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.
Another hot summer day; and Friday is the day for water activities at Mitchell school so I had William wear short with waterproof shoes. Today breakfast was egg hamburger but I noticed Ms. Heusser did not give William burger; she gave him tater tots (potatoes) instead so I asked. She said because the record shows that William has allergy with egg so that’s why they serve him different breakfast. I stood there and observed for 15 minutes while they were eating breakfast. William picked up only small piece of tater tots; some times he tried to use the fork to pick a bigger piece but he could not. Ms. Susan sat next to him but seemed to didn’t notice any thing. Not sure what ‘s she there for? Is she supposed to pay attention to them and help them eat their breakfast. She only tried once “Karen, try this!” and put the food down on her plate because Karen refused. That’s all she did! I just don’t think she tries enough!
Late afternoon Monday 5:45 PM.
Thursday night, William had session with Ms. Han from 5:45 – 7:45. It was the most difficult session for the ABEST staffs since we started 2 weeks ago. William threw tantrums, hit his hands against the wall, lied on the floor and cried. Ms. Nhu finally calmed him down by drawing the numbers on the board from 1 to 30.
I bought this exercise bike a month ago but rarely use it.