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FLORIDAíS MANAGED CARE FOR THE DISABLED
Below is a fictional story of how a DD
consumer might struggle to obtain services if the Florida Legislature
conference committee members vote YES to HMO
for APD. The vote is likely to happen the week of May 2, 2011. If you don't want a similar story to happen to you, act now by calling, visiting or emailing
your State of Florida Representative and / or Senator to vote NO HMO for APD. The Senate is on record as NO HMO and the House favors the HMO for APD.
Click on Florida Representative then "Find your Representative" tab near top left side for contact information. It lists all of your State and Federal elected officials.
Last day of scheduled session Friday May 6,
Script ©2011 by George J. Andrew
DESCRIPTION OF CHARACTERS
MRS. HAND: Concerned mom of a developmentally disabled daughter, Neda Hand
NEDA HAND: 22-year-old daughter who uses a wheelchair
IKA CARELESS: Uncaring HMO representative
CUSTOMER SERVICE RECORDED VOICE: A prerecorded HMO voice
MRS. HAND: Ever since the legislature approved the takeover of APD by the HMOs, things have not been going well for you, dear, have they?
NEDA HAND: Yeah, and since the HMO got rid of all support coordinators, I no longer have my coordinator, who used to assist me and look out after my best interests. My coordinator would always take the time to explain the complicated things that I donít understand. Why did they do this to me? How I am supposed to get help for the supports that I need to be more independent?
MOTHER: Iím so sorry, dear. I suppose the legislature was misled by those big HMOs. The new HMO provider did send us a letter with a number we could call if we have any questions. Letís give them a call now.
NEDA HAND: Iím lucky to have you, Mom. Most of my friends are not able to speak or understand enough to call anyone, much less deal with a HMO. Mom, ask the folks at the HMO about the physical therapy that my doctor told me I need.
Ring, Ring, Ring, Ring, Ring. A recorded machine voice answers the phone.
CUSTOMER SERVICE RECORDED VOICE: Hello, Welcome to the Nameless, Faceless HMO. Press 1 if you are important, like a doctor or lawyer.
Press 2 if you are a provider that we decided to employ at the new reduced rates.
Press 3 if you have an idea how we can further reduce our services to you to maximum our profit margin. Press 4 if you are no longer upset with us and have changed your mind not to appeal or sue us. Press 5 to leave a message, since we are always too busy to answer your questions and would probably reduce or eliminate your services if you actually did get through to a real person. Press 6 if you have finally given up after trying to reach us several times without any satisfactory answer to your inquiry. By the way, this last option is your best choice, since most calls we get normally request something from us, which, if granted, would decrease our obscene profits. And that is definitely not going to happen. If you didnít like any of these choices, you can try our website, namelessfacelesshmo.com. Expect to be confused, misled, and redirected to other websites designed to give you the runaround.
MRS. HAND: Yes, I am calling for my daughter whose name is Neda Hand. I donít know who I am supposed to talk to, but Nedaís doctor said she requires physical therapy to improve her leg strength. What I would like to knowÖ.
A loud beeping sound unexpectedly interrupts.
CUSTOMER SERVICE RECORDED VOICE: Your 15 seconds has expired.
After hearing a disconnecting dial tone, Mrs. Hand places several more calls to the HMO, resulting in busy signals. Frustrated, she gives up.
A few days later---
CUSTOMER SERVICE RECORDED VOICE: This is a message for Miss Neda Hand. Please call back The Nameless Faceless HMO Customer Service number and choose option 7.
MRS. HAND: Neda, the HMO left us a message to call back, but we need to press 7 this time. Funny, there wasnít an option 7 when I called the other day.
NEDA HAND: Okay, Mom. Letís give them a call.
IKA CARELESS: This is Mrs. Careless. Please state your complaint as quickly as you can since I have not yet met my quota for the day.
MRS. HAND: I am calling for my daughter, Neda Hand. What is your complete name so Iíll know who to ask for in the future?
IKA CARELESS: My name is Ika.
MRS. HAND: Mrs. Ika?
IKA CARELESS: No. Ika is my first name. My last name is Careless.
MOTHER: Let me get this straight. Your name is Ika Careless?
Mother gives Neda a shocked look. Neda just shakes her head.
IKA CARELESS: Correct.
MRS. HAND: Right. Well, Mrs. Careless, my daughter requires an ortho referral for some physical therapy so she can continue to walk without falling and without pain.
IKA CARELESS: Speaking in an irritated manner: I donít understand. She uses a wheelchair, so why on earth would she want to walk? She could fall. If she started to walk too much, we will have to take her wheelchair away. She doesnít want that, does she?Ē
MOTHER: Well, she is trying to be all that she can be. Neda does as much on her own as she can, which gives her self confidence and promotes her independence. Her past non-HMO doctor said physical therapy will help prevent Nedaís circulation problems and leg pain, as well as strengthen her legs and increase her balance.
IKA CARELESS: Speaking defensively: Even if your daughterís request got past this initial screening with me, we have our own doctors that will disagree with your doctor that physical therapy is necessary. Our review committee has predetermined that this type of request is not medically necessary. In addition, I shouldnít be telling you this, but our doctors wonít give you a ortho specialty referral because the less referrals he gives out the bigger the bonus from the HMOís. So, thatís that. I see that your maximum allotted time for this call has expired. Goodbye.
Weeks later, after Mrs. Hand has contacted her senator for help with the HMO, the phone rings. Mrs. Hand and Neda both move toward the phone. Mrs. Hand picks it up and puts the call on speaker so Neda can hear it.
IKA CARELESS: This is Ika Careless, calling from the Nameless, Faceless HMO. We have been informed by Senator Re Electme that our company has to make a special exception for your daughter regarding the physical therapy you requested. We are calling to refer you to our HMO physical therapy company, Faraway PT.
MRS. HAND: But why canít my daughter, Neda Hand, select her own physical therapy company that she is familiar with and that she has used in the past? What about Friendly PT?
IKA CARELESS: That physical therapy provider is not on our list. They charge more than what we are willing to pay. If we used them, we could no longer make obscene profits while giving the illusion that we actually save money. We just hope the public isnít told that after we were forced to reduce our overhead from 15% to 8% after being confronted by APD watch dogs, our rate is still double what the APD overhead rate used to be at 4%. I guess someone didnít do the math.
MRS. HAND: It sounds like my daughter no longer has a choice in the services the State of Florida used to provide for the disabled. Instead, you are making all the choices for her. Ms. Careless, as the HMO representative, I see that you advocate, but not for my daughter. You advocate to maximize profits for The Nameless Faceless HMO. You simply deny all the services that Neda used to receive. At the same time, you shamelessly charge the taxpayers of the State of Florida twice what they used to pay for services to the disabled.
IKA CARELESS: It was refreshing to talk to someone who finally understands where we are coming from. I need to say goodbye, since you have exceeded your 3 minute follow-up talk time and it is nearly my 5:00 p.m. quitting time. Besides, I already have met my quota of denials for the day.
NEDA HAND: Mom, tell her we used to be able to call my support coordinator 24/7 for help with services.
MRS. HAND: Before your HMO took over, we were able to contact Nedaís support coordinator any time, day or night, for help.
IKA CARELESS: We are available Monday through Friday, 9:00 a.m. to 5:00 p.m., with the exception of our lunch hours, which are noon to 2:00 p.m. Just make sure that any problems you have occur during our available times, and you will be fine.
MRS. HAND: Who can we talk to at the HMO to appeal the Faraway PT you have chosen for Neda? There is no way Neda will be able to travel that far to receive physical therapy.
IKA CARELESS: Oh, that is funny. Thanks for making me laugh at the end of a hard day. We curtailed the appeals process to one person. And that would be me, so your appeals are exhausted. We streamlined your due process rights, additional appeals, and other time-consuming, profit-shrinking procedures APD use to follow. We convinced the state legislators that quick denials would save the taxpayers money.
NEDA HAND: Turning toward her mother in exasperation: Mom, I donít understand why I am now being treated like a second class citizen. Who voted for and is responsible for this awful change to HMOs? I do wish that I had listened to the Florida United for Choice group who at least tried to warn us and educate us about the negative impact that the change to HMOs would have.
MRS. HAND: Giving Neda a hug: Ms. Careless, I need to say goodbye for now. But you will be hearing from me again.
IKA CARELESS: Just as long as itís during our abnormal business hours. Goodbye.
MRS. HAND: Neda, itís time to give Senator Re Electme another call and tell him what The Nameless Faceless HMO is doing to his disabled constituents. We need to remind him and his fellow legislators that the disabled have thousands of concerned family members that love to exercise their right to vote.
NEDA HAND: Thanks, Mom. Iíll get on the other phone. You and I will fight Ika Careless and The nameless Faceless HMO together.
Points made in script:
1. Services and support has worsened since HMO took over
2. WSCs provide valuable help explaining / navigating APD process for their consumers.
3. HMO has conflict of interest, cut services to max profit, misled legislature on savings. HMO doctors make more money when they donít refer to a specialist.
4. Many consumers don't have parents or someone else to speak up for them.
5. To get help, 1800 number, busy, or ans. machine with selection difficult for most to use.
6. Existing providers including WSCs laid off, HMO uses their own providers
7. Lack of choice or providers / services / increased denials
8. Lack of personal case mgt. leads to confusion, frustration, lack of advocacy for person
9. HMO representatives likely to have denial quotas to meet, not sensitive to client needs
10. Increased appeals / calls to Senators and Representatives likely since denials will increase.
11. Overhead cost to State
of Florida to run APD
program doubles once HMO takes over. 4% currently, 8%-15% with HMO.
12. Virtually none of the DD MW consumers want this change to an HMO and are frustrated that their voice is being ignored.
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