Success with Cimarron

In June of 2001 Emma * contacted P&A to request assistance in obtaining more supplies from Cimarron Salud for her son, James. James is a seven-year-old boy with a brain injury, quadriplegia and a g-tube. James receives supplies for his care from Cimarron through McKesson MedManagement.

Nine months before, Emma was contacted by McKesson MedManagement and informed that James was using too many supplies, that other patients did not require as many supplies and that his supplies would be cut. When the supplies for that month arrived, even more supplies had been cut. This change presented a great hardship to James’ family. Emma and other family members provide all of James’ daily care and have a very limited income. The cut in supplies resulted in additional costs of $150.00 to $300.00 per month to James’ family. When Emma protested that more supplies were needed and appealed the decision in September of 2000. In October, she was told that the supplies were adequate. A second request for review was sent in March of 2001. That review was never completed.

When Emma called P&A in June she was extremely frustrated, " Every time you talk to a person, they show you a blank wall. They can’t tell you whom to call to solve a problem. They told us we needed a letter of medical necessity and then told us our Doctor wouldn’t do it, but when he wrote the letter of medical necessity, it meant nothing."

When Emma called P&A for assistance, we set out to determine why the review was never completed. It soon became clear that the review system was very confusing. The attorney working on the case was sent to four different individuals within the McKesson MedManagement and Cimarron Salud Systems. No one seemed to know whom the primary decision-makers were or where Emma could turn to facilitate her appeal.

P&A staff determined that the appeals process had become so bungled that they needed to start the process all over again. When P&A staff contacted Doctor Herrington, James’ pediatrician, they discovered that Dr. Herrington was leaving for Africa in two days! Dr. Herrington graciously cooperated by writing out a prescription for all of James’ supplies with only one day’s notice.

When the supply list was reviewed. MedManagement sent a letter stating that they needed to know the medical necessity of the items. Dr. Herrington responded by stating that all the items were necessary. A few days later, Emma received a call from MedManagement and was informed that the majority of the supplies would be sent that week.

P&A thanks everyone involved who worked so hard to make this success a reality, particularly Dr. Herrington and Nurse Mullen who worked hard to advocate for this young client. Congratulations to James and his family. Their persistent advocacy made a big difference.

* Client and family names have been changed to protect their privacy.