Friday, May 21, 2010

Why Didn't Huntar Have Surgery This Week????

(This post contributed by Amy, a friend of Huntar and Barb).

As many of you are well aware of, this journey has been a roller coaster ride for Huntar's family and friends. Keeping all of the information in order and trying to get to the bottom of the real issues at hand has been a challenge. Here is the most recent news in regard to the denial of services for Huntar's surgery.

Fairview Hospital in Minnesota where Huntar was referred for his surgery ultimately denied services for Huntar due to the fact that they were not willing to accept the amount of payment that Michigan Medicaid was willing to pay for the procedure. Numerous phone calls by the family to the hospital have gotten us no where, and at this point, voice mails left to those who supposedly can give some answers and provide clarity to the situation have not been returned. The people that the family have been able to speak with at the hospital continually refer the problem to their supervisor or to someone else. All of the correspondence and information being given has been verbal, with no one having the "authority" to provide any written documentation for why the surgery was cancelled and services were denied. Again, the family is waiting for a supervisor for the financial counselor to return their phone calls and hopefully provide the necessary documentation.

The family has also contacted everyone and anyone they can in the state of Michigan, all the way up to the Assistant Director for Medicaid. Again, everyone tells them that they are not the proper person to talk to and refers the matter to someone else, either above or below the current person they are in contact with. Huntar has the Authorization for out of state services for Michigan Medicaid and Children's Special Health Care (CSHCS).

It appears that the State of Michigan Medicaid did not deny coverage, but the amount that they are willing to pay for the surgery in Minnesota is not being accepted by Fairview Hospital. The remaining question with the insurance provided is why are they willing to cover a higher percentage in state than they are out of state? (If this in fact is true, as all of the information in regard to this matter is coming from Fairview Hospital, and no one at this point is willing to put it in writing.)

The questions out there for Fairview Hospital are numerous. Why is the hospital not willing to perform the necessary surgery? It appears to be based on monetary reasons. Are they not obligated under their contract as a non-profit hospital to honor the medicaid agreement and accept the reimbursement rate as given? Why are they not willing to put any of the information or reasons for the denial in writing? Why do they keep giving this family the run around?

The family has contact with a couple of lawyers who are looking into this case. And the doctor and nurse in Minnesota are helping to make contacts with other potential sites where the surgery could potentially take place. The problem is finding a site that has all of the necessary equipment to perform the surgery that also has a a combination of the qualified medical personnel to handle the procedures. The power of social networking has also brought some potential options to the table, as a doctor in Lower Michigan is willing to review the case.

Thank you for your continued support, and additional updates will be made available as more information becomes available.

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