when they said it. Now, we are experiencing it.

Birth Control medication denied

Marilyn Kubler | mkubler@everestkc.net | 913-268-4472
Advocate says …

Before Kancare, one of the individuals on my caseload, was able to get her prescription for birth control pills filled without a problem. Since Kancare, she has been denied by Amerigroup. We met with the care coordinator recently to report this and she said she would look into the problem. The pills cost $68 a month and she is on a very limited monthly budget and cannot afford this out of pocket expense.

Some after-hours clinics take Sunflower cards, manager says

Susan Shaw says …

Last week I posted how baffled I was that Sunflower would recommend going to the ER for a minor problem, as their cards are not accepted by places such as Walgreen Take Care clinics.

That still baffles me, but on June 19 I got a call from the Sunflower customer service director, who identified herself as “Sharon.” She told me that there are indeed minor-emergency-type
clinics in Wichita that take Sunflower cards and are open extended hours and weekends. Continue reading