TCM Services Nearly Used Up Because of MCO Bureaucracy

Advocate says …

The process to get my daughter’s durable medical equipment repaired took 7 months and used up nearly all of her annual case management hours allowed by Sunflower!  Getting the prior authorization took about 5 months, then I had to wait for the denial which was another month only to find out that they approved the labor but denied part of the wheelchair repairs, mainly the tires and the hardware for them. This is why I filed an appeal and state fair hearing at the same time, which I finally won.
The time that her case manager has put into this has drained most of her case management hours. What concerns me is that Sunflower has a new policy; they have now capped Targeted Case Management hours. Once you have reached your limit, you are done. What happens to her when she runs out of hours? The MCO care coordinator was of no help through this entire process;  she admitted she had no clue on what to do.  The added layer of bureaucracy caused by the Care Coordinator’s inability to do the job has cost my daughter most of her hours for the year. The cap in hours could have a negative effect on her well being. If she needs any other services that are normally provided by her TCM she is out of luck.

When KanCare was implemented we were promised that TCM would be left alone, but that is not happening. Look at what is happening here. Sunflower approved the labor for her chair but denied the wheels.  This just proves that they are chipping away resources and putting my daughter at risk.

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