TRINIDAD, Texas (KLTV) - Red tape is keeping families from life-sustaining at-home medical supplies.
Rebekah Pok and her twin girls, Cora and Farrah, are in jeopardy of losing their medical supply provider or Durable Medical Equipment (DME) company that gives them access to equipment essential to their health.
“[Insurance company] They’re giving us a list of what their Dallas clients or Houston clients do but what about us out here in the middle of nowhere?” says Rebekah.
Before, Medicaid directly paid providers for their individual services. Now, in situations like Rebekah’s, there’s a middleman: Managed Care Organizations (MCO). MCO’s negotiate with medical service/supply providers and that’s where the problem lies.
Terri Carriker, board member of Protect TX Fragile Kids (PTFK), says “they don’t want to supply medical equipment, that is very costly, but that keeps our kids alive and at home because it eats away at their bottom dollar.”
PTFK is a non-profit organization that families connect to resources that can help resolve issues affecting their child’s health needs. If the MCO’s final negotiation is too low, then providers inevitably pull out of the contract.
“They retain full control because there’s no recourse from the providers or the families,” says Carricker, “the families can’t threaten to go elsewhere because there’s nowhere else to go.”
Cora and Farrah rely on very specific equipment like oxygen tubing, nebulizer kits, and g-tube supplies. So for parents like Rebekah, they’re left with an impossible decision.
“You’ve got one or two. Lose all your kid’s specialists or lose all your kids DME supplies. Which one would you pick? It’s just kind of scary,” says Rebekah, “I’m scared honestly, I don’t want to pick any of them right now.”
Rebekah tells us the pandemic complicates things further. Switching companies would mean people coming in and out of her home to replace equipment, risking the girl’s exposure to COVID-19. According to PTFK, the only option for parents like Rebekah is to file a formal complaint and hope someone listens.