Month: July 2017

Got the approval letter from Medi-Cal.  One day later got the BIC card.  Tried to contact our Medi-cal case manager Juliana Mendosa several times on Friday and Monday but all I got is the voice mail.

Updates:

Tues 7/25: Juliana returned my call; I told her about our current situation with William’s ABA services; and asked her if there’s a way to expedite the transfer of Medi-cal to CalOptima.  She said yes and scheduled to meet with the personnel from reimbursement department tomorrow at 9 AM.

Wed 7/26 @9 AM: Juliana called and set up a 3 way meeting so that the personnel from reimbursement department can ask me questions.  She only asked me 1 question “Have William been using ABA services?”

– With Medi-cal?  I was not sure so I asked.

– Yes – She responded.

– No, our ABA services agency said that our case must be transferred to Cal-Optima first before then can doing anything.

– OK, I’ll expedite the case, you can check with Cal-Optima tomorrow to see if you’re in Cal-Optima network; It should be in their system tomorrow.

That’s it.

Thursday 7/27/2017: I called Cal-Optima (714 246 8500) to check if our case is in Cal-Optima system yet or not.  After asking about our Medi-Cal number, name, DOB, they transferred me to another department because they said my son is disabled and that department would be able to assist us.  I left a voice message with my name, phone number and Medical-Number.

2 hours later I got a phone call (Vietnamese speaker) , asking what I need help with.  I told her that I’d like to select group United Care and add my son’s doctor in the plan.  I also asked her what does it take to get approval for ABA services.  She gave me the Behavorial Health department number to contact.

So I called the number (855 877 3885) asking about how to to obtain approval for ABA services; I told the lady that we already have the ABA Services agency so she tried to look up ABEST name but could not find it; I gave her Nhu’s last name and first name, she could not find it either.  She asked if I know any of the therapist name so I told her Nhi’s name; but she wanted to know Nhi’s last name which I don’t know.  She told me to call back when I have enough information.  (She refused to look up by MIS number).

So I called Nhu from ABEST, asked her for Nhi’s last name.  And then called the number again.

A different person answered the phone; and she said that they don’t work directly with parents; ABA agency must contact them!

I’ve been making quite a few phone calls for the last few days; I’m so frustrated!  ABEST told me to call Cal-Optima and Cal-Optima told me that they don’t work with parents; I really have no idea what to do!  Frustration!

So I called Nhu, told her exactly what Cal-Optima told me, gave her the phone number that I called earlier so that she could call them.  She said “That’s weird”, that with all the self-referring clients that she has, the parents always have to talk to the Insurance providers first to get a case manager assigned before she can talk to them.

Half hour later Nhu called back; she said she was assigned a case manager and given the case manager’s email to contact.  Hopefully the case manager will contact her soon.

What a relief! finally it’s going somewhere.  But I’m truly tired; mentally and physically tired!

Monday July 31, 2017: Mrs. Nhu came to our house for consultation; she said she still has not heard anything from the case manager.