One of the many ridiculous things MassHealth is doing to save money

When someone applies for MassHealth on the basis of having a disability, they have to fill out this patronizing disability supplement form where it asks, among other things, how often the person does things such as bowling, hunting, and fishing. Apparently not hunting or fishing frequently is some sort of indicator of impairment. The individual also signs consent forms to obtain medical records from any present or past providers s/he wishes.

After they get the form, they send back a confirmation saying that the form was received on X date, and if the person is determined to be eligible, the benefits will be effective on that date.

Less than three weeks after that date, the person receives a letter from MassHealth stating that they were unable to determine that the person has a disability based on the medical records received. The letter lists the names of the providers from whom they have not received medical records.

Naturally, they list ALL of the providers. Because there's no way they could have sent away for medical records and then expected to receive them with that short of a turnaround. Most private providers don't immediately send them without some review, and a hospital or clinic setting has a medical records department and takes several weeks to process the request.

The letter then goes on to state that since the not-yet-received medical records did not indicate that the person has a disability, MassHealth has scheduled an appointment for the applicant to see one of the disability evaluation services doctors. Clearly, this is going to lead to considerably fewer people being determined eligible, since many (most?) disabilities involve a complex history over time, and most people with a type of disability that would need evaluating at all are going to be asymptomatic on any given day. (People who have an easily defined condition such as blindness will usually already have an official determination of this, so MassHealth is mostly going to be evaluating people with psychiatric disabilities or chronic systemic issues -- things that cause loss of function when they flare up, but don't show up much of the time). They're going to make their determinations without records of a person's emergency room visits when their heart condition or bipolar disorder or epilepsy was out of control on that particular day.

1 comment:

margalit said...

Mass Health is run by morons. Anyone that has used them for insurance for any length of time will do just about anything to not have to deal with them. They lie, they make horrible errors, they have policies like the one you stated that make NO sense, and they seem to forget that they are in existance to provide HEALTH CARE to the poor, disabled and disenfranchised.

And I have been denied health care by mass health even though I'm 100% disabled with congestive heart failure. Why? I make too much money on SSDI. If that isn't insane, I don't know what is.