For years, Jim Barry relied on Waupaca County’s volunteer drivers to take him to his medical appointments.
The 67-year-old Weyauwega man needs dialysis three times a week. He is struggling with cancer and can no longer drive himself to his health care providers.
"The county drivers were never late and I never missed an appointment," Barry said. "Since the new guys took over, I have missed seven appointments. Their service leaves a lot to be desired."
In the past, the local program for non-emergency medical transportation (NEMT) was run by the Aging and Disability Resource Center, using local volunteer drivers recruited by the Waupaca County Department of Health and Human Services (DHHS). The drivers provided elderly and disabled Medicaid recipients rides to their medical appointments.
On July 1, LogistiCare, a private, for-profit corporation based in Atlanta, Ga., became Wisconsin’s sole broker for NEMT.
Pat Enright is the aging and disability resource manager for Waupaca County DHHS. He has logged dozens of complaints from patients who have missed their medical appointments due to their rides arriving late or not showing up at all.
On Aug. 1, Enright sent a letter to Greg DiMiceli, the Medicaid transportation analyst who oversees the state program, detailing the problems since LogistiCare took control.
Enright also filed an elder abuse complaint against LogistiCare as a result of Barry’s experience.
"A vulnerable adult that has a care provider who has assumed responsibility for a portion of their care and then failed to provide that care could be charged with abuse of a vulnerable adult," Enright said in his letter to DiMiceli.
"These people don’t understand that I get really sick when they’re late picking me up," Barry said, noting that being late for an appointment can result in his being at the clinic for eight hours as he waits for the dialysis equipment to become available again. And missing his dialysis treatment means toxic wastes are not being removed from his body. A Logisticare driver also failed to pick Barry up for a scheduled ride to the clinic for a CAT scan.
"I feel like they’re trying to kill me," Barry said. "Yesterday, I made my funeral arrangements."
Barry said his problems with LogistiCare began the day the company took over the program.
"It took me an hour and a half just to get my first three appointments," Barry said.
To schedule a ride, callers have to obtain a confirmation number from LogistiCare.
Callers are questioned about whether they have a car, whether they are able to drive and whether they have relatives or friends willing to drive them to their medical appointment without reimbursement. They can be denied rides if they answer yes to any of the questions, according to a copy of logistics call script obained by the County Post.
If callers do not have their doctor’s phone number at hand when they call LogistiCare, they will be denied a ride and told to call back later with the number.
"They are trying to talk the callers out of getting a ride," Enright said.
In LogistiCare’s first 10 days of providing service, Enright reported eight complaints from people who had a confirmation number but whose driver never showed up.
"Two of those eight had it happen more than once. One had it happen two days in a row," Enright said in his report to the state.
"I scheduled a ride for 8:30 in the morning. LogistiCare called at 11:20 and asked, ‘Are you ready for your ride?’ By then I was already sick," Barry told the County Post.
LogistiCare offers a complaint line called "Where’s My Ride?"
However, Enright has documented numerous complaints from riders who call the WMR line only to be placed on hold for 15 minutes or more, then disconnected.
In his report, Enright said one client called WMR to report that his driver had not arrived for his scheduled appointment.
"LogistiCare told him that someone called them and canceled his ride. He asked for the name of the person who canceled his appointment as it wasn’t him. The name they gave him was no one he knew and as the conversation developed it became apparent to this client that the person was his driver who was scheduled to take him to his appointment," according to Enright. "So LogistiCare didn’t take the time to call him and tell him."
Another local client told the county DHHS that her driver was an hour late and needed directions to her home. He then asked for directions to the clinic. She discovered that a Green Bay cab was providing her ride in Waupaca.
Later, the same woman called LogistiCare’s WMR number after another ride failed to appear. She learned that her ride had been canceled by the driver who was from Antigo.
Enright said he has also experienced difficulty in communicating complaints to LogistiCare.
"I called LogistiCare’s ombudsman on Tuesday. She returned my call on a Saturday and left a message. I returned her call on Monday and still haven’t heard back from her after four days," Enright said.
After LogistiCare repeatedly failed to send a driver to Barry, he and Enright attempted to make a conference call to the WMR number.
"I called their number and the phone was not answered after 35 minutes," Enright said. "I called again and waited 20 minutes."
After finally getting through to LogistiCare, Enright was assured that Barry’s rides would arrive on time in the future.
"They then missed four rides in a week and a half," Enright said.
Complaints with LogistiCare are being reported across the state, according to Carrie Porter with the Greater Wisconsin Agency on Aging in Madison. She said Barry’s problems making it to his dialysis appointments are not uncommon.
"It’s not an isolated case," Porter said. "Just missing one appointment is a huge health concern for a dialysis patient."
Porter added that missing dental appointments are especially a problem "because there are few dental clinics willing to take Medicaid patients. If they miss an appointment, they are at risk of losing their providers."
Stephanie Smiley, the communications director with the state Department of Health, said that while she has received complaints, LogistiCare is "managing to deliver 6,000 rides a day."
Smiley said that in the six weeks since LogistiCare took over the statewide transportation program, the complaint rate has dropped from 1 percent to 0.5 percent of the rides being provided.
"We are in daily contact with LogistiCare," Smiley said. She said the company has increased staff at the Madison call center and reduced the amount of time callers spend on hold. In addition, she said LogistiCare is introducing an incentive plan that rewards drivers who make their appointments on time.
Enright doubts the accuracy of LogistiCare’s complaint rate when callers have such a difficult time making contact with someone on the complaint line.
He also questions the wisdom of privatizing a service that used to be provided more effectively by local volunteer drivers.
"LogistiCare does not provide the transportation, they just broker it," Enright said.
LogistiCare contracts with vendors to provide rides, then receives calls for rides and schedules the rides with vendors.
"They are not paid by the ride, they are paid a per capita rate based on the number of Medicaid clients who are eligible for rides," Enright said. "A cynical person might wonder if they’re making their profit on every one of those rides that they don’t provide. This is privatization at its finest."
Enright encouraged riders to continue calling their complaints into the WMR line at 866-907-1494 and to keep Nancy Ferg, the county’s transportation coordinator, informed of problems by calling her at 715-258-6279.
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