Thursday, May 13, 2010
Update posted on Ohana Health Plan response on Tantalus shooting
by Larry Geller
The following is snipped from an article posted on the Disability Mom website yesterday. Ohana is the subsidiary of the Mainland company WellCare Health Insurance of Arizona, Inc., one of the two companies contracted by the state Department of Human Services to administer Hawaii’s managed care QExA system. Summer Harrison cites contract details taken from the RFP for the contracts:
According to a reporter I spoke with this afternoon, Ohana is saying that Martin Boegel had his medications paid for by Medicare and therefore his lack of medications, apparently, is not their responsibility.
The contract between the state of Hawaii and Wellcare (parent of Ohana) as well as UnitedHealth clearly requires the health plans to provide each member with a primary care physician and a case service coordinator.
The health plan shall ensure that each member has selected or is
assigned to one (1) PCP who shall be an ongoing source of primary care
appropriate to his or her needs. [section 40.180]
Each member shall be assigned a service coordinator who will assist in
planning and coordinating his/her care. The service coordinator shall
assist with coordinating QExA services with Medicare, the DOH programs
excluded from QExA, and other community services to the extent they are
available and appropriate for the member. [section 40.260]
Without a primary care physician, Martin Boegel had no one to write his prescription, regardless of whether the medication was to be paid by Medicare or Ohana. [Disability Mom, Update on potential Ohana involvement in Tantalus shooting, 5/12/2010]