MCO letter to guardian totally incomprehensible

Advocate says …

I recently received a letter from my ward’s KanCare insurance company notifying me that it had approved various numbers of units for a specific service – designated with a letter and a number, rather than a name – over the next ten or so months.  Although there was one month in which to appeal this decision, I received the letter two days before the end of the appeals period. Equally galling was that I had no idea what the decision was!   What service was being talked about? What was a “unit”? All I could tell from the letter was that my ward would get 20 units of some service some months, 40 units other months, and some months, none at all. I also knew which provider the letter concerned.  But since that provider gives my ward a variety of services, I was pretty clueless about what was being granted, or denied.

The letter also states, somewhat ominously, “This authorization is not a guarantee of benefits or payments.”  Although I have dealt with health insurance companies for a long time, I have never received a letter so totally incomprehensible.

2 thoughts on “MCO letter to guardian totally incomprehensible

  1. Cathy Pechin

    Well, at least you got a letter because we never did. We are supposed to have an appeal filed but I have not been able to verify that and neither has our TCM. IF I were reviewing a case for appeal, I would insist that a packet be made up including all of the documents that are required and in the format required which would include a much better description of what was being done than said letter described above is doing.

    I just wish there was a real parent advocate for KanCare. I am only referred to someone who advocates for KanCare and whose job depends on the survival of KanCare for people with DD and, who also does not have a loved one that is dealing with a system that may determine the well-being to include life and death so, frankly doesn’t have a stake in the outcome except for their own job.

    Our son’s situation isn’t desperate but I know the community well enough to know the “desperate” is there and being ignored.

    Reply
  2. terri Norgren

    This sounds like Sunflower. It took me 5 months to get a denial letter from them for my daughters wheelchair. They got it to me two days before the end of the appeal period. I truly believe they do this on purpose so that guardians can’;t do an appeal so that they don’t have to pay out on the needed services. I am sorry to hear of the frustration you are going through, if you have a case manager, get with that person and they can help guide you through the Person Center Support Plan (PCSP). The provider listed on your letter should be listed on the PCSP. Hope you can get this cleared up.

    Reply

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