- Spoke to Candace at Anthem behavioral health 7/22/2022 10:30am. She told me I need to speak to the case owner Nicholas B. since the decision has not been reached yet. She started to transferred me.
- Candace picked back up after about a minute and told me she needed to check into why Nicholas’s extension was not connecting and asked if I would continue to hold.
- Candace came back and said I cannot speak to the case owner until they have reviewed the case. She said “they” were telling her that we have to wait for the case review before anything can be done. I told her that, by the time the case was reviewed, I would not be able to do anything before they have to step her down to a different program. She said she understands and told me that was their protocol. I told her that if my daughter’s well-being is in the hands of the case owner, I need to be able to talk to them. She said they haven’t reviewed the case. I told her I needed to talk to them before the review. She said protocol didn’t allow that and she’s been told to tell me I will have to wait until after the review. I asked if I could speak to whoever is telling her that. She said that’s a lead (I think) and that she would try to get them to speak to me.
- Candace came back on. She said she had expressed my concern and they would go ahead and transfer me to Jovee (Jodi?) another case manager. She asked me to hold again.
- 11am I was transferred back into the queue to someone saying, “Hello?” I asked if she was Jovee. She was not and said I had been re-routed. She asked for my member ID, name, and my daughter’s name. She placed me back on hold and said she would try to get me to Jovee or Jodi.
- She came back on the line and asked if I had a last name for Jodi. I was not given a last name. She asked if I knew who I had been speaking with before her. I told her I’d been speaking with Candace at Anthem Behavioral Health. She said she can’t see my account because she doesn’t normally have calls like mine routed to her. I asked what department she’s in. She works in commercial plans out of New York. She said she wants to get me routed to the correct person and placed me back on hold.
- Kim got me back to the medical. Spoke to Andre P. She said she will stay on the phone with me to make sure I don’t have any bad transfers anymore. She asked for Dr. Lee’s phone number.
- Put her on hold at 11:38 and called Pathlight to get a phone number for Dr. Lee. Toby answered. I explained that I was trying to get a direct number for Dr. Lee. She said she could give me an email. I explained that they were trying to talk to her via phone. She said she would have to call me back. I gave her my callback number and informed her they are on the phone right now. She said she will call me right back with a number.
- Was transferred to Ally for information about my authorization. She said it was approved from 7/22
- Dr. Tina Lee would not give her phone number. She said they would have to coordinate any review with Pathlight.
- Behavioral health: 800.274.7767
- Ally told me she could only see the authorization status and would need to transfer to behavioral health to get more information.
- 11:58 Kara picked up. I explained my situation. She said the case managers do not speak with members. She told me the case is still pending. She said there were no status updates. They requested additional records from the facility. She said the facility has made a very good case for why she should stay. She said she is going to get in touch with a lead to see what she could do.
- She put me on hold. She came back and said her lead is trying to reach out to someone she knows in the authorizations department. That person is not answering right now, but they will continue trying to reach her and get back in touch with me. Kara said she will call after an hour just so I know I haven’t been dropped even if she hasn’t heard back.
- We disconnected the call after 2 hours 41 minutes. The approximate time the call ended was 12:30pm. I expect to hear back from Kara by 1:30pm.
- Josee they deemed her to be medically and psychiatric. Anthem doctor deemed her ready for a partial hospitalization program. Pathlight can appeal or step her down. She will send criteria they use to my email address. Facility can provide me with a copy of Calocus criteria. Only provider can appeal.
- Josee could sign her up with a case manager but recommends I do it because it will be quicker. 866.785.2789.
- I called to enroll Ambria. They are known as Elevance Health. Additional resource for members and eligible family members. At no cost to us. Voluntary over the phone. Seems like it is mostly for phone counseling.
- Recommends I call regular member services and ask for a patient advocate.
- Will not impact her benefits in any way. Will not diminish her coverage.
- She has enrolled Ambria. Number will show up as a Virginia number.
- Returned a call to Monique who left a voicemail while I was setting up
- Two options at this point: step down to PHP level of care or do an expedited appeal. If they still deny, I’m responsible for closing the gap.
- They cannot step her down and do the appeal. They don’t do step-downs on weekends. Discuss with therapist. We will not be charged for the weekend.
- They have not been notified of the peer review yet. They do not charge families while they wait for the results of a peer review.
- Talked to Alex. If this works the way it normally does, Ambria will step down to PHP program. They usually have the parents come get the kids around 10am. They can make it work at the time that works for me.
- I can take her to the PHP for the rest of the day.
- She checked in with Ambria this morning. Ambria was disappointed. She felt she was just getting into the program. She wants to stay and learn. Alex thinks she is committed to getting better.
- Alex will continue to work with her throughout PHP.
- McKayla wants to give me some information of.
- McKayla called
- Pick up Ambria at residential at 10:45am.
- They will walk with us to drop her off at the PHP program.
- They have a lobby with chairs in the PHP and there’s a Starbucks nearby and Sugarbakers