HILLSBOROUGH COUNTY, Fla — For the first time in 16 years, Karen Evonosky took a shower.
Evonosky, who was paralyzed from the chest down in a car accident, has been fighting for medical gear she needs to do the necessities, take a shower, and get in and out of her wheelchair. While Evonosky said her doctor requested the necessary gear, Medicaid kept denying her claims.
In March, Evonosky contacted ABC Action News Consumer Investigator Susan El Khoury. After weeks of pressing for answers, Evonosky got the news she was waiting for— her claims were approved.
“I’m so thankful, God you just don’t know, it’s wonderful,” she said. “Having contacted you with ABC I think it really made a difference.”
CLAIMS DENIED: “NOT MEDICALLY NECESSARY”
Evonosky spent nine months trying to replace the lift, which was her only way to get in and out of her wheelchair and into bed.
Medicaid paid for the lift nearly 30 years ago, right after the car crash, but it was showing its age. In addition, Evonosky moved into a house that she remodeled to include a roll-in shower, but she needs a medical chair to use it.
“I’d been having bed baths every day for 16 years,” she said.
Sunshine Health insures Evonosky, a private company contracted by the state of Florida to cover Medicaid patients. She showed ABC Action News denial letters from Sunshine Health, which said the lift and shower chair were, “not medically necessary.”
“My insurance should cover this,” Evonosky said. “Makes you just feel like you don’t matter.”
GETTING TO “APPROVED”
Action News kept pressing Sunshine Health for answers, that’s when Evonosky said things changed.
“To their credit they did finally step up,” she said. “I really thank you guys for taking the time and talking with me and following through to the end.”
It took a few more weeks but Evonosky now has a new lift and shower chair.
“They have the ability to make it happen, they just have to have their feet held to the fire."
After seeing Evonosky's story, many ABC Action News viewers offered to help pay for the equipment, but she wanted to wait.
“The willingness of viewers to step in and help is so wonderful and I’m thankful for that,” she said. “If we just take what people give us and we don’t fight then they’ve won, the insurance has won.”
PUSH FOR CHANGE
Sunshine Health declined an interview. The company also wouldn’t answer ABC Action News’ questions about what Evonosky’s case highlights: patients who rely on medical equipment can be left without it for months while they wait for insurance.
“That’s a big issue, I think they need to be thinking about,” Evonosky said. “There needs to be some way in an emergency situation to obtain the things you need.”
Following the deadline for this story, Sunshine Health's Director of External Relations Elizabeth Boyd, sent the following statement:
"Sunshine Health’s top priority is to support the health and well-being of all the members we serve. We are committed to helping members access the care and services they need, which includes working with our provider and ancillary partners to ensure services are clinically appropriate and align with the member’s coordinated care plan.”
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