When LME's Deny In-Network Status to Medicaid Providers under Medicaid Waiver, There is No Appeals Process

From: Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 1127
e mail: chomskysright@gmail.com

TO: Mark Grimaldi, LME Systems Performance Team, 919 715 1294, NC DHHS,

RE: Denial of In-Network for long-term Medicaid Provider

July 6, 2012

Dear Mr. Mark Grimaldi, of NC DMA, LME Systems PerformanceTeam:

I was directed to call you by Amanda Reeder, attorney working in the Department of Mental Health.  She advised me that when an LME denies In-Network capabilities to a Medicaid provider, such as myself, a Licensed Psychologist, there is no appeals process.  Why is that? Medicaid is not an HMO.  But it appears to be functioning as a HMO related to the 1915bc Waiver.

Here is the reply I received from Melissa Faulkner, Director of Provider Relations at WHN LME.  Noteably, I am not getting the same problems w/ being an InNetwork Provider from SMC LME.  Instead of 'katie bar the door', I am recently receiving helpful information back from SMC LME.

I am including what I put on my blog re: the matter. I think you might speculate that because of my documentation of all the problems at WHN LME regarding my re-credentialing, they would rather limit me to my current Medicaid patients.

I find this curious when so many Medicaid providers out this way have simply thrown in the towel.

Thank you for your response to me, in advance.

Marsha V. Hammond, PhD