Want advice.

Discussion in 'The Watercooler' started by DammitJanet, Sep 21, 2010.

  1. DammitJanet

    DammitJanet Well-Known Member Staff Member

    As many of you know, I have been going to this therapy program for years now. It is an agency that has been in somewhat of a flux because of the way this state has pushed down legislation on how mental health is to be run. Back in 05 I think it was, the state really screwed up our state run mental health system by taking it from a state run/county run system to doing this weird system where they decided that it would be more cost effective to allow the private business sector to run all these individual Psychiatric/psychological behavioral mental health businesses. What a fiasco. Every Tom, Jim and Harry opened up a shop on every corner and hired a few psychologists, a Licensed Clinical Social Worker (LCSW) or 2, a few case managers and some PCA's and then they got these revolving door psychiatrists that couldnt get a job in the private sector to revolve through all these places.

    This was all paid through medicaid, some private insurance and then of course, the state's indigent client funds. How this cost less money, I have no idea.

    Well, turns out they had so much fraud going on, that they have had to start closing these things down. They have started mandating so many hours per client, yada yada. Its a mess.

    Therapy as most folks know it is a thing of the past. Its all a numbers game and just a mess.

    Well, I have only been approved for about the next 6 months but supposedly I am getting therapy for 2 hours a week. Ok, thats good. But Im also supposedly getting something called Community Support Services which I have no idea what that is and then another service which is just filling out paperwork when needed.

    What makes me upset is, is that supposedly I am getting the CSS (Community Support Services) 2 hours a week and the other service at least an hour a week...and they are supposed to come to my home...which I really really dont like...but I have been told for the past three weeks they are coming and I have not seen them, no call, no text, no email. I sit here and wait...no nothing.

    Im ticked.

    I think I am just gonna fire them. I see no use for a service I dont want, cant see a use for and dont want in my house. I dont even know these people. If that means I have to give up my therapist at this point, oh well. Im gonna lose her in a few months anyway. I will have to find someone knew then. Probably a private run psychologist. I see a private psychiatrist anyway. Im just tired of having to wait around for people who arent going to show up. I offered to meet these people at their agency but heck, what good would that do if they werent going to be there either! My therapist said one of the people could probably come on a weekend but oh heck no! My house is a zoo on the weekends. I could have Keyana, everyone is home, or heck, we could be gone somewhere. I dont want to have to plan my weekends around someone who might or might not show up.

    The worst thing about this is I just dont like people in my house. Period, end of story.
  2. DaisyFace

    DaisyFace Love me...Love me not


    To me, this sounds like one of those set-ups that is designed to bill Medicaid for hundreds of thousands of dollars....and provide the patients as little as possible.

    What do you want to make a bet that Medicaid has paid for several weeks of home visits for you already?

    If I were you, I would call my caseworker and see what is up with these providers. Tell Medicaid that you were supposed to get these services, but never did.

    I'd be very interested to hear what you find out...
  3. CrazyinVA

    CrazyinVA Well-Known Member Staff Member

    I agree with Daisy. I understand wanting to just "fire" the company in question, but I also think they should be held accountable for their unprofessionalism (and possible fraud).
  4. Hound dog

    Hound dog Nana's are Beautiful

    Yep. Check with medicaid and see if they've been charged for these "visits" as they probably have. I'm thinking this is just a way for them to milk money out of the system.

    Ours is pretty messed up here too, although not that bad, at least it wasn't when Nichole was using it.

    Then I'd go with whatever private treatment they will allow you to do and have it set up the way you want it set up.
  5. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Well, I dont know if I will ever be able to tell what Medicaid was actually billed. Now if it was first billed through Medicare, oh yeah, I would see it then because I get an EOB with them just like any other insurance company. Medicaid? I have never seen one and it took me tons of red tape just to get one on a client when I worked for the agency.

    I may be able to see if this was billed through Medicare though. It might be a Medicare eligible service. That is one of my issues. My therapist isnt Medicare eligible even though she is Medicaid eligible but because she isnt Medicare and they are primary, they wont pay. Its a big snafu.