Iowans Share Their Stories

I'm a Physical Therapist and work with patients in their homes. Patients have had much apprehension about being able to continue receiving services. One patient stated that they were told that they needed to switch to a different MCO if they wanted to continue receiving services through Mercy Hospital in Des Moines. I've also heard reservations about clinics being started on the Des Moines area to serve only clients of one MCO.
- B.C. of Urbandale

I am not sure if we will be able to continue with speech and language therapy yet. I do not know if our MCO will continue this service that our child has had for 12 years.

-Anonymous, Indianola

 

 I work full time and am a full time student. My children still receive Medicaid but the MCO's are so difficult that I have been paying out of pocket or not seeking medical care. My son had an extreme dental issue and desperately needs braces but was denied under the new Medicaid laws. I also pay for extra dental insurance it is not enough to cover the procedure so he continues to suffer.

- A.D., Council Bluffs

My son has been covered under medicaid since 2000. He had the brain injury waiver, now has the intellectual disabilities waiver. I tried 10 times to call the various hotline numbers, and each time, was told they had no information on him. He currently receives services, so I don't know how that is possible. Eventually, I found out oh, about 10th hand, that because he is also covered by my insurance through my employer, he is not currently moving to a MCO. But I have heard NOTHING from Iowa medicaid itself about this. I might have been in favor of privatization had it been done more slowly, thoughtfully, with far more regular, explicit, and clear communication. As it is, I no longer trust the state to assist my son - which is shameful as he is the most innocent person one will ever meet.
- C.V., Montezuma
 

 I have guardianship of my 52 yr old sister. She has 11, yes 11, doctors she sees on a regular basis. 6 out of 11 of those Doctors have NOT signed with a MCO as of yet. We have changed the MCO that Medicaid has stuck her in to a different MCO because they had 5 of her Doctors already signed with them. We have NOT received anything from the new MCO as of yet. We have no clue who or where to go if we lose the 6 doctors that have not signed with anyone. It is completely sad that this was thrown in our laps with no say in the matter.

- R.K., Springbrook

Our mentally ill child is on the waiver program. Since October of 2015, she has lost all services because providers were hired away or went out of business. Case management is still a shambles, and she has not had therapy in the home for months. Because of this, she spent 2 days in two ER's, one week in patient, and is now on partial outpatient care.

- M.S., Ankeny

Many providers who felt their applications were complete and were given a heads up they were on a MCO provider list did not show up on the "on Line" provider list. This is very concerning if the "on line" lists are not updated on a timely fashion or if there are errors on the list. Most literature directs members and to go on line to verify providers. I would hope the MCO's would make it a priority to be sure their list are accurate and up to date. I have many concerns about pre-authorization for almost every service. I worry about the response time for pre-auths. and the implications of services denied.

- J.R., Cedar Rapids

I am not a MCO member. However, I am very concerned about both adults and children who are served by this program; and their access to continuous, sustained care by trusted physicians and medical professionals based on best practices. Research suggests that medical services governed by a profit, rather than a health and wellness motive, will scrimp on needed services and place individuals at higher risk of morbidity and mortality in order to save money - in both the short- and long-run. I believe that our medical services to lower income individuals and families, whether children or adults, must be centered on health promotion, preventive care, and also best practices in intervention, in order to be ethically and professionally viable. Thank you.

- T.D., Ames

 

This transition is a complete mess. There is no oversight and the call centers are unable to answer all my questions. This is a huge mistake to change a service that was working so well and put it into the hands of out of state for profit companies who main goal is bottom line. We have become a number on a spreadsheet instead of a person with major needs.

- Anon., Des Moines

We have a 14 year old daughter who got a pacemaker 2 weeks ago. We thought her wound was infected so we called the nurseline for help in determining if we should go to the ER or wait over the weekend. We could not get through the nurseline with her number, or her sister's. We had to make a decision and go ourselves. Her wound was fine but it was a wasted trip to the ER exposing her to sickness in a time when she is more likely to catch something. We had a case manager assigned to us, who has no access to my daughter's claims or records so I know more than she does. Someone called to do our health surveys but she literally took 35 minutes and could not remember who she was interviewing and kept asking us. I did not understand why she called, as she got no information that could help United in any way. We are not having luck trying to get things done, and not seeing much value in this new system so far for our family.
                                                                                                                 M.P., Bettendorf

I have 4 adopted children. We have been denied mental health services because our therapists have no way of authorizing them.

- N.B., Ames

 

This change was unnecessary. Now running into road blocks that didn't exist before: members were told nothing would change for 90 days but I'm seeing denials and things not covered already, putting the vulnerable in further hardship. These companies that are for profit lied...how could Iowa do this to its most vulnerable?

- J.G., Cedar Rapids

We have a 14 year old daughter who got a pacemaker 2 weeks ago. We thought her wound was infected so we called the nurseline for help in determining if we should go to the ER or wait over the weekend. We could not get through the nurseline with her number, or her sister's. We had to make a decision and go ourselves. Her wound was fine but it was a wasted trip to the ER exposing her to sickness in a time when she is more likely to catch something. We had a case manager assigned to us, who has no access to my daughter's claims or records so I know more than she does. Someone called to do our health surveys but she literally took 35 minutes and could not remember who she was interviewing and kept asking us. I did not understand why she called, as she got no information that could help United in any way. We are not having luck trying to get things done, and not seeing much value in this new system so far for our family.

- M.P., Bettendorf

I am not a Medicaid beneficiary but work for an OBGYN office in the Iowa City area. The transition has not been handled well by Medicaid. Many, if not most, patients are confused about the changes and are unsure of how it will impact their care. The rush to this transition will ultimately impact the members but it is also a huge administrative undertaking for providers. It is absurd that all claims which have Medicare as a primary payer will not be automatically crossed over. It will waste a lot of paper and time to send all these secondary claims on paper to the appropriate MCO.

- Anon., Lone Tree

I am a provider. I have spent HOURS on the phone the last 5 days trying to get access to MCO systems. We are still not showing up as in network providers for 2 of the MCOs (Amerihealth and Amerigroup). Everything I call, I'm directed to another number just to be told that I need to call the previous number. I have also been unable to pre-Auth through these 2 MCOs. In addition I cannot get a clear answer as to whether or not we need to show proof of Medicare denial before billing. We provide home-care services and there are very clear guidelines on when we can bill Medicare. It is a little ridiculous that this might be required but what makes it worse is that different representatives from the same MCO give us different answers.

- Anon., Manchester

 

We've been trying since late Jan to change MCO for our autistic son to the MCO that his group home is a member of. He moved there mid January after emails faxes and I've spent 24 hours in total on the phone. We finally got it changed but the change won't be effective until May I was told..... Holding my breath that I don't get slapped with the bill from the group home until then.....

- S., Independence