Sometimes, all it takes for our attorneys to settle a problem is getting on the phone. Usually this is because our client has already put in the time fighting for their care.
One such case involved a woman, receiving both Medicare and Medicaid benefits, who was having problems with her home healthcare waiver.
Her medical provider was refusing to schedule appointments because they did not have a contract with her Community Health Choices managed care organization (MCO) – something that shouldn’t have been a billing issue in the first place.
When she made the switch to a new managed care organization, she was finally able to see her medical providers, but her home health aide stopped receiving payments.
After countless phone calls she learned that by changing MCOs she was assigned a new service provider – something no one took the time to explain to her.
Our client knew the Service Coordinator needed to authorize the hourly payments to her home health care worker, but got the run-around every time she called.
Eventually, she reached out to the AIDS Law Project, apologetic for “wasting our time” on something that had been at a standstill for weeks.
Within seconds of identifying himself as a lawyer, our staff member’s call was put through to a supervisor at the service coordinator’s office, who immediately found the problem.
Payments for the home health aide had been authorized for 42 and a half hours a week, but required separate authorizations for the fulltime (40 hours) and overtime (2.5 hours) payments.
The supervisor was able to make the changes on the spot, and within a few days our client was resting easy as payments to her home health aide resumed.