I need to vent … a few months ago I posted about my frustration regarding Medi-Cal and how they had denied my request for reimbursement of costs associated with Gabriela’s care for the last year. They gave no in-depth explanation just a short letter telling me that I didn’t use one of their approved facilities so I was out of luck. There wasn’t a reduction in reimbursement, there was nothing!
I stewed about this for a week or so, then decided that I wasn’t going to give up; I would request an appeal hearing. While Medi-Cal requires use of their approved facilities in order to be reimbursed, they apparently don’t feel there is any obligation on their part to actually have a facility to use!
My daughter needed a psychiatric residential treatment facility that was in Ventura County and that would take a mentally ill patient with a serious medical condition. I searched for one but found nothing, then we called Gold Coast Health Care Plan (the Ventura County manager of Medi-Cal HMO). I was told to go to Gabriela’s primary care physician who advised me that she had no idea where my daughter could go but I could try “Jewish Family Services”.
Not satisfied with that response, I called the state level for Medi-Cal and asked them to provide me with an on-line resource to help me find a facility for my daughter; they told me they didn’t have anything on-line.
I asked if they could mail me the list of facilities that were Medi-Cal approved within Ventura County and again I was told no such a list existed but they recommended I contact Gold Coast Health Care Plan.
After exhaustive searching I finally found a facility for my daughter in Santa Barbara County, it was a non profit that had been a Medi-Cal provider through 2009 when the facility decided they could lower costs if they stopped doing business with insurance companies.
I filled out all the forms needed to appeal the denial of reimbursement by Medi-Cal. I was sent a notification that I was assigned a court date and time and that the hearing would be held over the phone.
In this notification there was a brief list of things I should have in preparation for the hearing which included a written personal statement, along with any statements from individuals that could supply facts that may support my argument, and any additional information that could prove supportive.
I worked diligently to put together a comprehensive personal statement, I also had three letters from individuals that supported my assertions that I had looked under every rock for a Medi-Cal facility appropriate for Gabriela.
I also included a great article “Managing Care for Acute Mentally Ill Patients In California Is Insane”, first of all because I love the title but also because it explains that the cost Medi-Cal is willing to pay per day for one of their approved facilities is $475 while the cost I was asking Medi-Cal to reimburse for the facility I used (because it was a non-profit) was slightly less than $167 per day.
On the day of the hearing I called the state hearing division and told them that because these documents were required in writing, I needed to fax them, could they please provide me with a fax number (which they did) and I explained to the gentleman on the phone that I had not received the “position statement” from Medi-Cal which was required to have arrived at least two working days prior to the hearing. The gentleman asked if I was asking to postpone the hearing. I told him no I would just like the statement faxed to me so that I might be able to see it before the hearing.
He told me that no such statement had been supplied to the Judge either so the trial would have to be postponed because the Judge would have to see the statement.
I opened my mail this last Saturday and low and behold what do I find but a letter from the State Hearing Division. The letter said, in all capital letters; “YOU WERE GRANTED A POSTPONEMENT FOR YOUR HEARING SCHEDULED ON …” followed by “BECAUSE THE HEARING WAS POSTPONED AT YOUR REQUEST, THE TIME FOR ISSUING A DECISION IN YOUR CASE WILL BE EXTENDED.”
OUTRAGEOUS!!!!
Here are my problems with that letter:
1. Didn’t anyone bother to tell the government that ALL CAPS IS YELLING!
2. I didn’t ask for any postponement! I was told it needed to be postponed because Medi-Cal hadn’t sent in the required paperwork.
3. If I hadn’t supplied my written statement and letters and other miscellaneous evidence on time as required, what are the chances that the court would have said “Hold everything! We can’t have a hearing, this nice lady isn’t quite ready yet. Let’s all just wait for her to get her shit together.”
4. If Medi-Cal didn’t supply the required documents for the hearing on time then the court should have just found in my favor.
That’s it, I feel a little lighter, thanks.