Medicaid Waiver: Western Highlands Network Inability to Respond to Emergent Situation re: My Medicaid Client

From Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 5197
e mail: chomskysright@gmail.com

TO: Bill Bullington, Liason for Western Highlands Network, NC DHHS  e mail: bill.bullington@dhhs.nc.gov
telephone number for mental health at NC DHHS 919 733 7011 (ask for 'LME team' and Bullington is liason for WHN LME)

Date: October, 22, 2012

RE: inability of WHN LME to work w/ Out of Network providers seeing Medicaid clients

Dear. Mr. Bullington:

Thank you for your assistance.  I will outline the issue and then tell you who I have contacted.

Most of my Medicaid clients, fortunately, are under SMC LME, which functions quite well.  However, I have one client, of which I have spoken many times to WHN LME specifically, beginning in February, 2012. The client is asking for an emergency meeting (I have continued to see him intermittently this past year though he needs regular mental health due to his severe mental health diagnosis) TODAY.  I will see him.

In order to continue to work w/ my Medicaid patients, and as associated with wanting to utilize my training as a doctoral level clinical psychologist, I attempted to be an In Network Provider w/ WHN LME beginning w/ my application January 25, 2012.  The deadline for that as per WHN was 1.3.2012.  Then I attempted to become an Out of Network Provider.  They reviewed, reportedly, my application for this OON on September 20, 20112.

I expected a letter. When I did not receive one, I called.  I then sent a certified return letter to the interim CEO, Mr. Schoenfeilt over a week ago.  I have received no call and not even the certified letter return has come back to me.  I then contacted the head of Provider Relations by phone call, once today, and once yesterday, Donna Baker Oliver re: this matter of the OON and more pressingly the matter of seeing my client.  I also, today, called the CEO's office and left a message.  As of now, I have heard nothing from either one.

Can you please cut through the red tape so that I can be authorized (paid) as I have for years, as associated w/ rendering my doctoral level psychologist services to my clients under WHN LME? Can you please discover what papers/ materials they may be missing re: my OON application?  I have spent 10x as much effort to simply drive through this OON provider recredentialing w/ WHN LME as I have w/ the SMC LME as pertaining to this very unhelpful Medicaid Waiver.

SMC LME has none of these issues.  I get people on the phone; I get return calls; I get people telling me that I am authorized to see clients.

thank you for your help.

Marsha V. Hammond, PhD, Licensed Psychologist, NPI 1194700591; Medicaid Provider: 6000320; Medicare: 249 2758

cc: Brian Ingram, CEO SMC LME