By admin 
PHOENIX (AZFamily) — A Phoenix mother struggled to get critical medical equipment for her son after a company failed to make an emergency replacement for broken equipment.
Stetson is 7 years old and has had profound medical challenges since he was born. His vitals are constantly monitored.
“My son has seizures daily and his oxygen drops sometimes when he has seizures, said Elizabeth Richards, Stetson’s mother. “It’s pretty scary.”
When his pulse oximeter stopped working, Richards called to get a replacement. She was expecting a quick delivery. But Preferred Homecare, the company that handles Stetson’s durable medical equipment, told her they needed a prior authorization.
“I was like you don’t need to wait for a prior authorization. It’s not a new item,” Richards said.
The company held firm, citing a policy change.
“They told me basically to admit my son to the hospital for seven to fourteen days until we get the approval,” Richards told On Your Side. “It is a very helpless feeling. I had no idea what to do over the weekend.”
Stetson’s medical team jumped in to try to help. After several days, Richards said she heard back from Preferred Homecare.
“They call me and say so we don’t need a prior authorization so we’re going to go ahead and schedule a delivery, and I about lost my mind because they’ve been telling me I needed a prior authorization for the past week,” Richards said.
“Everyone tells me it’s out of their hands, there’s nothing we can do. I’m like, my child is on a ventilator and I’m calling for life-saving equipment. I’m just asking you to do your job,” she said.
According to AHCCCS, there have been no recent state or federal policy changes that would cut coverage for medical equipment or emergency replacements.
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“AHCCCS contracts with managed care health plans, which are responsible for authorizing covered services and ensuring members have access to medically necessary equipment through contracted DME providers,” a spokesperson for AHCCCS wrote in a statement. “Health plans are also required to ensure continuity of care and to address urgent equipment needs appropriately.”
A spokesperson for Preferred Homecare said they cannot answer questions about Stetson’s case because of patient privacy but said the health and safety of patients is the top priority.
“Preferred Homecare collaborates with physicians, insurance companies, and other covered entities to ensure they receive timely and accurate information,” a spokesperson wrote in a statement to On Your Side.
Stetson ultimately got the equipment he needed, but Richards fears medical equipment delays could happen again. “I’m terrified,” she said. “If this continues to be an issue and these kids are continuing to get denied life-saving equipment, for medical conditions they didn’t ask to have, they don’t want to have, parents don’t want them to have either, it’s a little bit concerning.”
A spokesperson for AHCCCS said the agency is reviewing the situation.
“AHCCCS remains committed to ensuring members receive medically necessary, life-sustaining services in accordance with Medicaid requirements,” the spokesperson said. “Depending on their health plan and location, AHCCCS members generally have access to more than one contracted DME provider. Health plans can assist members in identifying alternative providers when needed.”
Anyone who is facing a medical equipment delay should contact their health plan or AHCCCS member services. If the health plan is unable to resolve the issue, families can call AHCCCS’ Clinical Resolution Unit at 602-364-4558 or 800-867-5808.
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