Genesis ----------------------------------------------------------------------------------------- Yikes, Denied It seems I may be having some problems occurring with Ruben at the Group Home I have him at. I'm not sure what to think or who to believe in this situation. But I spoke to both the Insurance Carrier and to the Therapist at the Group Home. The Insurance Carrier sent me a letter a couple days ago stating they have Denied Completely all funding for Ruben to remain at the CRR Group Home. I asked about appeals and that can be done over the phone. Whew Spoke to the Therapist and told him I'm having red flashing alarms go off in regards to the Group Home. He told me that it isn't what it seems, that there just happens to be miscommunications happening. Yeah, right I read him the letter I received from the Insurance and he said that some of that was news to him. He said that they have already re-submitted the information that they keep requesting and that they are putting a packet together, just in case they have to start an Appeal Process. I explained to him that I had also received a call from the person who manages the medical scheduling for the Children and she said last week that she needed me to sign a waiver allowing Ruben to go to the Dentist. I said there are a couple reasons I'm concerned about that request 1. I signed release forms upon Ruben's admission. 2. The Dental work should have been done within 30 days of his enrollment. 3. I have as yet received these forms that the Manager said needed re-signed and that was requested of her last week and Ruben's appointment is for next week. Too much time has passed for these requirements to be passed. I then explained to him I wanted a copy of Ruben's PsychEval. He then told me that I can't have a copy of that. I asked why, he said it was against policy. I said I wanted the name of the Executive Director so that I could appeal that policy, especially since it seems to be a concern with the Insurance Carrier stating that you are sending old and redundant information. ~*~ Like I stated, I really like this place, but I'm wondering how many regulations they are non-compliant with? All I can do is become more aware of what is happening and let them know that I'm aware of these deficiencies. At least this will keep them on there toes. Well, got to go and phone for a report on whether or not they are lacking and what it is they are in non-compliance with. 12:49 p.m. - 2004-03-18 ----------------------------------------------------------------------------------------- |
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