Category: Cal-Optima

Process To Switch ABA Vendor

Posted on by MICHELLE N

Now that ABEST doesn’t have staffs for William at home; we’re looking for the new vendor.   I searched Google , picked 2 from the list and called them; left them (CARD) a voice message, few days past with no return calls from them.

 

Tues 3/6/2018.   Called Cal Optima to check on the status; the lady said it’s in PENDING status, which means it’s not being reviewed yet; and that I should call back in a few days to check.  I already told ABEST that the last day of their service is Fri 3/9; looks like it takes a while for CalOptima to process our switching vendor request; which means the  approval for TasKids to start service might not arrive next week.  So William might not have any ABA services at all (home or day care) until TasKids receives the authorization from Cal Optima.

Medi-Cal System Is Not Updated

Posted on by MICHELLE N

Tues 1/3/2018

For the past month we could not get medication for William; when we came to the pharmacy, their system shows Williams has active coverage with Anthem BlueCross thus they cannot use Medi-cal.  The billing lady at the doctor office told us the same thing.

I was so surprised because we requested to remove William out of Tim’s policy few months back when we got Medi-cal.  So I had Tim to talk to his HR again.  Not sure if they did not do it that time or it just took that long to be effective.  Finally it shows up as in-active at Anthem web site on Dec, with the Ended Date is 11/1/2017.

I thought the Medi-cal system would update automatically so I gave it 2 weeks to come to the pharmacy again; and guess what? The status is still active!

So I called Cal-Optima, they said I have to send in the Termination Letter from Anthem before they can TEMPORARILY REMOVE William’s insurance so that I can get medication for William; but this is just temporary.  To PERMANENTLY remove insurance, we need to contact Social Service.

So I called Ms. Juliana from Medi-Cal office; she was our Medi-cal case manager.   She said that we no longer have a specific case worker, we need call the Medi-cal number.

So I called the Medi-Cal number Ms. Juliana provided (waiting time was 1 hour, I left the phone number and they called back).  The lady temporarily remove William’s insurance so that we can get medication for William but she said that we still need to send in the termination letter from Anthem so that it can be permanently removed.  She said the system gets updated by the State so she has no control over it.  She removed it temporarily but the state will put it back unless it’s permanently updated by the state.

Later in the evening, I asked the pharmacy, and they said the system is still not updated!

Thursday 1/4/2018

8:10 AM We called Anthem requesting the termination letter.   It took about 20 minutes, finally I got the letter sent to me via email.  It’s a 2 step authentication process to open the pdf file: From the email, clicking on the link to register (name, email, password, etc. ) then it’d load the pdf file after account is created.  When opening the file it’d ask for password, which is given to me by the Anthem rep.  It’s Anthem1234.

12:00 PM I came to Staples to fax the termination letter to Cal Optima and Medical.  I tried both fax numbers given to me by the lady at the Medi-cal but they all failed.  So I went to Medi-cal website to get a fax number and faxed to that.  I also faxed to CalOptima.

Friday 1/5/2018

10 AM I called CalOptima, it took 15 minutes for the rep to find our fax; then she said she temporarily update the system so that William can get his medication.

12:00 PM I came to the Social Security office because no-one from Medi-cal office returned my call.  The front desk said for this I need to see a case worker; so I waited for 1 hour and 10 minutes to see one.  His name is Alex.  He checked the system and said that the system  was still not updated! I was so disappointed because I just talked to CalOptima 2 hours ago, and she assured me that it was temporarily updated.  At this point, I really felt that I can’t trust what people say anymore.

Alex said he would email Sacramento and once they receive the email, they’d process it within 24 hours, which means by Tuesday the system should be updated.  He also said he’d try to see if he can temporarily remove the insurance; he’d call me in 30 minutes to let me know.

So I went back to work; Half hour later Alex called and said that he was able to remove BlueCross insurance temporarily.

Monday 1/8/2018

A case worker returned my call!  She confirmed that BlueCross doesn’t show up in the state system anymore.  I called CalOptima to confirm, Molly said the same thing.

Tues 1/9/2018

So I asked our pharmacist  to check, he still could not bill Medi-cal!

5:00 PM.  I called CalOptima, talked to Molly again; and she still said the same thing.  William’s record only shows United Care Group which is the group that I selected from Cal-Optima.

So at this point I really don’t know what else to do.  Everyone from Medi-cal and CalOptima said there’s no private insurance in William record but the pharmacist still cannot bill Medi-cal; which means I still cannot get medication for my son.  Unbelievable!

The pharmacist suggested that we call United Care Group.

Fri 2/2/2018

I called Cal-Optima, they confirmed that the BlueCross Health Insurance is no longer listed in the system.  I’m so happy that this is finally taken care of.

New Funding Source For ABA Services Begins

Posted on by MICHELLE N

Nov 1, 2017.  We got approval from Magellan at the last minute before the month of Oct ended; the contract from Magellan is valid till end of this year which means we have 2 months with Magellan.  Then after that we need to get approval from Cal-Optima because according to Ms. Nhu, Magellan will no longer handle ABA Services for Cal-Optima beginning Jan 2018.

 

Speech Evaluation

Posted on by MICHELLE N

I got an approval letter from Cal-optima regarding William’s doctor request for speech evaluation; which surprised me because I thought the doctor office should send the approval request few weeks back when they requested for hearing test.  So I called Magnolia Medical group, where William’s doctor is (Dr. Huy / YenChi) ; it turned out that last time they only requested for HEARING test; which means I need to make another appointment with Providence Speech and Hearing center for William to have a SPEECH evaluation.

So I called Providence, the next available appointment is Thursday Oct 26, which is 1 month away!  Looks like it’s the average appointment time with Providence because last time it also took about a month to have hearing test appointment too.

This time I chose the location in Fountain Valley (17075 Bushard, Fountain Valley, CA 92602).  Last time I didn’t know they have a location in FV so we went to Orange location).

I wish the doctor’s office ordered both hearing and speech test last time so that we don’t have to wait another month for speech evaluation; then wait about 2 weeks for the report to ready;  until then the doctor office can initiate speech therapy request to Cal-Optima for my 3 year old son.  This process is just taking too long.

RCOC Gave us extension

Posted on by MICHELLE N

Now that we have Medi-Cal, our RCOC Service Coordinator  Kim Than told me that we need to get Medi-Cal pays for ABA services.  Also, She wants us to send her a letter from Tim’s HR saying that we will remove William out of Tim’s policy with Anthem Blue Cross.  So we did.

Usually she has meeting with Behavioral Specialist on Fridays; so today she emailed me saying that they approved the contract extension between RCOC and ABEST so that William can continue to receiving ABA services while waiting for Medi-cal to approve.  And the new contract ends 10/31/2017, which means we have 2 months to get approval from Medi-Cal.

Now I can rest my mind without worrying about making sure William still can continue receiving ABA services until the next 2 months.

Medi-Cal Approved

Posted on by MICHELLE N

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.