This Success Story shows why a therapist and case management team, working together, can make all the difference in our patients receiving the AUQC (Absolutely Ultimate Quality of Care). Kimberley Gibson, THERAPY 2000 Patient Services Manager guided this successful process with a THERAPY 2000 patient.
Successful Case Management in action
Nancy Estes M.A. CCC-SLP was treating a foster patient in the southern part of Dallas. The patient was scheduled soon to go back to his biological family. Nancy found out that the child would still be located in her treating area with his biological family. I informed Nancy that as soon as Superior stopped following the patient, his insurance would be cancelled. In order to stop that from happening, his biological mother would have to apply for Medicaid as soon as she possible could. This would give the patient Traditional Medicaid for one month while he was assigned to manage care. Since THERAPY 2000 is only in network with Molina, Nancy informed the biological mom that if she wanted to continue therapy with T2K that she would need to choose Molina. I also inquired about the child’s scores and asked Nancy if she thought the patient would qualify for SSI.
On her first visit, Nancy explained to mom what needed to be done to keep the child in therapy. Amy Bihl, LMSW, and Nancy explained SSI to the family. Nancy stated that his scores were low enough to apply for Supplemental Security Income (SSI) and mom reported to Nancy that they did not have a lot of income.
Once the mom received all this information she began working on getting approved. After Nancy’s first visit in the biological home, mom called and chose Molina. She also called and applied for SSI. The very next day T2K received an SSI request for records. Wow, that was fast!
On the first of the next month the child switched to Molina. Molina had to honor the authorization since it was already in place, but the child was up for reevaluation. Molina denied services at that time and the child was put on hold. During this time, mom decided to switch to AGP or Parkland so that she could continue to receive services. Nancy submitted the DC but within a day or two, mom called back to say that she had gotten approved for SSI and wanted to continue with Nancy. The plan still showed Molina, but on the first of the next month, the child switched to Traditional Medicaid SSI.
Nancy is continuing to treat with minimal missed visits during the hold. This week, we added occupational therapy to the mix. Team work, early planning, understanding the system and recognizing that the child would benefit from SSI services were key to assisting this family in continuing with therapy at T2K!