• cottis

    I was a medical case manager for a non-profit, where all of my clients were Medicaid recipients. It’s not just Wellcare that is causing alarm right now. The Medicaid CMO Peachstate (not to be confused with peachcare for kids) has become increasingly selective in therapeutic and rehabilitative services it will approve for both adults and children. I fought denial letters from Peachstate for months over treatment for a child with Cerebral Palsy. Any further investigation GHN can provide about this overarching problem would be beneficial.

  • Thom

    Therapists are not seeking to understand, as WellCare says. They fully understand that the rates WellCare proposes will put them out of business, so they refuse to sign the contract.
    Regarding PeachState, they brought in a subcontractor from Miami that pre-approved therapy, then wrongfully refused to pay. PeachState lost a big court case over it, too. When the subcontractor got pressure to pay their claims, they bailed.
    When there are no providers left to provide services, the state still will not save. They will still be paying the CMO’s, who won’t be paying out for services. Sad state of affairs.

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