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Friday, February 5, 2010

It entitled him to Medicaid coverage: A pharmacy benefit error

Zumante Lucero struggled with asthma for the last nine years, since he was three months old. He loved karate, drawing cartoon figures, and riding bikes with his brothers and sisters near their Denver home. His doctor said his lungs were severely inflamed, so he required Advair twice a day. Zumante's condition had been so severe since age six that he was covered by Social Security, which entitled him to Medicaid coverage.

Yet the retail pharmacy's computer system mistakenly showed he was not eligible for prescription drug coverage.

He was brought to the Emergency Room in May and June and given free samples of the medicine.

But it was not enough. On July 16, his mother heard him call from upstairs: he couldn't breathe. She called an ambulance, but Zumante lost consciousness before it arrived, and never regained consciousness.

Advice to parents: If you can't get the medicine your child needs after three calls to the insurer, go to the CEO – and to the press, if necessary.

Read another asthma story. Thanks to Allison Sherry for the source story in the Denver Post on Feb 4.

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