Aria was about 7 years old when her family received a letter from the State indicating they had to choose a managed care organization (MCO). They selected the one that seemed to have all of their providers in-network except for Aria’s pediatrician. They were told that since they had primary private insurance they could continue to see their current pediatrician–but then the managed care insurance company would no longer cover anything prescribed by their current doctor.
Aria’s mother spent full days on hold or playing phone tag with the MCO to get basic things Aria needed like feeding tube supplies, medical formula, and more covered. Her family was required to submit pictures, video, testimony, and more to prove medical necessity every time Aria’s docs, therapists, and specialists sent something to the MCO. It was nearly impossible to provide for Aria’s basic needs. After a tear-filled breakdown over the phone with a Medicaid customer service rep, Aria’s mother learned she could transfer back to Traditional Medicaid and that the difficulties obtaining Aria’s medical supplies would no longer be an issue.