Tuesday, November 09, 2010


Hawaii’s QExA managed care on trial in federal district court

by Larry Geller

Judge Alan C. Kay heard opening witnesses in a case that healthcare advocates and many physicians and patients hope will bring badly needed reform to the state’s QExA managed care Medicaid system.

KITV said it well in their coverage last week:

Advocates for people with disabilities are accusing two insurance companies hired by the state with delaying, denying or withholding medical care for people in fragile health. In some cases, the clients have died.   [KITV, Advocates Say Disabled Are Being Denied Care, 11/5/2010]

The closing witness today was a neurologist, who testified that among problems such as no reimbursement or slow reimbursement, he is reimbursed only 1/3 as much for an initial visit by the two Mainland for-profit insurance companies as the state QUEST system pays. In other words, he is paid for a 15-minute visit even though the initial visit might take an hour or longer. He spoke of delays in payment of up to six months.

The doctor also described impediments to getting MRI or CT scans and an onerous burden of paperwork.

As a result, he does not now take QExA patients, though he will treat any that come in to Queens when he is on call.

The trial will continue this week and then recess until November 30. At that time patient witnesses and testimony will be taken.

This is shaping up to be a difficult case to win. Attorney Rafael del Castillo's every word was scrutinized by a cadre of six or seven state and insurance company attorneys at the other side of the courtroom. Objections rang out and were sustained or overruled. Del Castillo has the burden of proof and a daunting amount of work ahead of him to prevail.

At one point spectators were cleared out and the case sealed by the judge because private medical information was being discussed. This is one of the complexities of the case and one which prevents complete public access to the proceedings. It may turn out that the most compelling testimony may be blocked from the press by the medical privacy laws.


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